Daniel T. Casey v. Uddeholm Corporation, a New York Corporation and Uddeholm Health Benefits Plan

32 F.3d 1094, 1994 U.S. App. LEXIS 21278, 1994 WL 417306
CourtCourt of Appeals for the Seventh Circuit
DecidedAugust 10, 1994
Docket93-2970
StatusPublished
Cited by84 cases

This text of 32 F.3d 1094 (Daniel T. Casey v. Uddeholm Corporation, a New York Corporation and Uddeholm Health Benefits Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Daniel T. Casey v. Uddeholm Corporation, a New York Corporation and Uddeholm Health Benefits Plan, 32 F.3d 1094, 1994 U.S. App. LEXIS 21278, 1994 WL 417306 (7th Cir. 1994).

Opinions

KANNE, Circuit Judge.

Daniel Casey attempted to commit suicide by throwing himself in front of an elevated train in Chicago on March 6, 1991. Casey survived, but he was severely and permanently injured. This case involves Casey’s attempt to compel his health insurance carrier to pay his medical expenses.

Uddeholm Health Benefits Plan refused to pay Casey’s medical bills because, it claimed, Casey’s injuries were not “sustained accidentally” as his policy required. Casey protested, and a hearing on his case was held before the plan’s administrator. The administrator found against Casey.

Casey then sued under 29 U.S.C. § 1132(a)(1)(B), which allows a beneficiary to [1096]*1096bring a civil suit in federal district court to “enforce his right under the terms” of an insurance benefits plan. Uddeholm moved for summary judgment. Summary judgment was granted in favor of Uddeholm and against Casey, 828 F.Supp. 566. This appeal by Casey followed.

When a district court grants summary judgment in a § 1132(a)(1)(B) action which challenges a denial of benefits based on a plan interpretation, we review that decision de novo. Halpin v. W.W. Grainger Inc., 962 F.2d 685, 688 (7th Cir.1992). Moreover, as in any summary judgment, the moving party must establish in the district court that there is no genuine issue of material fact to be resolved at trial, and that judgment may be entered as a matter of law. If there is any doubt as to whether such an issue of fact exists, the summary judgment motion must fail. Id.

I. Interpretation of the Plan

The Administrator’s Interpretation of the Plan’s Language

The Uddeholm Health Benefits plan provided medical benefits for non-occupational injury. It defined “injury” as “an injury to the body that is sustained accidentally.” It did not define “accidentally.” The plan has nineteen exclusions, but it does not explicitly exclude attempted suicide or intentionally inflicted injuries.

The plan administrator concluded that Casey’s injuries were not accidental because they were the reasonably foreseeable consequence of his actions. Therefore Casey’s claim was not covered. The administrator also rejected the argument that “accidentally” could mean “not intended.”

In reaching these conclusions, the administrator relied on Senkier v. Hartford Life & Accident Ins. Co., 948 F.2d 1050, 1052-53 (7th Cir.1991), for the proposition that a plan’s terms should be interpreted as they would be by a plan participant of average intelligence and experience. The administrator. concluded that an ordinary person employing ordinary usage would not consider an attempted suicide to be an “accident” because an attempted suicide requires purposeful action. Therefore the resulting death or injury would not be considered accidental in ordinary usage.

The District Court’s Review of the Administrator’s Interpretation of the Plan’s Language

■ The benefit plan does not grant discretion to the administrator to construe uncertain terms. Thus, the district court was required to conduct a de novo review when it examined plaintiffs challenge to the plan administrator’s adverse interpretation of the language of the plan. In Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court, in reviewing a case which began its appellate journey through a grant of summary judgment, determined that de novo review applies when federal courts review actions under § 1132(a)(1)(B). Id., 489 U.S. at 116; 109 S.Ct. at 957.

The district court, properly applying a de novo standard of review, rejected the administrator’s interpretation that no injury resulting from a suicide attempt could be accidental as that term is used in the plan. The court relied on Phillips v. Lincoln Nat’l Life Ins. Co., 978 F.2d 302, 311-14 (7th Cir.1992), which held that ambiguous terms in an ERISA plan are to be strictly construed in favor of the insured. A term in an insurance policy is ambiguous if there is “genuine (meaning, substantial) uncertainty, not resolvable by other means” in interpreting the term. Harnischfeger Corp. v. Harbor Ins. Co., 927 F.2d 974, 976 (7th Cir.1991). Further, when construing ambiguous terms “the insured’s proposed reading must be reasonable.” Id.

The district court found that the plain language of the Uddeholm plan was ambiguous and did not mandate the result reached by the administrator. Specifically, (1) the word “accidentally” was not defined, (2) it is not explicit that “accidentally” may not be equated with “unintended” and, (3) the plan did not specifically exclude suicide attempts or self-inflicted injuries.

Therefore, following Phillips, the court concluded that it was possible under a reasonable reading of the plan to find coverage [1097]*1097for Casey. It did so by citing to several cases, Mutual Life v. Terry, 82 U.S. (15 Wall) 580, 591, 21 L.Ed. 236 (1873), Grand Lodge of Illinois, I.O.M.A. v. Wieting, 168 Ill. 408, 419, 48 N.E. 59 (1897), Varley v. General American Life Ins. Co., 664 S.W.2d 682, 683 (Mo.Ct.App.1984), Insurance Co. of North America v. Aufenkamp, 291 Md. 495, 435 A.2d 774, 779 (1981) and a treatise, 10 Couch on Insurance 2d § 41:198 (1982), for the proposition that suieide-while-insane is accidental. The district court also cited to Reinking v. Philadelphia American Life Ins. Co., 910 F.2d 1210, 1214-16 (4th Cir.1990), which examined an insurance plan which specifically excluded coverage for “intentionally self-inflicted injury.” Reinking, following Terry, held that despite this exclusion, a self-inflicted injury was covered by the plan if the person attempting suicide “lacked the capacity for effective choice” or was subject to an “affliction” which gave rise to an “irresistible impulse” to attempt suicide.

Based on this analysis, the district court determined that Casey would prevail if he could show that either (1) “he did not know or understand the nature or quality of his actions,” or (2) that “he was overcome by an irresistible impulse that essentially forced him to jump in front of the train against his will.” The court employed the language used in the cited cases and characterized such a mental state as “insanity.” The district court also emphasized that “a mere attempt to commit suicide, without more, does not evidence insanity.”

The district court found that the administrator’s conclusion, that the language of the policy required it to find that Casey was not covered, was wrong.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Anita Tekmen v. Reliance Standard Life Ins.
55 F.4th 951 (Fourth Circuit, 2022)
Siebert v. Nyhan
N.D. Illinois, 2020
Bunger v. Unum Life Insurance Co. of America
196 F. Supp. 3d 1175 (W.D. Washington, 2016)
Leight v. Union Security Insurance Co.
189 F. Supp. 3d 1039 (D. Oregon, 2016)
Bigham v. Liberty Life Assurance Co.
148 F. Supp. 3d 1159 (W.D. Washington, 2015)
Anderson v. Liberty Mutual Long Term Disability Plan
116 F. Supp. 3d 1228 (W.D. Washington, 2015)
Curtis v. Hartford Life & Accident Insurance
64 F. Supp. 3d 1198 (N.D. Illinois, 2014)
Thornton v. Hamilton Sundstrand Corp.
121 F. Supp. 3d 819 (N.D. Illinois, 2014)
Novak v. Life Insurance Co. North America
956 F. Supp. 2d 900 (N.D. Illinois, 2013)
Rabbat v. Standard Insurance
894 F. Supp. 2d 1311 (D. Oregon, 2012)
Kough v. Teamsters' Local 301 Pension Plan
437 F. App'x 483 (Seventh Circuit, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
32 F.3d 1094, 1994 U.S. App. LEXIS 21278, 1994 WL 417306, Counsel Stack Legal Research, https://law.counselstack.com/opinion/daniel-t-casey-v-uddeholm-corporation-a-new-york-corporation-and-ca7-1994.