The opinion of the court was delivered by: Alvin K. Hellerstein, United States District Judge.
OPINION AND ORDER GRANTING MOTION FOR SUMMARY JUDGMENT
On October 8, 1998, on a business trip for his employer A.T. Kearney,
Inc., Phillip Cronin was found dead in his hotel room in Helsinki,
Finland. Cronin was found hanging by his neck, suspended from a luggage
strap looped to a hook on the bathroom door. Immediately prior to his
death, Mr. Cronin was practicing autoerotic asphyxiation. Plaintiffs, the
decedent's wife and the trustee of his estate, bring this lawsuit against
Zurich American Insurance Company and A.T. Kearney, Inc., to recover
under two accidental death insurance policies. After discovery,
defendants move for summary judgment dismissing plaintiffs' claims
because, defendants argue, Cronin's death was not "accidental," and
because it was a "purposely self-inflicted injury" excluded from coverage
under the policy. For the reasons explained below, I hold (1) that the
insurance policies are "employee benefit plans," governed by ERISA and
interpreted according to federal law, and (2) that Cronin's death was not
accidental, and resulted from a "purposely self-inflicted injury."
Decedent Phillip Cronin was found dead in his hotel room in Helsinki,
Finland on October 8, 1999, while on a business trip for his employer,
defendant A.T. Kearney, Inc. ("Kearney"). Hotel personnel found Cronin
hanging by his neck from a luggage strap suspended from a hook on the
back of the bathroom door of his hotel room. According to investigators'
reports, Cronin was found hanging naked in a sitting position, his
buttocks suspended approximately 10 centimeters above the floor. The
medical examiner concluded in the death certificate that the
circumstances of Cronin's death suggested that it resulted from a botched
autoerotic asphyxiation. Autoerotic asphyxiation is the practice of
limiting the supply of oxygen to the brain in an attempt to heighten
sexual pleasure, usually, as in this case, by exerting pressure on the
arteries of the neck to constrict bloodflow to the brain while engaging
in sexual self-stimulation, presumably masturbation.
At the time of his death, Cronin was insured under two accidental death
and dismemberment insurance policies issued by defendant Zurich American
Insurance Company ("Zurich") through Kearney.*fn1 The first policy,
referred to in Kearney's summary plan description as a "Business Travel
Accident Insurance Plan," (hereinafter "the Travel Policy") provided
accidental death and dismemberment coverage for all full-time Kearney
employees while traveling on Kearney business. Kearney paid all premiums
for the Travel Policy, and coverage for full-time employees was automatic
and did not require any employee action or election. The travel policy
had an original effective date of January 1, 1995, and was renewed by
Kearney as of January 1, 1996 for three years.
The second policy, referred to in Kearney's summary plan description as
the "Voluntary Accident Insurance Plan," (hereinafter "the Voluntary
Policy") provided 24-hour-a-day accident insurance coverage to those
Kearney employees who expressly elected coverage and paid premiums
through paycheck deductions. The Voluntary Policy was effective from
January 1, 1998.
For the purposes of this motion, the Travel Policy and the Voluntary
Policy contain identical coverage provisions, obligating the insurer,
"[i]f injury to a covered person results in a loss of life" to pay the
sum of $500,000 per policy. Both policies define "injury" as an
"accidental bodily injury."*fn2 "Accidental" is not defined. The Travel
Policy and Voluntary Policy both contain identical exclusions, "not [to]
pay any claim that is caused by, contributed to, or results from . . . [a]
purposely self-inflicted injury."
C. Denial of Cronin's Claim
In January 1999, attorneys for plaintiff Fran Cronin, wife of the
decedent Phillip Cronin, made a claim to Zurich under the two policies.
Kearney's benefits department assisted with the submission and processing
of the claim. Zurich conducted an investigation, and on June 28, 1999,
Zurich denied the claim on two grounds: because the death did not result
from an "accidental injury" and because the "purposely self-inflicted
injury" exclusion applied. Plaintiffs appealed, exhausting Zurich's ERISA
appeal procedure. On September 20, 1999, Zurich advised plaintiffs that
its ERISA review committee had upheld the denial of plaintiffs claims.
This lawsuit followed.*fn3
A. Summary Judgment Standards
Summary judgment is appropriate if there is no genuine issue of
material fact in dispute and the moving party is entitled to judgment as
a matter of law. See Tops Markets, Inc. v. Quality Markets, Inc.,
142 F.3d 90, 95 (2d Cir. 1998). On a motion for summary judgment, a
district court "must view the evidence in the light most favorable to the
non-moving party and draw all reasonable inferences in its favor."
Consarc Corp. v. Marine Midland Bank, N.A., 996 F.2d 568, 572 (2d Cir.
1993). The initial burden of demonstrating the absence of a disputed
issue of material fact lies with the moving party. See Celotex Corp. v.
Catrett, 477 U.S. 317, 323 (1986). If the moving party ...