Arnold Ex Rel. Hill v. Hartford Life Insurance

542 F. Supp. 2d 471, 43 Employee Benefits Cas. (BNA) 2227, 2008 U.S. Dist. LEXIS 13484
CourtDistrict Court, W.D. Virginia
DecidedFebruary 21, 2008
DocketCivil Action 7:07CV00093
StatusPublished
Cited by4 cases

This text of 542 F. Supp. 2d 471 (Arnold Ex Rel. Hill v. Hartford Life Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Arnold Ex Rel. Hill v. Hartford Life Insurance, 542 F. Supp. 2d 471, 43 Employee Benefits Cas. (BNA) 2227, 2008 U.S. Dist. LEXIS 13484 (W.D. Va. 2008).

Opinion

MEMORANDUM OPINION

GLEN E. CONRAD, District Judge.

This case arises under the provisions of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). The case involves the plaintiffs claim for mandatory and voluntary Accidental Death and Dismemberment (“AD & D”) benefits from the defendant, Hartford Life Insurance Co., pursuant to the Volvo Welfare Benefit Plan, which included such coverage for the employees of Volvo Trucks North America, Inc., the employer of the plaintiffs deceased father, Arlys Arnold. This case is before the court on the parties’ cross motions for summary judgment. For the reasons set forth below, the plaintiffs motion will be denied, and the defendant’s motion will be granted.

FACTUAL BACKGROUND

In connection with the plaintiffs Motion for Full and Fair De Novo Hearing On the Merits or Opening of Administrative Record, this court previously determined that Arlys Arnold was, in fact, covered by the terms of the Volvo Welfare Benefit Plan (“the Plan”). See Memorandum Opinion dated December 28, 2007. In conjunction with that Plan, the defendant, Hartford Life Insurance Co. (“Hartford”), issued an AD & D Policy (“the Policy”) to Volvo Trucks North America, Inc. (‘Volvo”), the sponsor of both the Policy and the Plan. As the claims administrator under the Plan, Hartford has the discretionary power and authority to make factual findings and to construe the terms of the Policy for the purpose of reviewing and deciding claims under the Plan. Hartford acts as both the claims administrator and the insurer for this employee benefit plan.

Arlys Arnold, the plaintiffs father, worked for Volvo at its plant in Dublin from May 19, 2004 until the date of his death on April 17, 2005. The Policy covered the employees at the Dublin plant, including Arlys Arnold. The Policy includes two types of coverage: (1) a mandatory plan in which the principal sum is 55.5% of the employee’s annual basic rate of pay and (2) a voluntary plan in which employees may apply for an additional principal sum of up to $300,000. The Policy provides as follows:

If a Covered Person’s injury results in any of the following losses within 365 days after the date of accident, we will pay the sum shown opposite the loss.
For Loss of:
Life.The Principal Sum

See Defendant’s Memorandum of Law in Support of Motion for Summary Judgment, Exhibit A to Exhibit 1 (“AR”) p. HL *474 000020. Injury is defined in the Policy as follows:

Injury means bodily injury resulting directly and independently of all other causes from accident which occurs while the Covered Person is covered under this policy. Loss resulting from:
a) sickness or disease, except a pus-forming infection which occurs through an accidental wound; or
b) medical or surgical treatment of a sickness or disease;
is not considered as resulting from injury.

AR p. HL 000015. The term “accident” is not defined in the Policy. The Policy also contains the following relevant exclusion:

This policy does not cover any loss resulting from:

1. intentionally self-inflicted Injury, suicide or attempted suicide, whether sane or insane; ...

AR p. HL 000019. In addition to the mandatory benefits for which he was automatically eligible, Arlys Arnold requested the voluntary accidental death and dismemberment benefits available under the Policy in the amount of $300,000, and named the plaintiff as his primary beneficiary.

On April 17, 2005, Arlys Arnold attended a party in Max Meadows, Virginia. Upon leaving the gathering, Arlys Arnold drove his pickup to a grocery store located nearby. At the grocery store, he met James Dalton and apparently borrowed Dalton’s motorcycle. After leaving the store on the motorcycle, Arlys Arnold left the road on a level curve, went down an embankment, and struck a tree. Arlys Arnold died at the scene of this crash. According to the death certifícate issued by the Commonwealth of Virginia, the immediate cause of death was a closed head injury with cervical spine fracture. AR p. HL 000097.

The police crash report indicates that the crash took place at approximately 8:05 in the evening on a dry roadway. AR p. HL 000095. The weather was clear, although the light condition was noted as dusk. Id. There were no visible skid marks at the scene of the crash. Id. The police crash report also noted that Arlys Arnold had been drinking, resulting in impaired ability. Id. Furthermore, he had been traveling at 65 miles per hour at the time of the crash, although the speed limit was 55 miles per hour and the maximum safe speed, according to the police, was 35 miles per hour. Id.

On or about May 2, 2005, Tina Hill, the mother of Cassidy Arnold, completed claim forms for AD & D benefits under the terms of the Policy on behalf of her daughter. During its evaluation of the plaintiffs claim, Hartford requested a copy of the toxicology report for Arlys Arnold. The certificate of analysis from the Division of Forensic Science indicated that Arlys Arnold’s blood alcohol level was 0.18%. AR p. HL 000081.

On August 23, 2005, Hartford denied the plaintiffs claim, stating that Arlys Arnold’s death was not due to an “injury” as defined by the Policy. In support of its decision, Hartford noted Arlys Arnold’s blood alcohol level as indicated in the toxicology report and stated that:

According to the Policy, we will pay a benefit when bodily injury results directly from an accident and independently of all other causes. We do not interpret the word “accident” to include circumstances where it is reasonably foreseeable that death will occur. Accidents, by nature, are unforeseeable events. It is a well known fact that driving while intoxicated can cause serious bodily injury or death. For instance, alcohol affects a person’s ability to function, drive, or use machinery. It is our opinion that *475 Mr. Arnold having ingested the quantity of alcohol that would result in a blood alcohol level of 0.18%, should have reasonably foreseen that such actions may result in a severe injury or death, even if death was not intended. The assumption of a known risk by the insured does not constitute an “Accident” under the terms of the Policy, and the result of that assumption, death in this circumstance, does not constitute a covered “injury” under the terms of the Policy.

AR p. HL 000063-64. Hartford also stated, as a second basis for its denial, that: “The ‘self-inflicted’ injury exclusion is applicable since Mr. Arnold’s own volitional act of driving a motorcycle while legally intoxicated caused the injury.” AR p. HL 000064.

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Bluebook (online)
542 F. Supp. 2d 471, 43 Employee Benefits Cas. (BNA) 2227, 2008 U.S. Dist. LEXIS 13484, Counsel Stack Legal Research, https://law.counselstack.com/opinion/arnold-ex-rel-hill-v-hartford-life-insurance-vawd-2008.