The opinion of the court was delivered by: BAER
HAROLD, BAER, JR., District Judge, S.D.N.Y.
Plaintiffs Mary Eileen O'Keefe Bateman, as Executrix of the estate of Michael J. Bateman (the "Estate"), and Mary Eileen O'Keefe Bateman, individually, brought this suit against defendants Equitable Variable Life Insurance Company and INA Life Insurance Company of New York ("LICONY") to recover damages resulting from the alleged breach of two separate insurance policies.
Plaintiffs originally filed this action in New York State Supreme Court. After defendants removed it to federal court, the plaintiffs filed an amended complaint and included a claim under the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq. ("ERISA").
The amended complaint initially included three causes of action: the first cause of action has been settled and dismissed; the third cause of action has been withdrawn. The second and sole cause of action remaining in this case is the ERISA claim asserted by Mrs. Bateman, in her individual capacity, against LICONY. She seeks to recover benefits as a beneficiary of her late husband's group accident insurance policy issued by LICONY.
The parties provided this Court with a stipulated record from which to determine their respective rights and obligations under the deceased's insurance policy. For the reasons that follow, this Court finds in favor of LICONY.
Kidder Peabody & Co., Inc. ("Kidder"), a brokerage house, employed Michael Bateman as an Assistant Vice President. Kidder maintained an employee benefit plan (the "Plan"). As part of the Plan, Kidder offered benefits in case of accidental death or injury (the "Policy"), which were funded by a policy of group insurance issued by LICONY to Kidder. Mr. Bateman enrolled in the Policy in the principal sum of $ 500,000, designating two beneficiaries -- his former wife, Nancy Bateman (in the sum of $ 50,000) and the plaintiff, Mrs. Bateman (in the sum of $ 450,000). (R. at 101.) This policy provided, inter alia, benefits for loss resulting from bodily injuries caused by accident, (R. at 75), and excluded benefits for any loss resulting from " intentionally self-inflicted injuries, suicide, or any attempt thereat, while sane or insane. . . ." (R. at 76.)
On October 19, 1987, a date commonly referred to as "Black Friday" in the financial community, the New York Stock Exchange suffered tremendous losses. Mr. Bateman took a personal loss that day. As the record makes clear, he became depressed and sought psychiatric treatment from Dr. Robert Brooks, M.D., P.C. Dr. Brooks saw Mr. Bateman on three occasions from November 9, 1987, through November 17, 1987, (R. at 200-202), and diagnosed him as suffering from "a major depression," (R. at 650), which is frequently accompanied by suicidal ideation. (R. at 652.) Dr. Brooks prescribed anti-depressants to Mr. Bateman, (R. at 652), and noted that Mr. Bateman did not complain of side effects from the medication. (R. at 665.) Throughout the treatment, Dr. Brooks was concerned that Mr. Bateman was suicidal. (R. at 675.)
On November 22, 1987, Mr. Bateman died from injuries received after plummeting thirty-two stories from the balcony of his Manhattan apartment. The impact site of his body was ten feet east and thirty feet south from the base of the building beneath the apartment balcony. (R. at 230.) Neither a suicide note nor evidence of foul play was discovered.
Mrs. Bateman submitted a claim to LICONY for accident benefits. On January 7, 1992, LICONY rejected Mrs. Bateman's claim after concluding that Mr. Bateman committed suicide and could not have accidentally fallen from his balcony. By letter dated September 18, 1992, Mrs. Bateman requested LICONY to reconsider its January 7, 1992 decision and to determine whether Mr. Bateman may have been a homicide victim, or whether he may have involuntarily taken his life while under the influence of medications. In its March 29, 1993 letter to Mrs. Bateman, LICONY rejected both of these arguments and affirmed its denial of her claim.
ERISA regulates plans established or maintained by employers or employee organizations that, through the purchase of insurance or otherwise, provide benefits to employees. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987). A denial of benefits challenged under ERISA is reviewed de novo, unless the benefit plan gives the fiduciary the discretionary authority to determine eligibility for the benefits and construe the terms of the plan. Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 103 L. Ed. 2d 80, 109 S. Ct. 948 (1989); O'Neil v. Retirement Plan for Salaried Employees of RKO General, Inc., 37 F.3d 55, 59 (2d Cir. 1994) (citation omitted); Masella v. Blue Cross & Blue Shield of Connecticut, Inc., 936 F.2d 98, 102 (2d Cir. 1991) (citation omitted). Because the Plan in this action is governed by ERISA and does not give discretionary authority to the fiduciary, this Court exercises de novo review.
Although ERISA establishes specific requirements for employee benefit plans, it does not regulate the substantive content of the plans. Metropolitan Life Ins. Co. v. Commonwealth of Massachusetts, 471 U.S. 724, 732, 85 L. Ed. 2d 728, 105 S. Ct. 2380 (1985). Courts, therefore, must fill in the resulting gaps through the development of ...