Horton v. Life Ins. Co. of N. Am., Civil Action No. ELH-14-3

• Decision Date: 30 March 2015
• Docket Number: Civil Action No. ELH-14-3
• Parties: CHERYL HORTON, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.
• Court: U.S. District Court — District of Maryland

CHERYL HORTON, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

Civil Action No. ELH-14-3

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND

March 30, 2015

MEMORANDUM OPINION

Cheryl Horton, plaintiff, and Life Insurance Company of North America ("LINA"), defendant, have filed cross-motions for summary judgment with respect to a dispute concerning a claim for death benefits sought by Ms. Horton as a beneficiary under two group accident insurance policies that are part of a welfare benefit plan subject to the Employee Retirement Income Security Act of 1974 ("ERISA"), codified as amended at 29 U.S.C. §§ 1001 et seq. The insurance policies were issued by LINA to the employer of William G. Sawyers, the decedent and plan participant. Mr. Sawyers was Ms. Horton's domestic partner.

Mr. Sawyers was found dead in the Patapsco River on April 25, 2012, and his sailboat was found floating upside down. See ECF 1 (the "Complaint"). An autopsy of Mr. Sawyers revealed that he had a blood alcohol content of 0.13%. LINA's decision to deny accidental death benefits is premised on an alcohol exclusion in the insurance policies. Id. ¶ 10.

Claiming that LINA unlawfully denied her claim for death benefits, plaintiff filed a "Motion for Summary Judgment" (ECF 15) supported by a memorandum of law (ECF 15-1, "Horton Memo."), and exhibits. See ECF 15-2 through ECF 15-4. ECF 15 and ECF 15-1 shall be referred to collectively as the "Horton Motion." Defendant filed a consolidated "Cross-Motion for Summary Judgment and Opposition to Plaintiff's Motion for Summary Judgment" (ECF 16), inclusive of a memorandum of law ("LINA Motion"). LINA also submitted the Administrative Record for the claim, which exceeds 500 pages. See ECF 16-1.¹ Briefing is complete,² and no hearing is necessary to resolve the motions. See Local Rule 105.6.

In sum, the disposition of this case turns on whether the decedent's alleged intoxication was the cause of his death on or about April 24, 2012, directly or indirectly, in whole or in part. For the reasons that follow, I will deny both motions.

I. Factual Background³

A. The Policies

Mr. Sawyers was forty-three years of age at the time of his death in April 2012. At that time, he was employed as a chemist by Science Applications International Corporation ("SAIC"). ECF 1 ¶ 4, Complaint. Through his employer, id., Mr. Sawyers enrolled in a group accidental death plan funded by two insurance policies. ECF 16-1 at 221, Horton 000221, Group Accident Policy COA 004005; ECF 16-1 at 189, Horton 000189, Group Accident Policy OK819515, (collectively, the "Policies").

The Policies were issued by LINA to its policyholder, the Trustee of the Group Insurance Trust for Employers in the Service Industry (ECF 16-1 at 189, Horton 000189, Group Accident Policy OK 819515; ECF 16-1 at 221, Horton 000221, Group Accident Policy COA 004005), and for the benefit of the employees of SAIC. ECF 1 ¶ 4, Complaint. LINA administers the Policies. Id. ¶ 5. Ms. Horton was the sole primary beneficiary of Mr. Sawyers's Policies. ECF 16-1 at 185, Horton 000185, Beneficiary Designation Form.⁴ She is also the Personal Representative of the Estate of Mr. Sawyers.⁵ See ECF 16-1 at 44, Horton 000044, Letter from David Martino, Esquire, counsel for Ms. Horton, to CIGNA Group Insurance, dated October 18, 2012 ("Martino Letter").⁶

The relevant terms and definitions in the Policies are identical. The Policies provide that LINA "will pay the benefit for any one of the Covered Losses listed in the Schedule of Benefits, if the Covered Person suffers a Covered Loss resulting directly and independently of all other causes from a Covered Accident within the applicable time period specified in the Schedule of Benefits." ECF 16-1 at 210, Horton 000210, Group Accident Policy OK819515; ECF 16-1 at 239, Horton 000239, Group Accident Policy COA 004005.

A "Covered Loss" is defined as follows, ECF 16-1 at 197, Horton 000197, Group Accident Policy OK819515; ECF 16-1 at 227, Horton 000227, Group Accident Policy COA 004005:

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.

The Schedule of Benefits lists "Loss of Life" as a "Covered Loss." ECF 16-1 at 193, Horton 000193, Group Accident Policy OK819515; ECF 16-1 at 225, Horton 000225, Group Accident Policy COA 004005. The Policies define a "Covered Accident" as follows, ECF 16-1 at 197, Horton 000197, Group Accident Policy OK819515; ECF 16-1 at 227, Horton 000227, Group Accident Policy COA 004005:

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 the Policy;

2. is not contributed to by disease, Sickness,⁷ mental or bodily infirmity;

3. is not otherwise excluded under the terms of this Policy.

The Policies also contain "Common Exclusions" that prevent recovery of benefits. Of particular relevance, Common Exclusion No. 10 ("Intoxication Exclusion") states, ECF 16-1 at 203, Horton 000203, Group Accident Policy OK819515; ECF 16-1 at 232, Horton 000232, Group Accident Policy COA 004005:

[B]enefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits Section:

* * *

10. operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant. Under the influence of alcohol, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Accident occurred.

B. The Events of April 24 and April 25, 2012

Mr. Sawyers and Ms. Horton had lived together since 2001. ECF 16-1 at 77, Horton 000077, Affidavit of Cheryl Horton dated September 11, 2012 ("Horton Affidavit") ¶ 4. The couple shared a home in Pasadena, Maryland, purchased by Mr. Sawyers in 2005. Id. ¶ 5.

In the summer of 2011, Mr. Sawyers purchased a SNARK Sunflower sailboat, which was propelled only by sail. Id. ¶ 6. In the Horton Affidavit, Ms. Horton detailed Mr. Sawyers's "long history of sailing." Id. ¶ 4. She said: "As a teenager, and into his early 20s, [Mr. Sawyers] raced Hobie Cats in the Gulf Coast Region of Florida . . . ." Id. Thereafter, "[h]e sailed frequently for most of his adult life" and "countless times" throughout his twelve-year relationship with Ms. Horton. Id.⁸

On Tuesday, April 24, 2012, at approximately 3:30 p.m., Mr. Sawyers called Ms. Horton to inform her that he was "about to set out sailing . . . ." Id. ¶ 7. A boat ramp, located on a nearby community beach, was just a "short walk" from the couple's home. Id. ¶ 5.

Although the couple "regularly" sailed together in the summer, id. ¶ 4, it was not out of the ordinary for Mr. Sawyers to sail on his own. ECF 16-1 at 78, Horton 000078, Horton Affidavit ¶ 7. According to Ms. Horton, Mr. Sawyers "had been out [sailing] alone many, many times before, so [she] was not the least bit concerned" when he informed her that he planned toset sail on his own that afternoon. Id. Typically, these excursions would last "an hour or two." Id. Mr. Sawyers "would sail close to their shorefront home" and only in the "daylight hours" because the boat was "not equipped with a motor and/or navigation lights." ECF 16-1 at 132, Horton 000132, Investigative Report of the Maryland Natural Resources Police dated May 4, 2012 ("Police Report of May 4, 2012").

Ms. Horton described the SNARK Sunflower as a "simple sailboat often used by beginning sailors because the hull is filled with foam that makes it virtually unsinkable, though it can be easily capsized in high winds." ECF 16-1 at 77, Horton 000077, Horton Affidavit ¶ 6. She estimated the hull of the SNARK measured approximately eleven feet and weighed about fifty pounds. Id. The SNARK was equipped with a fifty-five square foot sail and a spar extension (ECF 16-1 at 44, Horton 000044, Martino Letter), which Mr. Sawyers purchased in the summer of 2011 (ECF 16-1 at 77, Horton 000077, Horton Affidavit ¶ 6), from the website sailstogo.com. ECF 16-1 at 44, Horton 000044, Martino Letter. The website indicates that this fifty-five foot sail with a spar extension is "[n]ot for winds above 18 mph." ECF 16-1 at 53, Horton 000053, Sail Boats To Go, http://www.sailboatstogo.com/catalog/PARTS/5011 (Oct. 1, 2012),

Mr. Sawyers sailed the SNARK approximately ten to twelve times during July to October 2011. ECF 16-1 at 77, Horton 000077, Horton Affidavit ¶ 6. But, prior to April 24, 2012, he had not sailed the boat during the 2012 calendar year. Id. According to Ms. Horton, "[w]hen [Mr. Sawyers] went sailing, he always brought a life jacket⁹ with him in the boat (though he would never actually put it on unless the boat would capsize) and a waterproof bag (which contained his cellphone, a towel, and often a sweater)." Id. ¶ 5. But, during the telephone callon the afternoon of April 24, 2012, Mr. Sawyers informed Ms. Horton that he could not find his waterproof bag.¹⁰ Id. ¶ 7. Ms. Horton and Mr. Sawyers conversed about the location of the bag, and eventually Mr. Sawyers found it. Id. According to Ms. Horton, during the call Mr. Sawyers "sounded in good spirits" and "his voice betrayed nothing out of ordinary." Id. That was the last time the two spoke with each other. Id.

Climatological reports taken at the Baltimore-Washington International Airport on April 24, 2012, indicate that wind speeds measured approximately eight to eleven miles per hour from 4:00 p.m. to 7:00 p.m., with the exception of one wind gust of twenty miles per hour, reported at 5:54 p.m. ECF 16-1 at 82, Horton 000082, Quality Controlled...