Gardner v. Minnesota Life Insurance Company

Filing 35

MEMORANDUM OPINION re 34 FINAL JUDGMENT. Signed by District Judge Sharion Aycock on 3/27/2014. (psk)

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF MISSISSIPPI
DELTA DIVISION
WAYNE GARDNER

PLAINTIFF

V.

CAUSE NO.: 2:12CV213-SA-JMV

MINNESOTA LIFE INSURANCE COMPANY

DEFENDANT

MEMORANDUM OPINION
The parties have filed cross-motions for summary judgment in this action seeking a
determination by the Court as to whether the Plan Administrator abused its discretion in denying
the heirs of Ava Sue Gardner coverage under her accidental death and dismemberment life
insurance policy.1 Defendant’s Motion for Summary Judgment [17] is GRANTED, and the
Administrator’s denial of coverage is AFFIRMED.
Factual and Procedural Background
Ava Sue Gardner was involved in a multi-vehicle collision on November 18, 2010, in
Southaven, Mississippi. Witnesses to the accident assert that Gardner was traveling at a high
rate of speed in the southbound lane of Highway 51 when she failed to brake, rear-ending two
vehicles that were stopped at a red light. Gardner’s vehicle then travelled across the intersection
and collided with another vehicle. Gardner was transported to the Regional Medical Center in
Memphis, Tennessee, and was pronounced dead soon thereafter.
Wayne Gardner filed a claim with Minnesota Life Insurance Company pursuant to the
employee welfare benefit plan his wife participated in at her employment. In particular, Gardner
filed a claim for the basic life insurance with accidental death and dismemberment rider,
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Defendant also seeks to strike the affidavits attached to Plaintiff’s Motion for Summary Judgment. ERISA cases
are strictly limited to the administrative records, and a participant is “not entitled to a second chance to produce
evidence demonstrating that coverage should be afforded.” Crosby v. Louisiana Health Serv. & Indem. Co., 647
F.3d 258, 263 (5th Cir. 2011) (citing Vega v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287, 299-300 (5th Cir. 1999)(en
banc)). The affidavits are hereby struck and not considered in this matter.

supplemental life insurance, and additional voluntary accidental death and dismemberment
coverage. Minnesota Life paid the life insurance proceeds under the basic life, supplemental life,
and the accidental death and dismemberment rider. However, the insurer denied the claim under
the voluntary supplemental accidental death and dismemberment policy, citing a policy
exclusion specific to that policy.
In particular, Minnesota Life contends that the policy provides that “[a]ccidental death or
dismemberment accidental injury means that an insured’s death or dismemberment results,
directly and independently of all other causes, from an accidental injury which is unintended,
unexpected and unforeseen.” Further, the policy excludes coverage where “the insured’s death
or dismemberment results from or is caused directly or indirectly by any of the following: (3) the
insured’s participation in or attempt to commit a crime, assault or felony; or . . . (6) alcohol,
drugs, poisons, gases or fumes, voluntarily taken, administered, absorbed, inhaled, ingested or
injected.”
Blood tests revealed that Gardner’s blood alcohol content on the date of the vehicle
accident was 0.32%, four times the legal limit. Accordingly, Minnesota Life determined that
Gardner was driving while intoxicated, in violation of Mississippi Code Section 63-11-30, and
therefore, committing a crime during the event.

Further, the insurer contended, “Death is

foreseeable when driving with a BAC of .32%.”
Plaintiff contends that the cause of death listed on the death certificate is “accident.”
While the Uniform Crash Report acknowledges her BAC at 0.32% and that emergency services
personnel and the doctor in the emergency room noted “a very strong odor of an intoxicating
beverage” coming from Mrs. Gardner after the accident, a “contributing circumstance” to the
collision is marked that Gardner was “following too closely.” Accordingly, Wayne Gardner

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filed this suit pursuant to the Employee Retirement Income Security Act (ERISA), and both
parties agree the case can be disposed of on summary judgment.
Standard of Review
The parties agree that the insurance policy in question constituted an employee welfare
benefit plan governed by ERISA. “The summary judgment standard for ERISA claims is unique
because the Court acts in an appellate capacity reviewing the decisions of the administrator of
the plan.” Riley v. Blue Cross & Blue Shield of Mississippi, 2011 U.S. Dist. LEXIS 79907, 2011
WL 2946716, *1 (S.D. Miss. July 21, 2011). The United States Supreme Court has set forth the
“appropriate standard of judicial review of benefit determinations by fiduciaries or plan
administrators” for policies subject to ERISA. Metropolitan Life Ins. Co. v. Glenn, 554 U.S.
105, 110, 128 S. Ct. 2343, 171 L. Ed. 2d 299 (2008) (citing Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, 108, 109 S. Ct. 948, 103 L. Ed. 2d 80 (1989)); see also 29 U.S.C. §
1132(a)(1)(B).
Where, as here, a plan governed by ERISA grants the administrator “‘discretionary
authority with respect to the decision at issue,’” the court reviews a denial of benefits for abuse
of discretion. Corry v. Liberty Life Assurance Co. of Bos., 499 F.3d 389, 397 (5th Cir. 2007)
(quoting Vega v. Nat’l Life Ins. Serv., Inc., 188 F.3d 287, 295 (5th Cir. 1999) (en banc)). When
the policy reserves this discretion to the fiduciary, courts apply a two-step analysis in
determining abuse of discretion. “First a court must determine whether the interpretation is
‘legally correct.’ If so, there is no abuse of discretion and the inquiry ends. However, if the
interpretation is not legally correct, a court must consider whether the fiduciary’s interpretation
constitutes an abuse of discretion.” Price v. Metropolitan Life Ins. Co., 2008 WL 4187944, at *2

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(N.D. Miss. 2008) (citing Plyant v. Hartford Life and Accident Ins. Co., 497 F.3d 536, 540 (5th
Cir. 2007)).
The court “appl[ies] this deferential standard of review even where (as here) the
administrator is also the party obligated to pay the benefits, although [the court] consider[s] any
conflict of interest as a factor in [its] review.” Ewing v. Metropolitan Life Ins. Co., 427 F. App’x
380, 381-382, (5th Cir. 2011) (citing Glenn, 554 U.S. at 118, 128 S. Ct. 2343). “If the decision
on eligibility is supported by substantial evidence and is not erroneous as a matter of law,” it will
be upheld. Barhan v. Ry-Ron Inc., 121 F.3d 198, 201 (5th Cir. 1997). An arbitrary decision “is
one made without a rational connection between the known facts and the decision or between the
found facts and the evidence.” Dudley v. Sedgwick Claims Mgmt. Servs. Inc., 495 F. App’x 470,
2012 U.S. App. LEXIS 22252, 2012 WL 5278919, 3 (5th Cir. 2012) (citations omitted).
Discussion and Analysis
The policy defines accidental death as one that results “directly and independently of all
other causes from an accidental injury which is unintended, unexpected, and unforeseen.” In
denying Gardner’s claim for benefits, Minnesota Life concluded that an insured operating a
motor vehicle while intoxicated foresees, and therefore expects, the potential for injuries or
death. Because the insured’s BAC was 0.32%, four times the legal limit, Minnesota Life insists
that the decedent’s intoxication caused the potential for foreseeable damages, thereby excluding
her from accidental death policy coverage.
The Fifth Circuit has upheld as reasonable an administrator’s finding that operating a
vehicle while intoxicated creates a foreseeable potential for death or injury. In Davis v. Life Ins.
Co. of North America, the Court held that “it was reasonable to decide that a foreseeable
consequence of riding a motorcycle [while intoxicated] would [cause] a serious accident.” 379

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F. App’x 393, 396 (5th Cir. 2010). The toxicology report on the decedent in Davis revealed that
he had a BAC between 0.28% and 0.368% at the time of the accident. Id. at 394. The Fifth
Circuit found that it was not arbitrary or capricious for the administrator to determine that death
or injury was foreseeable while operating a vehicle at three to four times the legal limit, thereby
rendering the loss excluded from policy coverage. Id. See also Sanchez v. Life Ins. Co of North
America, 393 F. App’x 229, 232-33 (5th Cir. 2010) (“[W]e find that LINA [insurer and
fiduciary] did not abuse its discretion when it determined that driving under the influence of
alcohol contributed to Mr. Sanchez’s automobile crash. This decision is supported by evidence
on the record . . .”).
Additionally, in Sanford v. Zurich American Ins. Co., the trial court, in granting
summary judgment in favor of the fiduciary, held that, while there certainly were other “possible
explanations for [decedent’s] death which [did] not involve intoxication,” substantial evidence
supported the administrator’s decision that alcohol and intoxication were indeed a factor
contributing to the insured’s death. 2009 WL 2986343, at *4 (N.D. Miss. Sept. 15, 2009).
Though drowning was the ultimate cause of death in Sanford, the fact that intoxication was a
contributing factor was enough to exclude the loss from policy coverage. Id. Therefore, the
administrator’s application of the facts to the policy language was reasonable and was not an
abuse of discretion. Id.
Similarly, Gardner argues that the death certificate/police report notes that Ava Sue
Gardner died from multiple blunt force injuries, rather than alcohol. Plaintiff argues that this is
sufficient to exclude the determination that alcohol might have been a contributing factor in the
decedent’s death. As the court held in Sanford, the fact that intoxication was not listed as the
cause of death will not suffice to bring the claim within policy coverage.

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This Court, after reviewing relevant case law and the administrative record submitted,
finds that the administrator’s determination that the decedent’s death was not accidental and
excluded from coverage is reasonable, and thus, not an abuse of discretion.

There was

substantial evidence in the record supporting the finding that the decedent had been using alcohol
while driving, including both the blood tests and the police reports stating that the decedent had a
strong scent of alcohol coming from her person. No other evidence has been brought before this
court to indicate that other factors, unexpected and unforeseeable by the decedent, caused or
contributed to her death. Absent evidence suggesting that other factors were involved in the
death of the insured, and weighing the conflict of interest in this case, this Court affirms the
decision of the administrator to deny benefits for accidental death. Therefore, the administrator’s
interpretation was “legally correct,” and the Court’s inquiry need not continue to the second
element of analysis. Price v. Metropolitan Life Ins. Co., 2008 WL 4187944, at *2 (N.D. Miss.
2008) (citing Plyant v. Hartford Life and Accident Ins. Co., 497 F.3d 536, 540 (5th Cir. 2007)).
Conclusion
Minnesota Life did not abuse its discretion in denying the voluntary supplemental
accidental death and dismemberment benefits to Plaintiff because the decedent’s death was not
accidental and thus not a covered loss as defined by policy language. Therefore, the Court
GRANTS Minnesota Life’s Motion for Summary Judgment [17]. Gardner’s cross-Motion for
Summary Judgment [19] is DENIED.
Judgment shall be entered accordingly in favor of Minnesota Life Insurance Company.
This case is CLOSED.
SO ORDERED, this the 27th day of March, 2014.
/s/ Sharion Aycock_________
U.S. DISTRICT JUDGE
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