The opinion of the court was delivered by: Sweet, District Judge.
Defendant Metropolitan Life Insurance Company
("Metropolitan") has moved for summary judgment dismissing the
complaint of plaintiff Catherine Arthurs ("Arthurs"). For the
following reasons, the motion is denied.
Arthurs is the widow of Raymond Arthurs, who was, at the time
of his death, employed as a splicer by the Consolidated Edison
Company of New York, Inc. ("Con Ed"). Mr. Arthurs died on June
17, 1986, following his collapse while working in a Con Ed
"vault" at the Port Authority Terminal in New York City.
Metropolitan is an insurance company licensed to do business
in New York. Metropolitan insures a Group Life Insurance Plan
("the Plan") provided by Con Ed to its employees. Mr. Arthurs
was covered by the Plan at the time of his death.
Prudential Insurance Company of America ("Prudential"), not
a party to the present motion, is also an insurance company
licensed to do business in New York. Prudential insured Mr.
Arthurs under two individual life insurance policies.
Both insurance companies paid Arthurs the basic death
benefits due to her, but refused to pay the additional
accidental death benefits called for under the policies.
Arthurs therefore sued the insurers in New York State Supreme
Court in May 1990 for breach of the insurance contracts.
Metropolitan removed the case to this Court pursuant to
28 U.S.C. § 1441(c), asserting that because Arthurs' claim against
it related to an employee benefit plan governed by the Employee
Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001-1461,
federal question jurisdiction existed.
On December 5, 1990, Metropolitan moved for summary judgment
dismissing the complaint. Oral argument on the motion was heard
on January 14, 1991.
The Summary Plan Description dated July 1984 ("the Summary"),
which was distributed to covered Con Ed employees pursuant to
ERISA, 29 U.S.C. § 1022, states
In addition to any other benefits which you may
receive, [accidental death or dismemberment]
benefits will be paid for bodily injury sustained
on or off the job while insured for this coverage
and caused solely through violent, external and
accidental means which results in death or the loss
of hand, foot, or sight or eye.
Benefits are paid when the death or loss takes
place within 90 days after the injury and is not
caused in whole or in part from disease, bodily or
mental infirmity, hernia, insurrection,
intentionally self-inflicted injury, or any act of
Summary at 4 (emphasis added).
Both parties appear to agree that Mr. Arthurs died as a
result of a heart attack. Arthurs claims that the attack was
brought on by his working for several hours in the enclosed
vault where the temperature exceeded 110 degrees, while
Metropolitan argues that a pre-existing disease or bodily
infirmity, namely coronary arteriosclerosis, was at least
partially responsible for the collapse and death, which excuses
it from paying the accidental death benefits.
Mr. Arthurs' death certificate contains the ...