The opinion of the court was delivered by: Charles J. Siragusa United States District Judge
Sedgwick, Detert Moran & Arnold 125 Broad Street 39th Floor New York, NY 10004 (212) 422-0202 INTRODUCTION Siragusa, J. This Employee Retirement Income Security Act (ERISA) case is before the Court on Plaintiff's motion for summary judgment (Docket No. 15), Defendant's cross-motion for summary judgment (Docket No. 15) and Defendant's motion to strike (Docket No. 24). For the reasons stated below, the Court finds that Defendant's decision to deny accidental death benefits to the decedent under the exclusion provision was not arbitrary and capricious. Defendant's motion to strike and cross-motion for summary judgment are granted and Plaintiff's motion for summary judgment is denied.
The following factual background is taken from the parties' statements of fact. Plaintiff Amanda D. Martin ("Martin") is the widow of Paul A. Martin ("Decedent"), who died on December 13, 2008, as a result of electrocution. Decedent had been employed at the time of his death by MKS Instruments, Inc. ("MKS") as an electrical engineer. MKS provided insurance to Decedent through its "Group Long Term Disability, Basic Term Life, Supplemental Dependent Life, Supplemental Term Life, Basic Accidental Death and Dismemberment, Supplemental Accidental Death and Dismemberment Plan for Employees of MKS INSTRUMENTS, INC." (the "MKS Plan" or "Plan"). Benefits under the MKS Plan were funded by Hartford Life and Accident Insurance Company ("Hartford") through its group policy GL/GLT-677074, effective April 1, 2007 ("the Policy"). MKS was the plan administrator for the Plan and Hartford was the claim administrator for the Plan.
The plan contained a provision for payment of benefits in the case of accidental death or dismemberment, the language of which stated in pertinent part as follows:
When is the Accidental Death and Dismemberment Benefit payable?
If You or Your Dependents sustain an Injury which results in any of the following Losses within 365 days of the date of accident, We will pay the injured person's amount of Principal Sum, or a portion of such Principal Sum, as shown opposite the Loss after We receive Proof of Loss, in accordance with the Proof of Loss provision.
(Martin 000051*fn1 (Docket No. 17-3).) The Plan also contains an exclusion provision, which states:
Exclusions: (applicable to all benefits except the Life Insurance, Accelerated Benefit): What losses are not covered?
The Policy does not cover any loss caused or contributed to by:
1) intentionally self-inflicted Injury..
(Martin 000057 (Docket No. 17-3).) It also contains a definition of Injury: "Injury means bodily injury resulting: 1) directly from an accident; and 2) independently of all other causes; which occurs while You or Your Dependents are covered under The Policy." (Martin 000062 (Docket No. 17-3).) Under the Plan, Hartford has the "full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of The Policy.where the interpretation of The Policy is governed by [ERISA]." (Martin 000060 (Docket No. 17-3).)
Martin filed a claim on or around December 26, 2008, for policy benefits following her husband's death. In her claim, Martin stated that Decedent died as a result of "accidental electrocution in home work area." (Martin 000326--333 (Docket Nos. 17-8 & 17-9).) On January 8, 2009, Hartford advised Martin that she, as Decedent's sole beneficiary, would be paid $162,000.00, the full benefit amount of the Basic and Supplemental Life Plans, but that her claim for Accidental Death & Dismemberment ("AD&D") benefits was still pending and that Hartford was in the process of obtaining additional information about the circumstances of Decedent's death.
On March 9, 2009, Martin sent the following documents to Hartford in support of her AD&D claim: (1) a Monroe County Incident Report dated December 13, 2008; (2) a Monroe County Supplemental Report dated December 18, 2008; (3) the Monroe County Sheriff's Office Technical Service Report; (4) the Medical Examiner's ("ME") report; and (5) a toxicology report. (Martin 000084--96 (Docket No. 17-4).) The Monroe County Incident report filed by Investigator S. Okocowicz (referred to in the report as "R/I"), stated in pertinent part the following: 0857H: R/I and [Officer] Roland were dispatched to 74 Village Walk for a 35 year old male, diabetic and turning blue. An OEC *fn2 update prior to arrival stated the male was not breathing, and CPR was in progress. Upon our arrival, Spencerport Ambulance was on scene. We went to the basement of the residence to assist SVA [Spencerport Volunteer Ambulance]. The victim was found to be naked from the waist down, and SVA was performing CPR. The (V), Paul Martin, was laying half way inside a Ham Radio work space. Due to the confined space, the (V) was pulled out to the main basement floor. R/I assisted with CPR efforts while Ofc. Roland did a preliminary interview of the (V)'s wife, Amanda. Ofc. Roland learned that when Amanda found Paul, he was laying face down on the basement floor, with wires wrapped around his arm. She then turned him over and received an electrical shock in the process. She then removed the wires and [s]he threw the wires on the workbench and started CPR as instructed by the OEC dispatcher. With this information, all emergency personnelle [sic] were instructed to stay away from the workbench due to a possible electrical hazard at the time. Spencerport Fire Department members had also arrived by this time and life saving measures were continued. As I was assisting with CPR, I noted several burn marks on the (V)'s hands. They appeared to be thin elongated burn marks across his fingers and hands. After an extended period of time, all life saving measures attempted had failed. The (V) was showed [sic] no signs of life, and the Paramedic was advised by the hospital to cease life saving efforts. The family was notified by on-scene first responders.
R/I checked the workbench and found a homemade wire device. It had a black power cord plugged into a regular home power strip. The power cord had been cut, and purple wires were soldered on. One of the purple wires had a soldered bare "loop" on one end and the other end had a soldered "handle." In the center where the wires came together, another soldered wire was noted that when touched to the purpose wires, sent electrical current through the wires. Spencerport Fireman, Mike Magin, was on scene. He is an electrician by trade and checked the device. It was determined to still be "live" using a multi-meter. The device was left until the Police technician could photograph it.
MCSO Technician Robert Benedict (547B) responded to the scene. Photographs of the electric device were taken where it was found on the workbench. R/I then unplugged the device for follow-up photographs. Photographs were also taken of the burn marks around the testicle region. See Technician Benedict's reports for further details.
Monroe County Medical Examiner Investigator Kevin McCoy arrived at the scene. He pronounced the victim at 1050H. Photographs were taken by the Investigator. Preliminary investigation indicated the victim had made the electrical device himself. It appears the loop end of the purple wire was attached around the victim's scrotum. The other purple wire "handle" end was held in the victim's hand, and the center "live" wire appeared to be a possible switch, which was held in his other hand. It appears the victim accidentally electrocuted himself to death with this device. The ME's Office removed the body from the residence for an autopsy.
R/I interviewed the victims [sic] wife, Amanda Martin. She indicated no problems in the marriage. She said the victim suffers from hypertension and diabetes. Because of this, the victim suffers from erectile dysfunction. Medications noted with the victims [sic] name on the bottles are: Enalapril malcate 5mg, Gabapentin 10 mg, Glyburide 5mg, Levitra 10 mg, Januvia 100 mg & Insulin. R/I asked Amanda if the (V) used pornography, or if he engaged in auto erotic stimulation. She indicated no for both questions. She reiterated that when she found Paul, the wires were wrapped around his hands. She indicated he was naked from the waist down, and didn't know why he would be. She said that when she removed the wires she got an electric shock. She was not injured. Amanda did not know what the device was, but indicated that Paul was an electrical engineer for KMS instruments in Henrietta.
R/I secured the wire device and victims [sic] underwear (which were on the floor by the workbench). R/I took photographs of the wire at the Police Department. R/I downloaded the images to CD-R. All items were placed into property custody. R/I will be in contact with ME's Office for the cause of death.
Note: R/I obtained permission to look in the victims [sic] upstairs closet for further investigation, as Amanda said she rarely goes in it. R/I did locate a drawing of interest. It contains a fantasy type image of a female dominatrix and a man bonded by a chain to the ceiling. Technician Benedict photographed the drawing.
(Martin 000085--87 (Docket No. 17-4).). In a December 14, 2008, "Case Summary Report," the Medical Examiner identified Decedent's cause of death as electrocution and manner of death as accident. In the final findings section of the report, the Medical Examiner noted a "[h]istory of contact with electrical current" and the presence of "[e]lectrical burns on right forearm and left hand, penis and adjacent thighs." (Martin 000092 (Docket No. 17-4).)
The Monroe County Sheriff's Office Technical Services Report, completed by R.D. Benedict, provided the following additional information concerning Decedent's death:
It appears that the harness was made of a small loop of wire that was connected to a live exposed wire with flex ties, and that when the live wire was touched to the exposed wire the circuit was completed and a current was sent to the loop. The victim had several small burn marks on the fingertips of his left finger and middle finger, as well as several burn marks on the inside of his right forearm. The width of the burn marks were consistent with the diameter of the exposed wires. Upon the arrival of the Medical Examiner, more close up photos of the victims [sic] genital area were taken that showed what appears to be a slight burn to the victims [sic] scrotum directly circling the victims [sic] penis. The size of the burn appears consistent with the diameter of the loop attached to the exposed wires, leading all to the assumption that the victim was partaking in some sort of Auto-erotic activity prior to his death.
(Martin 000089 (Docket No. 17-4).)
In a May 15, 2009, letter, Hartford advised Martin that it had determined that Decedent's death was the result of "an injury which was caused or contributed to by a specific exclusion from coverage." (Martin 000292 (Docket No. 17-8).) Hartford denied Martin's AD&D claim. On August 3, 2009, Martin's counsel submitted an administrative appeal of Hartford's determination. In Martin's affidavit, submitted in support of the appeal, and in Martin's counsel's letter, the following information was provided with regard to the events leading to Decedent's death:
On Friday, December 12, 2008, Mr. Martin bought food for an elaborate family dinner. That dinner gave Mrs. Martin stomach problems during the night. In the morning of December 13, 2008, Mrs. Martin remained in the bedroom because of her stomach problem, and Mr. Martin brought his daughter, Chloe, downstairs to their living room. Mr. Martin's mother was coming over to their home that morning. They had pre-arranged to go out to breakfast together and then to a craft show at a local elementary school.
So, at this time, Mrs. Martin was upstairs in the bedroom, Chloe was on the main floor of their home, in the living room, and Mr. Martin's mother was expected shortly for all of them to go out to breakfast and the craft show. Mrs. Martin assumed her husband was with Chloe.
When Mrs. Martin went downstairs to the living room, she saw Chloe, but Mr. Martin was not there. She went to the basement to look for him and found him lying on the basement floor, on his stomach, part way into the Ham Radio room, naked from the waist down, with wires attached to him. She received an electrical shock by touching the wires, but was able to throw them away. Her concern was that her husband was not breathing and she tried rescue breathing CPR on the phone with 911.
(Martin 000284--85 (Docket No. 17-8).)
Martin's counsel argued in the administrative appeal that Decedent's death was due to auto-erotic electrocution and was accidental because "[s]omething out of the usual manner of conducting the auto-erotic sexual practice happened and caused his death." (Martin 000285 (Docket No. 17-8).) Martin's counsel further argued in the administrative appeal that Decedent certainly did not intend to cause his own death and that the electrical burns "that were found on [Decedent's] body at the time of his death" were not intentional, since "when performed as intended," Decedent's auto-erotic practice would not cause burns, which, he further argued, Martin would have noticed "had they been there from prior times that [Decedent] performed this practice." (Martin 000286 (Docket No. 17-8).)
Martin's counsel analogized Decedent's burns to the scrapes and scratches that a rock climber receives when engaging in his hobby and asked whether anyone would say that the rock climber's death from an accidental fall while climbing was "'caused or contributed by an intentionally self-inflicted injury,' of scrapes and scratched [sic], because in the past practice in rock climbing, he had suffered this type of injury?" (Id.) Martin's counsel cited to Critchlow v. First Unum Life Ins. Co. of America, 378 F.3d 246 (2d Cir. 2003), stating it was "the lead case involving ERISA benefit plans as it applies to this exclusion ...