from the United States District Court for the Western
District of Louisiana
JOLLY, DENNIS, and ELROD, Circuit Judges.
GRADY JOLLY, Circuit Judge
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.
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
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.
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
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 §
the facts in the administrative record.
crash occurred on July 26, 2014, at around 4:36 pm: Broad
daylight; weather and road conditions clear; no speeding;
vehicles were functioning properly.
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
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.
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.
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.
now to the administrative proceedings.
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