Judge Overturns Benefits Denial in Accidental Death Case

December 5, 2005 (PLANSPONSOR.com) - A federal judge in West Virginia has thrown out a benefits denial by an accidental death and dismemberment benefit plan administrator who turned down death benefits to the widow after ruling the participant's death was not an accident.

US District Judge Joseph Goodwin of the US District Court for the Southern District of West Virginia said the plan administrator was off base in ruling that participant Earl Eckelberry should have foreseen that he could die when he drove while drunk. Eckelberry’s car struck a parked tractor trailer on the side of the road in March 2004 when his blood alcohol level was .15 percent. According to Goodwin, the administrator’s determination “defies logic.”

Comparing drunk driving to various other situations in which drivers are distracted, such as while talking on cell phones, Goodwin said there was no evidence that such drivers actually expect to die when they act negligently while driving. “[A]lthough a person that gets behind the wheel of a car while intoxicated increases the likelihood of dying in a crash, it is illogical to suggest that the driver reasonably foresaw that result,” Goodwin wrote.

Eckelberry’s widow asked for $86,000 in benefits from his employer’s accidental death and dismemberment benefit plan. The plan administrator, Reliastar Life Insurance Co., turned her down, citing a provision in the plan that defined the term “accident” as “an unexpected and sudden event which the insured does not foresee.” According to the court, Reliastar informed Eckelberry’s widow that her husband had “put himself in a position in which he should have known serious injury or death could occur.”

Eckelberry sued Reliastar under the Employee Retirement Income Security Act (ERISA), arguing that Reliastar had acted unreasonably in denying her claim for benefits.

The court also noted that if it were to find that Eckelberry’s death was not unexpected, then it would open the door for insurers to exclude coverage for any accident in which an insured engaged in some activity that increased the chances of dying. “The fact that negligence or a decision that makes an accident more likely to occur exists does not mean that once the accident occurs, that it was really not an accident,” the court said.

The opinion in Eckelberry v. Reliastar Life Insurance Co., S.D. W.Va., No. 6:04-cv-01185, 12/1/05 is here .