The opinion of the court was delivered by: MCAVOY
This case concerns a dispute over benefits under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. Specifically, the dispute involves the construction of the term "accidental" in an accidental death insurance policy and arises from the death of Plaintiff's husband. Defendant Hartford Life Insurance Company ("Hartford Life") declined to pay the policy's benefits after concluding that the death was not accidental.
Plaintiff Carole Howard originally filed this action in New York State Supreme Court, Broome County, but defendants National Education Association of New York ("NEANY") and Hartford Life removed the case to this Court pursuant to 28 U.S.C. § 1441. Between May 19, 1997 and May 22, 1997, the Court held a bench trial on Plaintiff's claims. The Court's findings of fact and conclusions of law follow.
Richard Howard, Plaintiff's deceased husband, was an employee of defendant NEANY. He was also a member of the Staff Organization of New York Educators ("SONYE"), the recognized collective bargaining unit for employees of NEANY. Pursuant to a collective bargaining agreement between NEANY and SONYE, NEANY provided Mr. Howard with life insurance, accidental death and dismemberment insurance, and common carrier coverage at no cost. Plaintiff is the beneficiary of the insurance policy issued by defendant Hartford Life upon Mr. Howard ("the Policy").
As a Uniserve Representative, Richard Howard was responsible for assisting the various bargaining units within NEANY in contract negotiations with their respective school districts. Initially, Mr. Howard's territory included the service area surrounding Ithaca, New York. However, as the evidence at trial made clear, Mr. Howard's geographic territory and workload significantly increased each year after he began work as Uniserve Representative in Vestal. In 1988, Mr. Howard was responsible for thirteen local unions, including nine teachers associations. In 1989, Mr. Howard was responsible for seventeen local unions.
In the Spring of 1989, Richard Howard injured his knee and was unable to work from March until July. As a result of Mr. Howard's knee surgery he underwent a routine pre-operative examination by his primary care physician, Dr. Frank Floyd, on April 13, 1989. Dr. Floyd recorded Mr. Howard's weight as 257 lbs; Dr. Floyd testified that he considered Richard Howard to be obese. Dr. Floyd also testified that his examination showed Mr. Howard to have a history of high blood pressure and elevated cholesterol. In addition, an EKG was performed. Although the EKG showed signs of sinus arrhythmia, Dr. Floyd testified that he considered Mr. Howard's EKG to be within the range of normal.
Plaintiff provided extensive evidence, much of which was unchallenged, that after Mr. Howard's knee injury, his workload began to exact a toll on him. In the fall of 1989, Carole Howard testified that Mr. Howard appeared exhausted and that her husband often expressed frustration with his workload. Carole Howard also stated that Mr. Howard began spending a large portion of his day driving to the many school districts in his territory and that he installed a telephone in their bedroom so that he could catch up on work-related telephone calls in the evenings. Mrs. Howard testified that in the Spring of 1990 her husband was growing increasing irritable and that he expressed to her that he felt he was "in over his head"; that he was carrying a heavier workload than the other Uniserve Representatives; and that he was not getting enough support from his coworkers.
On June 13, 1990, Richard Howard experienced heart palpitations and was examined by his primary care physician, Dr. Frank Floyd. Dr. Floyd administered an EKG in his office, which revealed that Richard Howard was experiencing atrial fibrillation. Mr. Howard was taken to Lourdes Hospital where a second EKG was performed; the second EKG showed that his heart rhythm had returned to normal. Upon admission to Lourdes Hospital, Richard Howard's weight was 264 lbs, and Dr. Floyd testified that Mr. Howard's blood pressure and cholesterol were borderline elevated. Richard Howard was placed on Digoxin, a heart medication, and released from the hospital on June 15, 1990.
On August 10, 1990, Richard Howard went to a cardiologist for a follow-up examination. Dr. John DiMenna performed a stress test and thallium scan. Richard Howard's stress test EKG showed an abnormal heart rhythm and ST-segment depression. Dr. DiMenna testified that because the abnormal EKG may have been due to Mr. Howard's heart medication, he had Richard Howard undergo a thallium scan (the use of a radioactive isotope to measure blood flow in the heart). Dr. DiMenna testified that the thallium scan was within the range of normal and he concluded that Richard Howard did not suffer from coronary disease. No further tests were conducted.
The policy in effect at the time of Richard Howard's death stated:
The Hartford will pay a benefit according to the schedule of Losses and Benefits on page 17 if:
(1) you suffer accidental bodily injury while your insurance is in force;
(2) a loss results directly from such injury, independent of all other causes; and
(3) such a loss occurs within 90 days after the date of the accident ...