Bennett v. American Intern. Life

• Decision Date: 18 February 1997
• Docket Number: No. 95-CV-1730.,95-CV-1730.
• Citation: 956 F.Supp. 201
• Parties: Theresa M. BENNETT, Plaintiff, v. AMERICAN INTERNATIONAL LIFE ASSURANCE COMPANY OF NEW YORK, Defendant.
• Court: U.S. District Court — Northern District of New York

956 F.Supp. 201

Theresa M. BENNETT, Plaintiff, v. AMERICAN INTERNATIONAL LIFE ASSURANCE COMPANY OF NEW YORK, Defendant.

No. 95-CV-1730.

United States District Court, N.D. New York.

February 18, 1997.

Chernin & Gold (John Rittinger, of counsel), Binghamton, NY, for Plaintiff.

Bond, Schoeneck & King (Jonathan B. Fellows, Louis Orbach, of counsel), Syracuse, NY, for Defendant.

MEMORANDUM-DECISION & ORDER

McAVOY, Chief Judge.

I. BACKGROUND

This case concerns a dispute over benefits under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. Specifically, the dispute involves the construction of the term "accident" in an accidental death insurance policy and arises from the death by asphyxiation of Plaintiff's husband. Defendant insurance company declined to pay the policy's benefits after concluding that the death was not accidental.

Timothy J. Bennett was found dead in his hotel room in Gaithersburg, Maryland, on November 16, 1994. The cause of death was determined to be autoerotic asphyxiation. At the time of his death, Mr. Bennett was 32 years old and had been married to Plaintiff for seven years. The Bennett's have three children.

Since 1993, Mr. Bennett had been employed as a Systems Engineer at Loral Corporation. On November 14, 1994, Mr. Bennett, accompanied by a coworker, left the Binghamton area and traveled to Gaithersburg, Maryland on a business trip in connection with their employment at Loral. Mr. Bennett and his coworker, Rosewell Butterworth checked into separate rooms at a Marriott Courtyard Hotel in Gaithersburg.

Mr. Bennett and Mr. Butterworth had dinner together on the evening of November 15, 1994. During this meal, Butterworth observed that Mr. Bennett appeared to be his normal self and did not give any indication of being under stress or depression. (Butterworth Aff. ¶ 5). Butterworth also recalled that Mr. Bennett purchased gifts for his family while on the trip and was looking forward to delivering those gifts when he returned home. (Butterworth Aff. ¶ 5). Also on November 15, 1994, Mr. Bennett made plans to visit an old friend who lived in the area, Ralph Albano, on the evening of November 16, 1994. (Albano Aff. ¶ 4).

The following morning, on November 16, 1994, Butterworth noticed that Mr. Bennett was not in attendance at the Loral Business Center where classes were being conducted. (Pltf.Exh. B). After calling Mr. Bennett's hotel room and receiving no answer, Butterworth went back to the hotel to check on Mr. Bennett; upon returning to the hotel, Butterworth noticed that Mr. Bennett's vehicle was still in the parking lot. (Pltf.Exh. B).

With the assistance of the hotel manager, Butterworth and another coworker knocked on Mr. Bennett's door but received no answer. (Pltf.Exh. B). Because the door was dead bolted from within, a drill was used to disable the dead bolt. (Pltf.Exh. B). Mr. Bennett was found dead in his hotel room bathroom. He was clad in blue and brown pantyhose; his legs were bound together at the ankles with a brown belt, and a blue cloth approximately 5 feet in length with a slip knot was tied to the belt. (Pltf.Exh. C). Mr. Bennett's hands were positioned behind his body and were tied at the wrists by a black belt; a separate blue cloth approximately 4 feet in length was attached to the black belt between his wrists. (Pltf.Exh. C). A brown stocking covered his head, a plastic bag covered the stocking, and a green tie was loosely looped around his head with a slip knot. (Pltf.Exh. C).

The police concluded that Mr. Bennett had been engaged in autoerotic asphyxia, the practice of limiting the flow of oxygen to the brain in an attempt to heighten sexual pleasure, and that his death was an accident. (Pltf.Exh. B). The Post Mortem Report also stated that Mr. Bennett's death was due to asphyxia and that his death was an accident. (Pltf.Exh. C).

At the time of his death, Mr. Bennett was covered by a "Group Travel Policy" provided by his employer, Loral Corporation, as part of an employee welfare benefit plan falling within the ambit of ERISA. The policy was issued by the defendant, American International Life Assurance Company of New York. (Pltf.Exh. A).

Plaintiff, Theresa Bennett, was the decedent's wife and his beneficiary under the policy. Shortly after her husband's death, Mrs. Bennett presented her claim for benefits. By letter dated March 15, 1995, Defendant denied Mrs. Bennett's claim finding that "[t]he circumstances of [Mr. Bennett's] death point to the fact that he was rising his life by his own actions" and explaining that "death cannot be considered accidental if, his conduct was such that he should have anticipated that in all reasonable probability he could die as a result of his actions." (Pltf.Exh. E).

As required by ERISA, Plaintiff appealed the denial to Defendant's ERISA Appeals Committee. By letter dated August 15, 1995, Defendant's ERISA Appeals Committee upheld the denial of Plaintiff's claim. (Pltf.Exh. J). As the basis for the denial, the Appeals Committee letter cited the reasons given in the initial denial letter dated March 15, 1995. No other specific grounds for denial were set forth. (Pltf.Exh. J).

On December 6, 1995, Plaintiff filed the instant complaint alleging that the denial of benefits is a violation of ERISA. Presently before this Court are Plaintiffs' Motion for Summary Judgment and Defendant's Motion for Summary Judgment.

A. Autoerotic Asphyxia

Autoerotic asphyxia refers to the practice of deliberately inducing hypoxia (a state of diminished oxygen supply to the brain) with the intention of producing sexual arousal. (Hucker Aff., Exh. 2). The Diagnostic and Statistical Manual of the American Psychiatric Association (Fourth Edition), known as DSM-IV, refers to "asphyxiophilia" or "hypoxyphilia" as a mental disorder under the general rubric of Sexual Masochism. (Hucker Aff., Exh. 2). The DSM-IV describes the practice as follows:

One particularly dangerous form of sexual masochism, called hypoxyphilia involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical (often a volatile nitrate that produces a temporary decrease in brain oxygenation by peripheral vasodilation). Oxygen-depriving activities may be engaged in alone or with a partner. Because of equipment malfunction, errors in the placement of the noose or ligature, or other mistakes, accidental deaths sometimes occur. Data from the United States, England, Australia, and Canada indicate that one to two hypoxyphilia-caused deaths per million population are detected and reported each year.

DSM-IV § 302.83, at 529.

Plaintiff's expert Stephen Hucker writes that "[t]he prevalence of the behaviour is unknown but, like the present case, most come to light as fatalities." (Hucker Aff., Exh. 2). He goes on to note that "death is due to the failure of some mechanism or strategy that the practitioner thought was fail-safe. Sometimes the devise is quite complex but in others they have simply relied on their subjective awareness of losing consciousness to reverse the process by, for example, grabbing onto nearby supports or extending their legs to reduce the pressure on their neck and thereby avoid a fatal mishap." (Hucker Aff., Exh. 2).

II. DISCUSSION

A. Summary Judgment Standard & Standard of Review

Pursuant to Fed.R.Civ.P. 56(c), a court may grant summary judgment if it appears "that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). Furthermore, it is the substantive law that will determine what facts are material to the outcome of a case. See Anderson, 477 U.S. at 250, 106 S.Ct. at 2511-12.

Initially, the moving party has the burden of informing the court of the basis of its motion. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986). If the moving party satisfies its burden, the burden then shifts to the nonmoving party to come forward with "specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e). The Court must then resolve all ambiguities and draw all reasonable inferences against the moving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986). However, the non-moving party must do more than simply show "that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at 586, 106 S.Ct. at 1355-56. Only when the Court concludes that no rational finder of fact can find in favor of the non-moving party should summary judgment be granted. Gallo v. Prudential Residential Servs., Ltd., 22 F.3d 1219, 1223 (2d Cir.1994).

Furthermore, under ERISA, "a denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989); see also Schultz v. Metropolitan Life Ins. Co., 872 F.2d 676, 678 (5th Cir.1989).

Here, Plaintiff argues, and Defendant does not appear to dispute, that no such grant of authority was included in the instant policy. Thus, this Court will perform a de novo review of Defendant's denial of benefits. Accord, Todd v. AIG Life Ins. Co., 47 F.3d 1448, 1451 (5th Cir.1995)

B. Interpretation of ERISA Regulated Insurance Policies

The instant dispute essentially presents only one issue: whether Tim Bennett's death was an "accident" within the meaning of the Group Travel Accident Policy (the "Policy") issued by Defendant.

The benefit provisions of an ERISA regulated insurance program must be interpreted under principles of federal substantive law. Congress, in...