Smith v. Metropolitan Life Insurance Company
ORDER Granting Defendant's Motion to Affirm the Administrator's Decision 9 , Denying Plaintiff's Motion for Reversal of Administrative Denial of Claim for Benefits 10 and Dismissing Plaintiff's Cause of Action. Signed by District Judge Denise Page Hood. (LSau)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MICHIGAN
Case No. 16-13737
Hon. Denise Page Hood
ORDER GRANTING DEFENDANT’S MOTION TO AFFIRM
THE ADMINISTRATOR’S DECISION [Dkt. No. 9], DENYING
PLAINTIFF’S MOTION FOR REVERSAL OF ADMINISTRATIVE
DENIAL OF CLAIM FOR BENEFITS [Dkt. No. 10] and
DISMISSING PLAINTIFF’S CAUSE OF ACTION
Plaintiff Robert Smith is an intended beneficiary of his late wife Debra T.
Smith (“Mrs. Smith”) pursuant to the terms and provisions of the Dependant Life
Insurance (“DLI”) and the Voluntary Accidental Death and Dismemberment
(“AD&D”) Insurance Plan Policy No. 73903 purchased by his employer FCA L.L.C.
(“FCA”). Following the tragic death of Mrs. Smith, Plaintiff made a timely claim for
disbursement of DLI and AD&D benefits with the Policy administrator, Defendant
Metropolitan Life Insurance Company (hereinafter “Defendant”). Defendant paid
Plaintiff’s claim for DLI benefits, but denied his claim for AD&D benefits because
of the manner of Mrs. Smith’s death. Plaintiff filed a breach of contract suit in
Oakland County Circuit Court. Defendant removed the case to this Court because the
pertinent issues of Plaintiff’s claims are governed by the Employment Retirement
Income Security Act (“ERISA”).
Defendant and Plaintiff filed cross-dispositive motions on February 16, 2017
[Dkt. Nos. 9, 10], and Defendant filed a response to Plaintiff’s motion. The Court,
having concluded that the decision process would not be significantly aided by oral
argument, ordered that the motions be resolved on the motion and briefs submitted by
the parties. E.D. Mich. L.R. 7.1(f)(2). [Dkt. No. 13] For the reasons that follow, the
Court grants Defendant’s motion, denies Plaintiff’s motion, and dismisses Plaintiff’s
cause of action.
Plaintiff participated in the Voluntary Group Accident Insurance Program
(“Plan”) available to FCA employees, and he insured Mrs. Smith under Dependent
Life Insurance (“DLI”) and Voluntary Accidental Death and Dismemberment
Insurance (“AD&D) policies. Mrs. Smith died on February 28, 2016. According to
the Death Certificate, Mrs. Smith died after she “Ingested washer fluid in craving for
alcoholic beverage.” [Dkt. No. 9, Ex. A] The Death Certificate includes a section for
identifying the manner of death, with the following options: “Accident, Suicide,
Homicide, Natural, Indeterminative or Pending.” Id. The Death Certificate reflects
that the medical examiner determined that Mrs. Smith’s manner of death was
On March 15, 2016, Plaintiff applied for DLI and AD&D benefits under the
Plan because of his wife’s death. The Plan defines the eligibility criteria for AD&D
benefits as follows:
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
If You or a Dependent sustain an accidental injury that is the Direct and
Sole Cause of a Covered Loss described in the SCHEDULE OF
BENEFITS, Proof of the accidental injury and Covered Loss must be
sent to US. When We receive such Proof We will review the claim and,
if We approve it, will pay the insurance in effect on the date of the
Direct and Sole Cause means that the Covered Loss occurs within 12
months of the date of the accidental injury and was a direct result of the
accidental injury, independent of other causes.
We will deem a loss to be the direct result of an accidental injury if it
results from unavoidable exposure to the elements and such exposure
was a direct result of an accident.
[Dkt. No. 9, Ex. B] The Plan does not define “accidental injury.”
The Plan provides that some events preclude an award of AD&D benefits. In
relevant part, the Exclusions section provides:
We will not pay benefits under this section for any loss caused or
contributed to by:
physical or mental illness or infirmity, or the diagnosis or
treatment of such illness or infirmity;
suicide or attempted suicide;
the voluntary intake or use by any means of:
• any drug, medication or sedative, unless it is:
• taken or used as prescribed by a Physician; or
• an “over the counter” drug, medication or sedative
taken as directed;
• alcohol in combination with any drug, medication, or
• poison, gas, or fumes.
[Dkt. No. 9, Ex. B]
After reviewing the information on the Death Certificate, Defendant paid the
DLI benefit to Plaintiff but, by a letter dated April 15, 2016, advised him that the
AD&D benefit claim was being denied. [Dkt. No. 9, Ex. D] Defendant’s letter set
forth the Plan’s eligibility criteria for AD&D benefits, including the exclusion for the
voluntary intake or use by any means of a poison. In explaining the basis for the
denial of Plaintiff’s AD&D benefit claim, Defendant stated:
According to our records, the death certificate issued by the State of
Michigan lists the decedent’s cause of death as “Methanol Intoxication
and Complications Thereof,” with other significant conditions listed as
“Alcoholic Liver Disease; Hypertensive and Arteriosclerotic
Cardiovascular Disease.” It further states the injury occurred as the
decedent “ingested washer fluid in craving for alcoholic beverage.” The
Policy excludes any death that is caused or contributed to by physical
illness as well as the voluntary intake of any poison. The insured’s liver
and heart disease contributed to her passing and her passing was caused
by ingesting washer fluid which would be deemed poisonous if ingested.
Therefore, based on the record before MetLife, we must deny your claim
for Voluntary Dependent Accidental Death Insurance.
[Dkt. No. 9, Ex. D] Defendant advised Plaintiff that he could file an appeal from the
initial adverse benefit determination.
On June 14, 2016, Plaintiff, through his attorney, filed an appeal from the initial
determination. [Dkt. No. 9, Ex. E] Plaintiff’s letter noted that the Death Certificate
listed the cause of death as methanol intoxication and complications thereof and that
Mrs. Smith passed away after she ingested washer fluid in craving for alcoholic
beverage. Id. Plaintiff stated that “In ingesting the washer fluid, Mrs. Smith was
under the genuine assumption that this would [a]ffect her in the same manner that an
alcoholic beverage would.” Id.
Plaintiff acknowledged that it was “no secret that Mrs. Smith suffered from
these conditions” (Alcoholic Liver Disease, Hypertensive and Arteriosclerotic
Cardiovascular Disease) but contended that these conditions were not the cause of
her immediate death. Id. “The direct and proximate cause of her accidental injury,
which again was highlighted on her death certificate, was the ingestion of washer
fluid.” Id. Plaintiff stresses that the medical examiner identified the manner of death
as “Accident.” Id.
In his appeal, Plaintiff submitted an article from MedlinePlus that described the
effects of windshield washer fluid, part of which stated:
Windshield washer fluid is a brightly colored liquid made of methanol,
a poisonous alcohol.
Methanol, the main ingredient in windshield washing fluid, is extremely
poisonous. As little as 2 tablespoons can be deadly to a child. About 2 to
8 ounces can be deadly for a adult. Blindness is common and often
permanent despite medical care.
[Dkt. No. 9, Ex. E]. Plaintiff’s appeal also included articles about alcoholic liver
disease, hypertensive heart disease, and arteriosclerosis. Id.
On July 19, 2106, Defendant issued its final adverse benefit determination with
respect to the AD&D benefits. [Dkt. No. 9, Ex. F] Defendant reiterated the applicable
provisions of the Plan, including the exclusion for the voluntary intake or use by any
means of a poison, and stated:
According to our records, the death certificate issued by the State of
Michigan lists the decedent’s cause of death as “Methanol Intoxication
and Complications Thereof,” with other significant conditions
contributing to death but not resulting in the underlying cause of
methanol intoxication listed as “Alcoholic Liver Disease; Hypertensive
and Arteriosclerotic Cardiovascular Disease.” It further states the injury
occurred as the decedent “ingested washer fluid in craving for alcoholic
beverage.” Methanol is a poisonous substance that is used to keep liquids
from freezing, as a fuel, etc. Washer fluid is typically characterized as a
hazardous substance and its containers are typically marked with poison
labels and warnings.
Because (i) the Plan excludes any death that is caused or contributed to
by physical illness and the insured’s liver disease contributed to her
passing, and (ii) the Plan also excludes any death caused or contributed
to by the voluntary intake of any poison and her death was caused by the
ingesting of washer fluid which is poisonous when ingested, based on
the record before MetLife, we denied your client’s claim for Voluntary
Dependent Accidental Death Insurance on April 14, 2016.
Because it is objectively foreseeable that ingesting washer fluid would
cause an injury and thus is not an accident and because ingesting a
poisonous liquid like washer fluid meets the Plan’s exclusion for the
voluntary intake of poison, we must uphold our determination to deny
your client’s claim for Voluntary Dependent Accidental Death Insurance
[Dkt. No. 9, Ex. F]
The general rule in cases challenging the denial of employee benefits under
ERISA Section 502(a)(1)(B) is that the district court reviews the plan administrator’s
decision de novo (unless the plan gives the administrator discretionary authority to
determine participants’ eligibility for benefits, in which case the court must apply the
highly deferential arbitrary and capricious standard of review). Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); Cox v. Standard Ins. Co., 585 F.3d
295, 299 (6th Cir. 2009). In this case, the parties agree that the Court should conduct
a de novo review of Defendant’s decision.
The de novo standard requires the reviewing court to “determine whether the
administrator made a correct decision,” Hoover v. Provident Life & Accident Ins. Co.,
290 F.3d 801, 808-09 (6th Cir. 2002), based only upon consideration of the evidence
presented to the claims administrator. Perry v. Simplicity Engineering, 900 F.2d 963,
966 (6th Cir. 1990). “The administrator’s decision is accorded no deference or
presumption of correctness.” Hoover, 290 F.3d at 808-09. See also McCollum v. Life
Ins. Co. of N. America, 495 F. App’x 694, 696 (6th Cir. 2012) (“Under de novo
review, a reviewing court weighs the evidence and determines whether the
administrator made the correct decision, giving no deference or presumption of
correctness to the administrator’s decision. Some courts have explained that the
question on de novo review is whether the plaintiff’s claim for benefits is supported
by a preponderance of the evidence.”). A court does not have to address a defendant’s
potential conflict of interest in determining eligibility for benefits when the review is
de novo. Conway v. Reliance Std. Life Ins. Co., 34 F.Supp.3d 727, 730 (E.D. Mich.
There is no dispute that Mrs. Smith’s intake of the washer fluid was voluntary.
As Plaintiff states, “In ingesting the washer fluid, Mrs. Smith was under the genuine
assumption that this would [a]ffect her in the same manner that an alcoholic beverage
would.” [Dkt. No. 10, PgID 387] Defendant argues that there are two bases for denial
of Plaintiff’s claim to AD&D benefits: (1) the Plan specifically excludes from
entitlement to the AD&D benefits the voluntary intake of a poison; and (2) even if the
intake of the washer fluid was an “accidental injury,” it was not the direct and sole
cause of Mrs. Smith’s death because her conditions of alcoholic liver disease,
hypertensive and arteriosclerotic cardiovascular disease contributed to her death.
Plaintiff argues that the direct and sole cause of the death of Mrs. Smith was
“Accident,” as Mrs. Smith thought she was ingesting a fluid that would provide the
same effect as alcohol, not the effect of a poison.
Plaintiff suggests that, because Mrs. Smith’s death was an accident, the question
before the Court is whether “a reasonable person, with the background and
characteristics similar to [Mrs. Smith], would have viewed the injury as highly likely
to occur as a result of the insured’s intentional conduct.” Kovach v. Zurich Am. Ins.
Co., 587 F.3d 323, 336 (6th Cir. 2009). Plaintiff asserts that, because Mrs. Smith was
a troubled alcoholic and addicts “will do almost anything in an effort to reach the
euphoric feelings they seek,” she (as a reasonable addict) would “seek out other
substances outside of your run-of-the-mill alcoholic beverage just to become
intoxicated, including drinking washer fluid which she reasonably believed would get
her drunk much quicker than a standard alcoholic beverage.” [Dkt. No. 10, PgID
394-95 (emphasis in original)] For this reason, Plaintiff contends that Mrs. Smith’s
death was entirely accidental. Citing Wickman v. Northwestern N’tl Ins. Co., 908 F.2d
1077 (1st Cir. 1990).
Defendant argues, and the Court concludes, that a reasonable person, with
background and characteristics similar to Mrs. Smith, would have viewed injury or
death as highly likely to occur as a result of drinking windshield washer fluid. There
is no indication that Mrs. Smith had any functional challenges other than being an
alcoholic. There is no indication that she could not read labels or had any learning or
intellectual impairment. As the article from MedlinePlus notes, windshield washer
fluid is extremely poisonous. The poisonous nature of windshield washer fluid is
evident in the containers in which it is sold, as evidenced by the labels on the
containers that identify the contents as a poison. The Court finds that a reasonable
adult would know that windshield washer fluid is poisonous and that drinking it is
highly likely to cause serious injury or death.
Even if Mrs. Smith did not know that the windshield washer fluid was poison,
the Court finds that the language in the Plan precludes recovery of the AD&D benefit
as a result of her death. As noted above, it is undisputed that Mrs. Smith voluntarily
consumed the windshield washer fluid. It also is undisputed that windshield washer
fluid is extremely poisonous, a fact reflected in the MedlinePlus article. Because Mrs.
Smith voluntarily drank a poison, Defendant had the right to deny Plaintiff’s claim for
the AD&D benefit pursuant to the “Exclusions” section of the Plan. If the intent to
consume poison (and commit, or attempt to commit, suicide) was required, there
would not be a separate exclusion for suicide or attempted suicide.
The Court also concludes that Defendant had the right to deny Plaintiff’s claim
for the AD&D benefit pursuant to the “Exclusions” section of the Plan because,
according to objective evidence, the ingestion of the washer fluid was not the sole
cause of Mrs. Smith’s death. As reflected on the Death Certificate, the medical
examiner indicated that alcoholic liver disease, hypertension and arteriosclerotic
cardiovascular disease were factors contributing to her death. For this reason, the
Court concludes that there was preponderance of the evidence to support Defendant’s
determination, such that Defendant’s decision was correct. McCollum, 495 F. App’x
at 696; Hoover, 290 F.3d at 808-09.
The Court is not persuaded by Plaintiff’s argument that AD&D benefits should
be awarded because the Plan does not: (1) contain a specific exclusion for “ingestion
of washer fluid;” (2) identify what a “poison” actually is; or (3) state that all poisons
are covered by the exclusion. Plaintiff’s arguments ignore that “poison” is not an
ambiguous term and that the voluntary intake of poison is clear. The Court finds that
requiring the Plan to state that “all poison” (rather than “poison,” as it does now)
would not clarify the exclusion. Plaintiff’s suggestion that the Exclusions section
should have contained a specific exclusion for “ingestion of washer fluid” is not
reasonable. If the Court were to adopt that argument, the Plan would have to
specifically identify every method of poison a person could voluntarily intake for the
exclusion to apply. That requirement would be unwieldy and likely impossible to
satisfy – or at least satisfy without necessitating constant updates and amendments to
The Court concludes that Defendant made a correct decision, Hoover, 290 F.3d
at 808-09, and denies Plaintiff’s motion to reverse the denial of his claim for AD&D
IT IS ORDERED that Defendant’s Motion to Affirm the Administrator’s
Decision [Dkt. No. 9] is GRANTED.
IT IS FURTHER ORDERED that Plaintiff’s Motion for Reversal of
Administrative Denial of Claim for Benefits [Dkt. No. 10] is DENIED.
IT IS FURTHER ORDERED that Plaintiff’s cause of action is DISMISSED
S/Denise Page Hood
Denise Page Hood
Chief Judge, United States District Court
Dated: May 19, 2017
I hereby certify that a copy of the foregoing document was served upon counsel of record on
May 19, 2017, by electronic and/or ordinary mail.
S/LaShawn R. Saulsberry
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