Cozzie v. Metropolitan Life Insurance

963 F. Supp. 647, 1997 U.S. Dist. LEXIS 15319, 1997 WL 235492
CourtDistrict Court, N.D. Illinois
DecidedMarch 20, 1997
Docket95 C 4235
StatusPublished
Cited by3 cases

This text of 963 F. Supp. 647 (Cozzie v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cozzie v. Metropolitan Life Insurance, 963 F. Supp. 647, 1997 U.S. Dist. LEXIS 15319, 1997 WL 235492 (N.D. Ill. 1997).

Opinion

ORDER

ANN CLAIRE WILLIAMS, District Judge.

Magistrate Judge Rebecca R. Pallmeyer has issued a Report and Recommendation (“R & R”) recommending that this court *648 grant defendant’s motion for summary judgment and deny plaintiffs motion for summary judgment

Plaintiff Terry L. Cozzie objects that Judge Pallmeyer improperly applied the “arbitrary and capricious” standard (for several reasons), and that the decision of Defendant Metropolitan Life Insurance Company (“MetLife”) was arbitrary and capricious (for several reasons). After carefully reviewing the R & R, the factual record, and Cozzie’s arguments, the court overrules Cozzie’s objections, finding that Judge’s Pallmeyer applied the appropriate standard and reached the proper result.

MetLife objects to two relatively minor aspects of the R & R. The court overrules MetLife’s objection to footnote five of the R & R, because the footnote is supported by the record, makes logical sense, and (in any event) has no bearing on the outcome of this case. However, the court agrees with Met-Life’s “ministerial” objection to footnote six of the R & R because McLain v. Metropolitan Life Ins. Co., 820 F.Supp. 169 (1993) involved cocaine (as the R & R correctly states in the text on page 13), not codeine (as the R & R incorrectly states in a parenthetical in footnote six). Therefore, footnote six should be corrected so that the McLain parenthetical refers to cocaine rather codeine.

In conclusion, the court overrules Cozzi’s objections, overrules MetLife’s first objection, grants MetLife’s second objection, adopts the R & R in full with one extremely minor correction, denies Cozzi’s motion for summary judgment, and grants MetLife’s motion for summary judgment.

REPORT AND RECOMMENDATION

PALLMEYER, United States Magistrate Judge.

Plaintiff Terry Cozzie brought this action against Defendant Metropolitan Life Insurance Company (“MetLife”) alleging wrongful denial of accidental death benefits under an Ameritech Company (“Ameritech”) employee welfare benefit plan, funded in relevant part by a group life insurance policy issued by MetLife. On June 21, 1995, Plaintiff filed a complaint in the Circuit Court of Cook County seeking state law contract and exemplary damages. Because the policy in question is regulated by the Employment Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001-1461, Defendant removed the case to federal court pursuant to 28 U.S.C. § 1441 and 1331. On September 14, 1995, Plaintiff filed an amended complaint adding allegations of ERISA violations and seeking contract, exemplary, and punitive damages.

Both parties filed cross-motions for summary judgment on July 10, 1996, and on August 1, 1996, the case was referred to this court pursuant to 29 U.S.C. § 636(b). Plaintiff argues that she is entitled to the accidental death benefits from her late husband’s policy because the insurance plan contains ambiguous language that must be construed in favor of coverage. Alternatively, Plaintiff insists that Defendant’s decision to deny the benefits was arbitrary and capricious. Defendant, on the other hand, claims that it reasonably concluded that the decedent’s death was not accidental as contemplated by the plan and was, therefore, specifically excluded from coverage. For the reasons set forth below, Plaintiffs motion for summary judgment should be denied and Defendant’s motion should be granted.

FACTUAL BACKGROUND 1

On November 6, 1994, Robert Cozzie (the “decedent”) died as a result of a single car crash in Putnam County, Illinois. (The Parties’ Joint Local Rule 12(M) Statement of *649 Material Facts as to Which There is No Genuine Issue (hereinafter “Jt. 12(M) Statement”) ¶ 2; Ex. B to Jt. 12(M) Statement, at 46, 49.) According to the investigating officer, the decedent drove his vehicle off a rural highway after missing a curve in the road. (Ex. B to Jt. 12(M) Statement, at 33-34.) The vehicle traveled down a ditch, struck an embankment, and rolled over approximately three times, ejecting the decedent from the driver’s seat and pinning him underneath the vehicle. (Id. at 34.) The pressure of the ear on his chest rendered Mr. Cozzie unable to breathe, and he died of asphyxiation. (Id. at 34, 49.) Toxicology tests performed a short time after the crash revealed that the decedent’s blood alcohol content (“BAC”) was 0.252 percent, more than two and a half times the legal limit under Illinois law. 2 (Id. at 35.)

At the time of his death, the decedent was an employee of Ameritech and a participant in the Ameritech Life Insurance Program (the “Plan”). (Jt.l2(M) Statement ¶ 1; Ex. A to Jt. 12(M) Statement, at 22.) The Plan is an employee welfare benefit plan regulated by ERISA and funded primarily by a group life insurance policy issued by MetLife, the Plan’s claim fiduciary. (Jt.l2(M) Statement ¶ 1.) Under the Plan’s Basic Life Coverage, an employee’s beneficiaries receive payments when the employee dies (from any cause) while covered by the program. (Ex. A to Jt. 12(M) Statement, at 7.) Additional coverage is also provided under the accidental death and dismemberment provisions (“AD & D”) where death results from injuries caused solely by an accident. (Id. at 8.) These benefits are paid if “the employee [dies] ... while insured and as a direct result of the accident and independently of all other causes.” (Id. at 9.) Accidental death benefits are not available, however, where death is caused by injuries that were “purposely self-inflicted.” (Id.)

The decedent was enrolled in both of these plans (Basie Life and AD & D) in the amount of $42,000 each. He designated his wife, Plaintiff Terry Cozzie, as the beneficiary. (Jt.l2(M) Statement ¶2.) After his death, Plaintiff submitted a claim for benefits under each policy. (Id.) Shortly after receiving Plaintiffs claim on January 3, 1995, MetLife paid her $42,000 in basic life insurance benefits plus applicable interest. (Id.; Ex. B to Jt. 12(M) Statement, at 50-51.) On or about March 15, 1995, however, MetLife notified Plaintiff that her claim for accidental death benefits was denied. (Jt.l2(M) Statement ¶ 5.)

MetLife’s explanation of the decision to deny Plaintiff AD & D benefits was two-fold. Defendant first reasoned that “the act of driving while so impaired rendered the infliction of serious injury or death reasonably foreseeable and, hence, not accidental as contemplated by the Plan.” (Ex. B to Jt. 12(M) Statement, at 2, 26.) In addition, MetLife concluded that the physical and mental impairments caused by the decedent’s alcohol consumption were “injuries intentionally self-inflicted” and, therefore, specifically excluded from AD & D coverage. (Id.)

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Cite This Page — Counsel Stack

Bluebook (online)
963 F. Supp. 647, 1997 U.S. Dist. LEXIS 15319, 1997 WL 235492, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cozzie-v-metropolitan-life-insurance-ilnd-1997.