checked into separate rooms at a Marriott Courtyard Hotel in Gaithersburg.
Mr. Bennett and Mr. Butterworth had dinner together on the evening of November 15, 1994. During this meal, Butterworth observed that Mr. Bennett appeared to be his normal self and did not give any indication of being under stress or depression. (Butterworth Aff. P5). Butterworth also recalled that Mr. Bennett purchased gifts for his family while on the trip and was looking forward to delivering those gifts when he returned home. (Butterworth Aff. P5). Also on November 15, 1994, Mr. Bennett made plans to visit an old friend who lived in the area, Ralph Albano, on the evening of November 16, 1994. (Albano Aff. P4).
The following morning, on November 16, 1994, Butterworth noticed that Mr. Bennett was not in attendance at the Loral Business Center where classes were being conducted. (Pltf. Exh. B). After calling Mr. Bennett's hotel room and receiving no answer, Butterworth went back to the hotel to check on Mr. Bennett; upon returning to the hotel, Butterworth noticed that Mr. Bennett's vehicle was still in the parking lot. (Pltf. Exh. B).
With the assistance of the hotel manager, Butterworth and another coworker knocked on Mr. Bennett's door but received no answer. (Pltf. Exh. B). Because the door was dead bolted from within, a drill was used to disable the dead bolt. (Pltf. Exh. B). Mr. Bennett was found dead in his hotel room bathroom. He was clad in blue and brown pantyhose; his legs were bound together at the ankles with a brown belt, and a blue cloth approximately 5 feet in length with a slip knot was tied to the belt. (Pltf. Exh. C). Mr. Bennett's hands were positioned behind his body and were tied at the wrists by a black belt; a separate blue cloth approximately 4 feet in length was attached to the black belt between his wrists. (Pltf. Exh. C). A brown stocking covered his head, a plastic bag covered the stocking, and a green tie was loosely looped around his head with a slip knot. (Pltf. Exh. C).
The police concluded that Mr. Bennett had been engaged in autoerotic asphyxia, the practice of limiting the flow of oxygen to the brain in an attempt to heighten sexual pleasure, and that his death was an accident. (Pltf. Exh. B). The Post Mortem Report also stated that Mr. Bennett's death was due to asphyxia and that his death was an accident. (Pltf. Exh. C).
At the time of his death, Mr. Bennett was covered by a "Group Travel Policy" provided by his employer, Loral Corporation, as part of an employee welfare benefit plan falling within the ambit of ERISA. The policy was issued by the defendant, American International Life Assurance Company of New York. (Pltf. Exh. A).
Plaintiff, Theresa Bennett, was the decedent's wife and his beneficiary under the policy. Shortly after her husband's death, Mrs. Bennett presented her claim for benefits. By letter dated March 15, 1995, Defendant denied Mrs. Bennett's claim finding that "the circumstances of [Mr. Bennett's] death point to the fact that he was risking his life by his own actions" and explaining that "death cannot be considered accidental if, his conduct was such that he should have anticipated that in all reasonable probability he could die as a result of his actions." (Pltf. Exh. E).
As required by ERISA, Plaintiff appealed the denial to Defendant's ERISA Appeals Committee. By letter dated August 15, 1995, Defendant's ERISA Appeals Committee upheld the denial of Plaintiff's claim. (Pltf. Exh. J). As the basis for the denial, the Appeals Committee letter cited the reasons given in the initial denial letter dated March 15, 1995. No other specific grounds for denial were set forth. (Pltf. Exh. J).
On December 6, 1995, Plaintiff filed the instant complaint alleging that the denial of benefits is a violation of ERISA. Presently before this Court are Plaintiffs' Motion for Summary Judgment and Defendant's Motion for Summary Judgment.
A. Autoerotic Asphyxia
Autoerotic asphyxia refers to the practice of deliberately inducing hypoxia (a state of diminished oxygen supply to the brain) with the intention of producing sexual arousal. (Hucker Aff., Exh. 2). The Diagnostic and Statistical Manual of the American Psychiatric Association (Fourth Edition), known as DSM-IV, refers to "asphyxiophilia" or "hypoxyphilia" as a mental disorder under the general rubric of Sexual Masochism. (Hucker Aff., Exh. 2). The DSM-IV describes the practice as follows:
One particularly dangerous form of sexual masochism, called hypoxyphilia involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical (often a volatile nitrate that produces a temporary decrease in brain oxygenation by peripheral vasodilation). Oxygen-depriving activities may be engaged in alone or with a partner. Because of equipment malfunction, errors in the placement of the noose or ligature, or other mistakes, accidental deaths sometimes occur. Data from the United States, England, Australia, and Canada indicate that one to two hypoxyphilia-caused deaths per million population are detected and reported each year.
DSM-IV § 302.83, at 529.
Plaintiff's expert Stephen Hucker writes that "the prevalence of the behaviour is unknown but, like the present case, most come to light as fatalities." (Hucker Aff., Exh. 2). He goes on to note that "death is due to the failure of some mechanism or strategy that the practitioner thought was fail-safe. Sometimes the devise is quite complex but in others they have simply relied on their subjective awareness of losing consciousness to reverse the process by, for example, grabbing onto nearby supports or extending their legs to reduce the pressure on their neck and thereby avoid a fatal mishap." (Hucker Aff., Exh. 2).
A. Summary Judgment Standard & Standard of Review
Pursuant to Fed. R. Civ. P. 56(c), a court may grant summary judgment if it appears "that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 91 L. Ed. 2d 202, 106 S. Ct. 2505 (1986). Furthermore, it is the substantive law that will determine what facts are material to the outcome of a case. See Anderson, 477 U.S. at 250.
Initially, the moving party has the burden of informing the court of the basis of its motion. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986). If the moving party satisfies its burden, the burden then shifts to the non-moving party to come forward with "specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56(e). The Court must then resolve all ambiguities and draw all reasonable inferences against the moving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 89 L. Ed. 2d 538, 106 S. Ct. 1348 (1986). However, the non-moving party must do more than simply show "that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at 586. Only when the Court concludes that no rational finder of fact can find in favor of the non-moving party should summary judgment be granted. Gallo v. Prudential Residential. Servs., Ltd., 22 F.3d 1219, 1223 (2d Cir. 1994).
Furthermore, under ERISA, "a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 103 L. Ed. 2d 80, 109 S. Ct. 948 (1989); see also Schultz v. Metropolitan Life Ins. Co., 872 F.2d 676, 678 (5th Cir. 1989).
Here, Plaintiff argues, and Defendant does not appear to dispute, that no such grant of authority was included in the instant policy. Thus, this Court will perform a de novo review of Defendant's denial of benefits. Accord, Todd v. AIG Life Ins. Co., 47 F.3d 1448, 1451 (5th Cir. 1995)
B. Interpretation of ERISA Regulated Insurance Policies
The instant dispute essentially presents only one issue: whether Tim Bennett's death was an "accident" within the meaning of the Group Travel Accident Policy (the "Policy") issued by Defendant.
The benefit provisions of an ERISA regulated insurance program must be interpreted under principles of federal substantive law. Congress, in adopting ERISA, expected that "a federal common law of rights and obligations under ERISA-regulated plans would develop." Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56, 95 L. Ed. 2d 39, 107 S. Ct. 1549 (1987); see also Firestone, 489 U.S. at 110. In ascertaining the applicable federal common law, a court may " 'draw guidance from analogous state law.' " Brandon v. Travelers Ins. Co., 18 F.3d 1321, 1325 (5th Cir. 1994) (quoting McMillan v. Parrott, 913 F.2d 310, 311 (6th Cir. 1990)). However, "in so doing, [a court] may use state common law as a basis for new federal common law . . . only to the extent that state law is not inconsistent with congressional policy concerns." Thomason v. Aetna Life Ins. Co., 9 F.3d 645, 647 (7th Cir. 1993); see also Heasley v. Belden & Blake Corp., 2 F.3d 1249, 1257 n.8 (3d Cir. 1993); Jamail, Inc. v. Carpenters Dist. Council of Houston Pension & Welfare Trusts, 954 F.2d 299, 304 (5th Cir. 1992).
Applying the basic tenets of contract interpretation, the first place to look for a definition is in the terms of the policy contract itself. See Pilot Life, 481 U.S. at 56-57. These terms must be given their plain meanings, meanings that comport with the interpretations given by the average person. See, e.g., Wickman v. Northwestern Nat. Ins. Co., 908 F.2d 1077, 1084 (1st Cir. 1990); Hoffman v. Life Insurance Co., 669 P.2d 410, 416 (Utah 1983); Knight v. Metropolitan Life Ins. Co., 103 Ariz. 100, 437 P.2d 416 (Ariz. 1968). "Courts have also held, nearly unanimously, 'that insurance contracts must be liberally construed in favor of a policyholder or beneficiary . . . and strictly construed against the insurer in order to afford the protection which the insured was endeavoring to secure when he applied for the insurance.'" Wickman, 908 F.2d at 1084 (quoting 13 Appleman, Insurance Law and Practice § 7401 at 197 (1976)); see also Howard v. Federal Crop Ins. Corp., 540 F.2d 695 (4th Cir. 1976).
Turning to the policy in question, the Policy defines "injury" as "bodily injury caused by an accident and resulting directly and independently of all other causes in loss covered by the policy." (Pltf. Exh. A) (emphasis added). The Policy also contains a schedule of benefits payable; under the heading "Accidental Death and Dismemberment Indemnity," loss of life entitles the beneficiary to payment of the entire value of the policy. (Pltf. Exh. A). The instant policy also contains various exclusions from coverage, including loss due to "suicide or any attempt thereat by the Insured Person while sane" and loss due to "disease of any kind," but there is no general exclusion for self-inflicted injury. (Pltf. Exh. A).
i. What is Meant by the Term "Accident"
As with all contractual terms, the Court looks first to the policy itself for a definition of the term "accident." Here, unfortunately, the Policy is silent. Accordingly, the Court must seek guidance from alternative sources.
In one of the more remarkable cases to deal with this issue, the Supreme Court distinguished between accidental means and accidental results in holding that a man who died of heat stroke while golfing had not died of accidental means in Landress v. Phoenix Mutual Life Ins. Co., 291 U.S. 491, 78 L. Ed. 934, 54 S. Ct. 461 (1934) (no longer binding as federal common law after Erie Railroad Co. v. Tompkins, 304 U.S. 64, 82 L. Ed. 1188, 58 S. Ct. 817 (1938)). The Landress Court reasoned that because the insured had intentionally played golf and exposed himself to the hot sun for a long period of time, the means of his death, overexposure to the sun, was not accidental. Landress, 291 U.S. at 491. In dissent, Justice Cardozo harshly criticized what he termed an "artificial" distinction between accidental means and accidental results:
"Probably it is true to say that in the strictest sense and dealing with the region of physical nature there is no such thing as an accident." Halsburg, L.C. in Brintons v. Turvey, L.R. . . . . On the other hand, the average man is convinced that there is, and so certainly is the man who takes out a policy of accident insurance. It is his reading of the policy that is to be accepted as our guide, with the help of the established rule that ambiguities and uncertainties are to be resolved against the company. . . . When a man has died in such a way that his death is spoken of as an accident, he has died because of an accident, and hence by accidental means.
Landress, 291 U.S. at 499 (citations omitted).
Not surprisingly, courts have consistently rejected the distinction between accidental means and accidental results, noting that
it is illogical to purport to distinguish between the accidental character of the result and the means which produce it; that the distinction gives to "accidental means" a technical definition which is not in harmony with the understanding of the common man; and that the ambiguity found in the concept should be resolved against the insurer so as to permit coverage.