Drunk Driving Death Not Self-Inflicted Injury

September 1, 2006 (PLANSPONSOR.com) - The US District Court for the Eastern District of Michigan ruled that Metropolitan Life Insurance Co. acted arbitrarily in its decision to refuse benefits to the beneficiary of a plan on the grounds that the plan participant's blood alcohol level was above the legal limit when he was in a fatal car crash.

According to the court opinion, Nancy Lennon filed a suit in November 2005 against MetLife, claiming that she qualified for personal accident insurance benefits because she was the beneficiary under her deceased son’s insurance policy. She claimed that by failing to pay her benefits, the insurance company was in breach of contract, and that the company violated the Employee Retirement Income Security Act (ERISA) by failing to provide her with a summary description of her son’s plan when she asked for it.

David Lennon, Nancy Lennon’s son, was a salaried employee of General Motors Acceptance Corporation for about 13 years. In mid-2003, Lennon died in a car accident, and the medical examiner’s report showed that his blood-alcohol level was three times the legal limit to be driving a car.

According to the MetLife plan, benefits would be paid out if a participant suffered “accidental bodily injuries” and died as a result. According to the opinion, the plan would not award benefits for death caused by suicide, attempted suicide or self-inflicted injury.

As a result, MetLife then denied the mother’s claim for benefits, categorizing her son’s death as “non-accidental, and concluding that injuries leading to death were caused by excessive consumption of alcohol, and were therefore self-inflicted.”

There is a split of legal authority as to whether death occurring when the insured is driving while intoxicated is accidental, with some courts concluding that such deaths are accidental, according to the opinion. The District Court has to decide whether MetLife was arbitrary and capricious in deeming Lennon’s death non-accidental.

In its reasoning, the court said that “the relevant inquiry is not whether a reasonable person views death as a highly likely or inevitable consequence of drunk driving.”

The court found that that MetLife acted in an arbitrary and capricious manner in finding that Lennon’s death was not an accident, because it relied a police report saying he lost control of car and was driving while intoxicated, and that the insurer should not have assumed that death is a reasonably foreseeable driving while intoxicated.

In the opinion, the court said that : “However unlike the Russian roulette player who pulls the trigger of a gun pressed to his or her head, tempting the chance that a bullet is in the firing chamber, the drunk driver does not necessarily expect to die. A person who holds a gun to his or her head and pulls the trigger intentionally chances death. While a driver who consumes alcohol may intentionally impair his or her faculties, one cannot assume that the individual also intends to cause his or her death.”

The court also found that Lennon did not produce enough evidence to counter MetLife’s proof that it provided her with a summary description of the plan.

Lennon v. Metropolitan Life Insurance Co., E.D. Mich., No. 05-73450.