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White v. Life Insurance Company of North America

United States Court of Appeals, Fifth Circuit

June 14, 2018

ESTHER HILL WHITE, Plaintiff - Appellant

          Appeal from the United States District Court for the Western District of Louisiana

          Before JOLLY, DENNIS, and ELROD, Circuit Judges.

          E. GRADY JOLLY, Circuit Judge

         Esther White, the beneficiary of David White's life-insurance policy, appeals a summary judgment granted in favor of the insurer and plan administrator, Life Insurance Company of North America ("LINA"), on her claim for benefits. LINA had denied benefits on the ground that David's death was caused in part by intoxication or drug abuse. Finding that LINA abused its discretion in denying benefits, we reverse and instruct the district court to enter judgment in favor of White.


         In July 2014, David and Esther White were in a horrible car crash in Arkansas. David was driving. As the highway curved right, David inexplicably kept going straight. He thus crossed three lanes of traffic, including the center divider line, and then collided head-on with an oncoming eighteen-wheeler truck. David died as a result. Esther is the beneficiary of his life-insurance policy.

         In this section, we briefly state the relevant policy provisions. We then turn to the evidence in the administrative record. After that, we describe the questionable administrative proceedings giving rise to this appeal.


         David was insured under two life-insurance policies issued by LINA. LINA both insures the plans and determines entitlement to benefits. Esther, David's widow and the plaintiff here, is the beneficiary of those policies. Relevant to this appeal, both policies contain exclusions if death is caused, at least in part, either by "intoxication" as defined by Arkansas law, or by the "voluntary ingestion" of any "narcotic" or "drug" that is not prescribed.[1]

         Under Arkansas law, a driver is "intoxicated" if he is "influenced or affected by the ingestion of alcohol [or] a controlled substance . . . to such a degree that the driver's reactions, motor skills, and judgment are substantially altered and the driver, therefore, constitutes a clear and substantial danger of physical injury or death to himself or herself or another person." Ark. Code § 5-65-102(4).

         Now for the facts in the administrative record.


         The crash occurred on July 26, 2014, at around 4:36 pm: Broad daylight; weather and road conditions clear; no speeding; vehicles were functioning properly.

         At the scene of the crash, however, paramedics reported to the police that they smelled alcohol on David's breath. So the Arkansas State Police drew a blood sample and cited David for "Driving While Intoxicated" ("DWI"). On the collision report, however, the police also noted that it was "unknown" whether David was impaired at the time of the accident. Two hours later, at the hospital, another blood sample was taken to test for alcohol. And two hours after that, the hospital collected a urine sample for a drug-screen panel.

         The hospital's toxicology analysis indicated that David tested negative for alcohol. The results did, however, reveal the presence, but not the amount, of a variety of controlled substances in David's system. Specifically, the drug screen indicated that David tested positive for amphetamines, cocaine, opiates, benzodiazepine, and cannabinoids. All of the toxicology reports indicated that these positives were only preliminary, non-quantitative results and that further confirmatory testing would be required to determine the level of drugs in David's system. No additional testing was requested by anyone.

         On August 1, 2014, a few days after the crash, David died from a stroke. The coroner prepared a death certificate, which stated that the "immediate cause" of David's death was a "massive stroke, " and that the "underlying cause[s]" of death were "multiple trauma, " "cocaine abuse, " and "amphetamine abuse." The death certificate also listed "marijuana abuse" as "other significant conditions contributing to death but not resulting in the underlying cause" of death.

         In September 2014, the Arkansas State Crime Laboratory issued its own blood toxicology report. Like the hospital's toxicology reports, the police toxicology report indicated that David tested negative for alcohol but positive for benzodiazepine, cannabinoids, cocaine, and opiates. Also like the hospital's reports, the police toxicology report indicated that these results were only preliminary, non-quantitative results. The toxicology report indicated that if no additional testing was requested, the blood specimen would be destroyed after 90 days. No additional testing was requested within that 90-day window.

         We turn now to the administrative proceedings.


         In January 2015, while processing Esther's claim for benefits under the life-insurance policies, LINA hired Dr. Fochtman, a toxicologist, to review her claim. Among other things, LINA asked Dr. Fochtman to "comment on any impairment Mr. White would have been experiencing at the time of his crash and to what extent might these impairments affect his driving abilities." So Dr. Fochtman reviewed the ...

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