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Stanton v. Lincoln Life & Annuity Company of New York

September 1, 2010


The opinion of the court was delivered by: Charles J. Siragusa United States District Judge



This is an action to recover accidental death insurance benefits, brought pursuant to the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. The decedent was intoxicated and operating a snowmobile when he struck a tree and was killed. Defendants denied coverage, on two grounds: 1) the death was not accidental; and 2) the policy excludes coverage for losses caused by "driving a motor vehicle while intoxicated."

Plaintiff, a beneficiary of the subject policy, contends that the decision denying benefits was arbitrary and capricious. Now before the Court is Defendants' summary judgment motion [#19] and Plaintiff's cross-motion [#22] for the same relief. For the reasons that follow, Defendants' application is granted, Plaintiff's application is denied, and this action is dismissed.


Unless otherwise noted, the following are the facts of this case, viewed in the light most favorable to Plaintiff. The decedent, Brian Zamiara ("Zamiara"), was an employee of Lecesse Construction Services, LLC ("Lecesse") and was covered by Lecesse's group insurance policy covering accidental death ("the policy"). Specifically, the policy covers "loss of life" that is "accidental." The policy contains an exclusion, which states, in pertinent part: "Benefits are not payable for any loss to which a contributing cause is... the Insured Person's driving a motor vehicle while intoxicated." The policy does not define the term "motor vehicle." However, the policy, which uses the term "auto accident" in certain sections, defines "auto" as follows: "'Auto' means a 4-wheel passenger car, station wagon, jeep, pick-up truck or van-type car. It must be licensed for use on public highways. It includes a car owned or leased by the Group Policyholder." Policy p. 33.

The policy was issued by defendant Jefferson Pilot Life America Insurance Company ("Jefferson"), and defendant Lincoln Life & Annuity Company of New York ("Lincoln") was the claims administrator for the policy.

On the night of December 19, 2008, Zamiara and some friends were operating their snowmobiles in and around Avon, New York. Zamiara consumed a quantity of beer at several different taverns during the outing. While traveling home on a snowmobile trail through a wooded area, Zamiara failed to make a turn, left the trail, and struck a tree with his snowmobile. Zamiara's riding companion indicated that they had been traveling approximately 55 miles per hour. The riding companion also indicated that he and Zamiara had needed to stop their snowmobiles several times that night to remove ice from their helmet face shields. However, there is no indication in the record as to whether or not Zamiara's face shield was iced over at the time of the crash.

Zamiara died at the scene from a fractured spine, and an autopsy indicated that his blood alcohol concentration ("BAC") was between 0.12 and 0.14. The autopsy report states, in pertinent part: "Cause of Death: Fracture of spine. The manner of death is Accident." On December 20, 2008, an officer with the New York State Office of Parks, Recreation & Historic Preservation completed an accident report, indicating, in part, that "alcohol involvement" was an "apparent contributing factor" in the crash. (AR0112-0113). The Livingston County Sheriff's Office also conducted an investigation, but did not indicate whether alcohol was a factor in the crash.

Lincoln denied coverage, and Plaintiff exhausted his appeal rights under the policy. On July 17, 2009, Lincoln issued its final denial of Plaintiff's claim. In that regard, Lincoln denied the claim for two reasons. First, Lincoln indicated that Zamiara's death was not accidental, within the meaning of the policy, because a reasonable person would have viewed the injury (Mr. Zamiara's death) as a reasonably foreseeable result of his operating a snowmobile at a high rate of speed at night on a trail in a wooded area while intoxicated. Second, Lincoln indicated that even if the death was accidental, coverage was excluded because a contributing cause of the injury was the fact that Zamiara was operating a motor vehicle while intoxicated.

On August 25, 2009, Plaintiff commenced the instant action. Plaintiff contends that the decision to deny coverage was arbitrary and capricious, because the death was an accident within the meaning of the policy, and because a snowmobile is not a motor vehicle within the meaning of the relevant exclusion. Following a period of discovery, the parties filed the subject motions for summary judgment. On August 12, 2010, counsel for the parties appeared before the undersigned for oral argument.


Summary Judgment Standard Summary judgment may not be granted unless "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c). A party seeking summary judgment bears the burden of establishing that no genuine issue of material fact exists. See, Adickes v. S.H. Kress & Co., 398 U.S. 144, 157 (1970). "[T]he movant must make a prima facie showing that the standard for obtaining summary judgment has been satisfied." 11 MOORE'S FEDERAL PRACTICE, § 56.11[1][a] (Matthew Bender 3d ed.). "In moving for summary judgment against a party who will bear the ultimate burden of proof at trial, the movant may satisfy this burden by pointing to an absence of evidence to support an essential element of the nonmoving party's claim." Gummo v. Village of Depew, 75 F.3d 98, 107 (2d Cir. 1996)(citing Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986)), cert denied, 517 U.S. 1190 (1996).

The burden then shifts to the non-moving party to demonstrate "specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56(e); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986). To do this, the non-moving party must present evidence sufficient to support a jury verdict in its favor. Anderson, 477 U.S. at 249; see also, FED. R. CIV. P. 56(e)("When a motion for summary judgment is made and supported as provided in this rule, and adverse party may not rest upon the mere allegations or denials of the adverse party's pleading, but the adverse party's response, by affidavits or as otherwise provided in this rule, must set forth specific facts showing that there is a genuine issue for trial."). Summary judgment is appropriate only where, "after drawing all reasonable inferences in favor of the party against whom summary judgment is sought, no reasonable trier of fact could find in favor of the non-moving party." Leon v. Murphy, 988 F.2d 303, 308 (2d Cir.1993). The parties may only carry their respective burdens by ...

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