U.S. District Judge Marcia S. Krieger of the U.S. District Court for the District of Colorado ruled that the July 2004 car crash in which Mark LaAsmar died was considered an “accident.”
The decision was a difficult one because the plan document for the life insurance and accidental death and dismemberment plansmaintained by the LaAsmar’s employer did not explicitly define “accident,” Krieger claimed.
“In the absence of a definition in the Plan, this Court is compelled to conclude that a reasonable person in Mark LaAsmar’s position would have understood the term “accident” in a motor vehicle context to simply refer to an event involving the vehicle, not the cause or forseeability of the event,” Krieger wrote. “Thus, under the Plan, the Court concludes that the rollover of Mark LaAsmar’s vehicle was an “accident.” â€¦ One might speculate that Mark LaAsmar’s intoxication was related to the accident, but there is no evidence in the administrative record to establish that it caused either the accident or Mark LaAsmar’s death. Thus Mark LaAsmar’s death is an injury for which accidental death benefits must be paid.”
MetLife, which administered the plans for LaAsmar’s employer paid LaAsmar’s parents $96,000 in life insurance benefits but refused to pay accidental death and dismemberment benefits because they are barred under a plan provision denying benefits for self-inflicted injuries.
“The Court finds that this exclusion has no apparent application,” Krieger asserted. “The plain language of the exclusion addresses conduct which is undertaken with the specific purpose to harm oneself. There is nothing in the record which establishes that Mark LaAsmar either consumed alcohol or drove thereafter with the specific intent to harm himself. One might easily judge Mark LaAsmar’s conduct to be reckless and unlawful, but absent evidence of his intent to injure himself, this exception does not apply.”
The case is LaAsmar v. Phelps Dodge Corp. Life, Accidental Death & Dismemberment and Dependent Life Insurance Plan, D. Colo., No. 06-cv-00013-MSK-MJW, 6/1/07).