Alexandre v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA

• Decision Date: 03 January 2022
• Docket Number: No. 21-1140,21-1140
• Citation: 22 F.4th 261
• Parties: Mary ALEXANDRE, Plaintiff, Appellant, v. NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, Defendant, Appellee.
• Court: U.S. Court of Appeals — First Circuit

22 F.4th 261

Mary ALEXANDRE, Plaintiff, Appellant,

v.NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA, Defendant, Appellee.

No. 21-1140

United States Court of Appeals, First Circuit.

January 3, 2022

Lawrence R. Metsch, Miami, FL, with whom Metschlaw, P.A., Amiel Z. Weinstock, and AZW Law, LCC were on brief, for appellant.

Lincoln A. Rose, Boston, MA, with whom Tamara Smith Holtslag, Boston, MA, and Peabody & Arnold LLP were on brief, for appellee.

Before Thompson and Kayatta, Circuit Judges, and Katzmann,^* Judge.

KATZMANN, Judge.

This action arises under the Employee Retirement Income Security Act of 1974 ("ERISA"), a federal statute designed to protect the interests of participants and their beneficiaries in employee benefit plans.¹ 29 U.S.C. § 1001 et seq. Plaintiff Mary Alexandre appeals a decision by the U.S. District Court for the District of Massachusetts upholding defendant National Union Fire Insurance Company of Pittsburg, PA's denial of accidental death insurance benefits to Alexandre following her husband's death on the grounds that he had committed suicide. Plaintiff asks that we remand to the district court with instructions to enter judgment in her favor. We are not persuaded by Plaintiff's arguments and we affirm the district court's decision.

I. Background

A. Facts

1. The Accidental Death and Dismemberment Insurance Plan

In May 2018, Plaintiff Mary Alexandre ("Alexandre") was employed by PricewaterhouseCoopers, LLP ("PwC") and resided in Boston. Through PwC, Alexandre enrolled in an accidental death and dismemberment insurance policy ("the AD&D Policy" or "the AD&D Plan"), an employer-sponsored welfare plan that afforded participants like Alexandre rights and protections under ERISA. Under said AD&D Policy, Alexandre's husband, Marzuq Muhammad ("Marzuq"),² was insured for a death benefit of $500,000 with Alexandre named as the beneficiary.

While PwC served as the Sponsor and Administrator of Alexandre's AD&D Policy, PwC retained defendant National Union Fire Insurance Company of Pittsburgh, PA ("National Union") to insure the Policy and to assume fiduciary responsibility for claim determinations. Concerning claims, the Summary Plan Description ("SPD")³ provided to Alexandre by PwC states, in relevant part:

Payment of Death Benefits

If you or a covered dependent die as the result of, and within 365 days after, an accident that occurs while AD&D coverage is in effect, the full amount of your or your covered dependent's AD&D coverage will be paid to the designated beneficiary(ies) in a lump sum.

(emphasis added). Neither the SPD nor the official Plan documents -- which articulate the complete details of and legally govern the AD&D Policy -- define the term "accident." However, the AD&D Policy explicitly excludes from coverage "losses, disability, or death caused by" "suicide or any attempt at suicide or intentionally self-inflicted injury or any attempt at intentionally self-inflicted injury." The AD&D Policy further states that National Union "has the right to interpret the provisions of th[e] Plan, and [that] its decisions are conclusive and binding," but explains that unsatisfied participants "have the right to bring a civil action under Section 502(a) of ERISA within one year of the final adverse benefit determination."

2. Marzuq Muhammad's Death

The circumstances that gave rise to Alexandre's claim for death benefits under the AD&D Policy are as follows: On May 20, 2018, Alexandre's husband, Marzuq, died after falling nine stories from a hotel balcony in Atlanta, Georgia. Marzuq and his brother, Mujihad, had traveled from Boston to Atlanta on May 18 for an event and were staying overnight in a tenth-floor hotel room at the Hyatt Regency Hotel at the time of Marzuq's death.

According to the Fulton County Medical Examiner's Investigative Summary -- which details the accounts of Mujihad and another witness in the immediate aftermath of Marzuq's death -- early on May 20, 2018, Marzuq "grabbed and squeezed" Mujihad's hand so that Mujihad "awakened to see [Marzuq] in a full sprint towards the door." Immediately thereafter, Mujihad heard a "loud noise" and emerged from his hotel room to see Marzuq "kicking and wiggling" in a flower arrangement one story below on the ninth-floor ledge.

The Medical Examiner's report further details that Mujihad yelled to his brother "no[,] no, keep still," and that the other witness -- who was in the hotel atrium below -- heard Mujihad yell to Marzuq "no[,] no, keep still, don't do it." Marzuq then rolled off the ninth-floor ledge and fell to the atrium floor. Marzuq died on impact and his final Death Certificate listed his death as a suicide.

3. The Claim Denial

Following Marzuq's death, Alexandre submitted a claim under the AD&D Policy to National Union for accidental death benefits. On July 31, 2019, AIG Claims Inc. -- the Claims Administrator for National Union -- informed Alexandre by letter that because Marzuq's "death was not a result of bodily injury sustained as a direct result of an unintended, unanticipated accident but was the result of suicide or an intentionally self-inflicted [i]njury," it was outside the scope of the AD&D Policy's coverage; Alexandre's claim for accidental death benefits was thus denied. According to the denial letter, AIG based this rejection upon Alexandre's claim form, Marzuq's Death Certificate, the autopsy report, the City of Atlanta Incident Report, and the Fulton County Medical Examiner's Investigative Summary.

Alexandre appealed the denial of benefits to AIG's Global Personal Accident & Health Division on September 4, 2019. As part of this appeal, Alexandre submitted a sworn declaration by Mujihad -- taken on September 3, 2019 -- disputing the determination that his brother had committed suicide. Mujihad's sworn declaration differed in certain respects from the account he gave to the authorities at the scene of Marzuq's death; specifically, in contrast to Mujihad's statement recorded in the Medical Examiner's report that Marzuq exited the brothers' hotel room "in a full sprint" immediately before landing in a flower arrangement on the ninth-floor ledge, Mujihad's September 2019 account stated that Marzuq "did not appear to be disturbed or alarmed" as he "went out the door."

On May 4, 2020, AIG -- on behalf of National Union -- affirmed the denial of benefits to Alexandre by letter. In reaching this decision, AIG conveyed that it had considered Alexandre's appeal letter, Mujihad's September 2019 sworn declaration, case law submitted by outside counsel, and other materials, including those outlined in the July 31, 2019 denial letter. AIG further explained that in assessing the nature of Marzuq's death on appeal, it considered the contemporaneous investigative reports by the officials in Georgia to be "more credible than the singular, after-the-fact Declaration of Mujihad."

B. Proceedings

On January 21, 2020, Alexandre filed suit against National Union under § 502(a)(1)(B)⁴ of ERISA in the U.S. District Court for the Southern District of Florida seeking $500,000 in accidental death benefits provided for by the AD&D Policy. On February 19, 2020, National Union moved to transfer the case to the U.S. District Court for the District of Massachusetts ("district court") pursuant to 28 U.S.C. § 1404(a),⁵ which the Florida District Court granted on March 30, 2020.

Prior to the transfer, on March 17, 2020, Alexandre moved for summary judgment, invoking the presumptions against suicide and in favor of an accident adopted by the Eleventh Circuit in Horton v. Reliance Standard Life Insurance Co., 141 F.3d 1038 (11th Cir. 1998). Following the transfer, on May 19, 2020, National Union cross-moved for summary judgment on the grounds that Marzuq's death was not accidental, as informed by the First Circuit's analytical framework set forth in Wickman v. Northwestern National Insurance Co., 908 F.2d 1077 (1st Cir. 1990).

The district court granted National Union's motion for summary judgment, denied Alexandre's motion, and entered a final judgment in favor of National Union on January 20, 2021. In reaching this decision, the district court applied the First Circuit's Wickman framework to find that National Union did not abuse its discretion in determining that Marzuq's death was not an "accident," and was, thus, excluded from coverage under the AD&D Policy. In dicta, the district court also considered the Eleventh Circuit's presumption against suicide, as set forth in Horton, but found it to be overcome.

Alexandre timely filed her notice of appeal on February 18, 2021.

C. Legal Framework

Before we dive into the parties' specific contentions on appeal, we note that "[t]he reader may understand our decision in this case more easily by keeping in mind the following legal background."

Bos. Trading Grp., Inc. v. Burnazos, 835 F.2d 1504, 1507 (1st Cir. 1987). In enacting ERISA, Congress sought to implement "a unified system of federal rules to govern the administration of employee benefit plans."⁶ As such, Congress included a "virtually unique preemption provision," Franchise Tax Bd. v. Constr. Laborers Vacation Tr., 463 U.S. 1, 24 n.26, 103 S.Ct. 2841, 77 L.Ed.2d 420 (1983), that states ERISA "supersede[s] any and all State laws insofar as they ... relate to any [covered] employee benefit plan," 29 U.S.C. § 1144(a).⁷ ERISA "provides an exclusive federal cause of action" for resolving "suit[s] by a beneficiary to recover benefits from a covered plan," Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 62–63, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987), with state common law causes of action preempted, id. at 60, 107 S.Ct. 1542 (citing Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987) ).

Although ERISA is a "comprehensive and reticulated statute," Nachman Corp. v. Pension Benefit Guar. Corp., 446 U.S. 359, 361, 100 S.Ct. 1723, 64 L.Ed.2d 354 (1980), since its inception, both Congress and the Supreme Court have recognized that courts must...