Danouvong v. Life Ins. Co. of North America

• Decision Date: 30 September 2009
• Docket Number: Civil No. 3:08cv667 (JBA).
• Citation: 659 F.Supp.2d 318
• Court: U.S. District Court — District of Connecticut
• Parties: Sisavang DANOUVONG, Administratrix of the ESTATE OF Sang DANOUVONG, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

Page 318

659 F.Supp.2d 318

Sisavang DANOUVONG, Administratrix of the ESTATE OF Sang DANOUVONG, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

Civil No. 3:08cv667 (JBA).

United States District Court, D. Connecticut.

September 30, 2009.

COPYRIGHT MATERIAL OMITTED

Michael A. Stratton, Stratton Faxon, New Haven, CT, for Plaintiff.

James E. Hennessey, Jeffrey Mueller, Joseph Kevin Scully, Day Pitney LLP, Hartford, CT, for Defendant.

RULING ON CROSS-MOTIONS FOR JUDGMENT ON THE ADMINISTRATIVE RECORD [Doc. # 18, 27]

JANET BOND ARTERTON, District Judge.

Plaintiff Sisavang Danouvong, the daughter of decedent Sang Danouvong and administratrix of his estate, brings suit against Defendant Life Insurance Company of North America ("LINA") challenging LINA's denial of a claim for benefits under a Group Accident Policy (the "Policy"). The insurance plan, provided through the decedent's former employer, is governed by the Employee Retirement Income Security Act of 1974 (ERISA), as amended, 29 U.S.C. §§ 1001 et seq. The parties have cross-filed for "judgment on the administrative record." For the reasons stated below, Defendant's motion will be denied and Plaintiff's motion will be granted in part to order remand with instructions but not to award benefits due under the policy or attorney's fees or costs.

I. Background

The Administrative Record,¹ which the parties have agreed provides the basis for the Court's decision, reveals the following.

A. Collision Leading to Decedent's Death

Early in the morning on Saturday, August 19, 2006, construction work was ongoing in the left lane on the westbound side of Boston Avenue at North Hallett Street in Bridgeport, various construction zone warnings—including at least seven signs set up over the course of approximately one mile and at least a quarter-mile of reflective cones directing westbound traffic into the right lane-had been set up on Boston Avenue east of the construction site, and a dump truck was facing east in the left lane with its headlights and flashing lights activated. (LINA 319, 364, 366, 391, 406-07, 417-19.) At approximately 1:20 a.m., Mr. Danouvong, driving west on Boston Avenue in a Dodge Caravan "at a high rate of speed," entered the left lane and, without taking any "avoidance maneuver[s]," collided "head on" with the dump truck. (Id.; see also Pl.'s Mem. Supp. J. at 2-3.) Emergency response and medical personnel responded to the scene and brought Mr. Danouvong to Bridgeport Hospital, but shortly after reaching the hospital Mr. Danouvong died from the "multiple blunt force traumatic injuries" he suffered during the collision. (Id. at 319, 391, 417-19.) At the time of his death, the decedent had cirrhosis of the liver, was experiencing "acute ethanol intoxication," and had a Blood Alcohol Content ("BAC") of between 0.26 and 0.27 percent. (Id. at 383-84, 419.)

At oral argument Plaintiff conceded that the collision would not have occurred had the decedent not been drunk and agreed that it was impossible to determine the decedent's subjective mindset prior to the collision.²

B. Insurance Policy

LINA underwrote the Policy under which the decedent was insured. (See LINA 001-036.) This Policy provided a benefit of "100% of the Principal Sum"—calculated by reference to the insured's annual compensation—for any "Loss of Life" determined to be a "Covered Loss." (LINA 006, 008.) A "Covered Loss" is defined by the Policy to be

[a] loss that is all of the following:

1. the result, directly and independently of all other causes, of a Covered Accident;

2. one of the Covered Losses specified in the Schedule of Covered Losses;

3. suffered by the Covered Person within the applicable time period specified in the Schedule of Benefits.

(LINA 012.) The parties agree that Mr. Danouvong's death qualifies under the second and third portions of the Policy's definition of a "Covered Loss," but dispute whether his death is "the result, directly and independently of all other causes, of a Covered Accident." The Policy defines a "Covered Accident" to be

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.

(Id.) While some of the terms in the definition of "Covered Accident" are further defined in the Policy, the Policy does not define "unforeseeable," which is the term critical here.

C. Benefits Claim and Denial

Mr. Danouvong designated three of his children, including Plaintiff, as his beneficiaries. (LINA 296.) On August 25, 2006, Mr. Danouvong's former employer submitted a claim for benefits in the amount of $119,000 on behalf of one of Mr. Danouvong's beneficiaries. (See LINA 287-315.) On May 1, 2007, LINA denied this claim for benefits in a letter that listed and summarized the "[e]vidence [e]valuated"— which included the "[p]olice [c]rash [r]eport"—and stated:

We have confirmed that Mr. Danouvong's blood alcohol level was .26%. This data shows that his blood alcohol level was over three times the DUI limit for the state of Connecticut which is .08%. We have determined that the crash does not meet the definition of Covered Accident.

As stated above, a Covered Accident must be an unforeseen event. The hazards of driving while intoxicated are widely known and publicized. It is also well-known in the general public that driving while intoxicated could result in bodily harm or death.

(LINA 201-04.) The letter also suggested that in the alternative, Mr. Danouvong's death fell within an exclusion for "intentionally self-inflicted [i]njur[ies]." (Id.)

On October 30, 2007, having been appointed the administratrix of Mr. Danouvong's estate and having obtained counsel, Plaintiff sought reconsideration of the May 1st denial, arguing both that Mr. Danouvong's death was not an intentionally self-inflicted injury and also that while the Policy does not define the term "unforeseeable," under a dictionary definition of "foreseeable" Mr. Danouvong's death was "unforeseeable" because "it cannot reasonably be asserted that death as a result of driving while intoxicated is `certain' or `unavoidable.'" (LINA 193-94 (quoting "Webster's").) Two months later, on December 27, 2007, then-counsel for Plaintiff submitted Mr. Danouvong's medical records and "supplement[ed]" the October 30th letter in order to reference a District of Connecticut case that had ruled a decedent—insured's drunk driving death to be accidental, see Glynn v. Bankers Life & Cas. Co., 432 F.Supp.2d 272 (D.Conn.2005), and to invoke the principle that courts in the Second Circuit "construe[] ambiguities in Plan language against the drafter." (LINA 050-52; id. at 053-186 (cases and medical records submitted).)

LINA construed the October 30th and December 27th letters as appeals from the May 1st denial of benefits, and denied the appeal on February 11, 2008. In the denial-of-appeal letter, LINA stated that it reviewed, inter alia, the Police Accident Report, the Autopsy and Toxicology Report from the Office of the Chief Medical Examiner, the October 30th and December 27th letters, and the supplemented medical records of Mr. Danouvong. (LINA 043-47.) Like the May 1st letter, the February 11th letter summarized the evidence, including the medical records' documentation of "a history of alcohol abuse by Mr. Danouvong," and concluded that Mr. Danouvong's apparent alcoholism rendered his death within the exclusion for deaths caused by sickness or disease. (LINA 045.) The letter also noted that "[o]n May 1, 2007, this claim was denied based upon the fact that Mr. Danouvong's motor vehicle crash was the result of his intoxication. Based upon this fact, Mr. Danouvong's death was foreseeable in nature, and thus not the result of an accident as required by the [P]olicy." (Id.) It then addressed Plaintiff's arguments on appeal. It rejected application of the contra proferentem doctrine in light of the Policy's grant of discretion to the Plan Administrator as well as Plaintiff's argument that deaths from drunk-driving-related vehicle collisions are not per se foreseeable:

The dangers of drinking and driving are well known and widely publicized. In addition, driving under the influence of alcohol constitutes criminal conduct in all 50 states, including the State of Connecticut. All licensed motorists are aware that such conduct violates the law and is subject to criminal punishment. The Legislature of the State of Connecticut, in criminalizing Driving under the Influence, has declared such conduct to represent a recognized and unacceptable danger to the motoring public and to the citizens of Connecticut. The insured, as a licensed driver in the State of Connecticut, is charged with this knowledge. In addition, administratively, a DUI conviction for a BAC level above .16% carries an enhanced DMV administrative license suspension. . . . This enhanced penalty is a further reflection of the State of Connecticut's disapproval for conduct involving vehicular operation with dangerously high BAC levels. Thus, loss which is resultant of impaired vehicle operation, as is the case in Mr. Danouvong's motor vehicle crash based upon the opinions of the Bridgeport Police Department and the Medical Examiners Office, does not meet the required definition of Covered Accident in the [P]olicy. As such, no benefits are payable under [the][P]olicy.

. . . We trust your review of the federal common law of ERISA will reveal that DUI related deaths in the [Accidental Death and Dismemberment] context have been routinely determined by the federal appellate courts addressing the issue to be "non-accidental" in nature.

With regard to your assertions surrounding the term "unforeseeable" as referenced in the [P]olicy, LINA...