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Irina Ulyanenko v. Metropolitan Life Insurance Company and Life Insurance of North America

November 13, 2012


The opinion of the court was delivered by: J. Paul Oetken, District Judge:


Irena Ulyanenko ("Plaintiff") brings this action against Life Insurance Company of North America ("LINA"), contending that her claim-as beneficiary of the accident death insurance policy of her daughter, Nadia Ulyanenko-was improperly denied under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. §§ 1001 et seq. Considering the entirety of the evidence, this Court finds that Plaintiff has not met her burden of proving that her daughter's death stemmed from an external accident, as mandated by Nadia's insurance policy. Therefore, Plaintiff's claim is not covered under Nadia's accidental death policy.


A.Factual Background

Nadia Ulyanenko was a Vice President at Lehman Brothers when she died, far too young at the age of 29, as the result of a pulmonary embolism. She fell ill in a subway station on June 23, 2005, and was found in a subway bathroom, complaining of shortness of breath. Nadia told the responders that she "fe[lt] sick," but "denie[d]" being in any pain. She also "projectile vomit[ed]" twice in front of the responders. It appears that Nadia's illness came on "after eating a peach." Nadia was taken to St. Luke's-Roosevelt Hospital Center. While in the emergency room she suffered several seizures and subsequently from cardiac arrest. CPR was performed and her pulse returned, at which point she was taken to the hospital's intensive care unit. On June 26, 2005, having been without brainstem reflexes since the night before, she was pronounced clinically brain dead. Nadia died on July 10, 2005. (LINA 0129-132, 134, 139, 147, 151, 241.)

On July 12, 2005, Michael J. Greenberg, M.D., of the New York Office of the Chief Medical Examiner, performed an autopsy on the body. The autopsy report of Dr. Greenberg, dated August 4, 2005, indicates that Nadia died of a pulmonary embolism. The causes of Nadia's death, according to Dr. Greenberg, were the genetic mutations of "Factor V Leiden (G1691A) and MTHFR C677T Double Heterozygote . . . and oral contraceptive use." (LINA 0120.) Dr. Greenberg's report contained a genetic testing report by Yingying Tang, MD, PhD, FACMG, noting that "Heterozygotes for the factor V Leiden mutation have an approximately 4 to 8-fold increased risk of venous thrombosis as compared to individuals without mutation." (LINA 0127.)

Dr. Greenberg also noted that there were contusions all over Nadia's body: INJURIES:

There are three contusions of the back. One measures 1" x 3/4" and is on the midline of the lumbar region. The other two are on the right shoulder area and measure 1" x 1/2" each. There is a contusion of the posterior right thigh measuring 3" x 2". There is a group of three contusions superior to the larger thigh contusion ranging from 1/2" to 1". There are scattered contusions of the right arm and forearm ranging from 1/4" to 1/2". (LINA 0121.) The contusions Dr. Greenberg discovered on Nadia's body were not mentioned in either the EMS report or the hospital admission records. (LINA 0129- 0132.) They were, however, discussed in the hospital records from June 26, 2005 and June 30, 2005. (LINA 0341, 0373.)

Through her employment at Lehman Brothers, Nadia was insured by a group accidental death policy, OK 980053 ("the Policy"), issued by LINA to Trustee of the Group Insurance Trust for Employers in Finance, Insurance and Real Estate Industry, under which Lehman Brothers was a covered affiliate. The Policy provides benefits to the beneficiary for losses caused by "covered accidents." "Covered accident" is defined in the Policy as

A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and meets all of the following conditions:

1. occurs while the Covered Person is insured under this Policy;

2. is not contributed to by disease, Sickness, mental or bodily infirmity;

3. is not otherwise excluded under the terms of this Policy. (LINA 0057.) "Sickness" is defined by the Policy as a "physical or mental illness." (LINA

0059.) The Policy also explicitly excludes certain types of losses, including "any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from . . . Sickness, disease, bodily or mental infirmity, bacterial or viral infection ...

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