Mullaney v. Aetna U.S. Healthcare

103 F. Supp. 2d 486, 25 Employee Benefits Cas. (BNA) 2273, 2000 U.S. Dist. LEXIS 9970, 2000 WL 968472
CourtDistrict Court, D. Rhode Island
DecidedJuly 14, 2000
DocketC.A. 99-0404L
StatusPublished
Cited by19 cases

This text of 103 F. Supp. 2d 486 (Mullaney v. Aetna U.S. Healthcare) is published on Counsel Stack Legal Research, covering District Court, D. Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mullaney v. Aetna U.S. Healthcare, 103 F. Supp. 2d 486, 25 Employee Benefits Cas. (BNA) 2273, 2000 U.S. Dist. LEXIS 9970, 2000 WL 968472 (D.R.I. 2000).

Opinion

OPINION AND ORDER

LAGUEUX, District Judge.

This matter is before the Court on cross motions for summary judgment by plaintiff, Kathleen Mullaney and by defendant, Aetna. This action was brought by Kathleen Mullaney, who claims that Aetna has wrongfully denied her the Accidental Death and Dismemberment (“AD & D”) benefits owed to her by the Electric Boat Corporation Dynaflex Life Insurance and Disability Plans (the “Plans”) following the death of her husband resulting from an automobile collision.

In her Amended Complaint, plaintiff has asserted one count under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(a)(l)(B)(1994)(“ERISA”) for denial of benefits under the relevant plan. Defendant has moved for summary judgment. Plaintiff has also moved for summary judgment on the ERISA claim. Defendant claims that plaintiffs husband was driving while intoxicated, and there *488 fore, his death does not constitute an “accident” under the terms of the Plans. Plaintiff asserts that any death that results from driving while intoxicated is not intended and, thus, is an “accident” under the Plans.

The question before this Court is whether death resulting from driving while intoxicated constitutes an accident under the federal common law that governs ERISA. This Court concludes, based on the undisputed facts of this case, that it does not. For the reasons set forth in this opinion, plaintiffs motion for summary judgment is denied, and defendants motion for summary judgment is granted.

I. Background

The following recitation of facts is not disputed by the parties. Plaintiffs late husband, Michael J. Mullaney, was an employee of the Electric Boat Corporation, a division of General Dynamics. He obtained a Group Accidental Death & Dismemberment Policy (the “Policy”) through his employer, General Dynamics, who maintained the Policy, as part of its overall Insurance Plans, for the benefit of its employees. Defendant, Aetna, served as the Claims Administrator and Group Insurer of the Policy. At the time of Mr. Mulla-neys death, the Policy was in full force and effect. Plaintiff was named as beneficiary of her husbands Policy.

Shortly after midnight on October 25, 1997, Michael Mullaney was driving his 1996 GMC pick-up truck east on Ives Road in Warwick, Rhode Island. He was the sole occupant of the vehicle. Mullaneys vehicle was traveling in excess of the posted 40 m.p.h. speed limit for the area.

Mullaneys vehicle crossed the road, left the pavement, and collided with a tree on the north side of Ives Road. At the time of the incident, the pavement was dry and in excellent repair, and visibility was good. The absence of skid marks on the ground or the pavement, as well as subsequent tests performed by the police on the rear brake lights of Mullaneys vehicle, revealed that Mullaney had made no attempts to apply his brakes before striking the tree.

The collision was so severe that the vehicle’s interior firewall and dashboard were pushed forward to the driver’s seat. As a result of the crash, Mullaney sustained severe trauma and was pronounced dead at the scene. The autopsy revealed that the cause of death was “[mjassive [hjemor-rhage [d]ue [t]o [flransection [o]f [the][a]orta [d]ue [t]o [b]lunt [floree [t]rau-ma.” See Autopsy Report at 9, Muleahy Affidavit, Ex. I. Mullaney also suffered multiple lacerations and fractures of the lower extremities and fractures of the pelvis.

The autopsy report also listed “acute ethanol intoxication” under the heading “Other Significant Findings,” and a toxicology report revealed that at the time of death, Mullaney had a blood alcohol content of 370 mg/dl — nearly four times the legal limit. The medical examiner listed the cause of death as an “accident.” “Accident” was also listed as the cause of death on the Medical Examiner’s Certificate of Death.

Plaintiff sought to collect the amount of $50,000 which she claims is owed to her under the AD & D policy. On August 21, 1998, defendant’s medical consultant wrote a memorandum analyzing the evidence relating to plaintiffs claim. He concluded that plaintiffs husband had been legally intoxicated at the time of the accident. He also noted that, in a person with a blood alcohol level approximating that of Mr. Mullaney, the symptoms that would have been present were “approaching loss of motor functions, markedly decreased response to stimuli, marked muscular incoor-dination, inability to walk or stand, vomiting, incontinence, impaired consciousness, sleep or stupor.” See Interoffice Communication from Bartenstein to Muleahy, Muleahy Affidavit, Ex. J. Defendant’s medical consultant concluded that “acute alcohol intoxication appears to have been a *489 contributing factor” in the motor vehicle incident in which Mullaney died. Id.

In a tactless letter containing unnecessarily lurid details regarding Mr. Mulla-ney’s condition at the time of his death, defendant informed plaintiff that her claim for benefits had been denied. The letter stated: “As a responsible individual, Mr. Mullaney should have been aware of the fact that his alcohol consumption impaired his ability to operate ... his vehicle. In his attempt to drive while intoxicated, he eliminated the elements of an accident from his death.” Letter from Mulcahy to Mullaney of Sept. 11, 1998 at 2, Mulcahy Affidavit, Ex. K.

This letter defined an “accident” as “an unusual, fortuitous, unexpected or un-looked for event occurring by chance or arising from unknown causes” and stated that “an injury is considered accidental if it was not reasonably foreseeable by the insured person.” Id. This definition is contained nowhere in the Plan documents or in the Summary Plan Description (SPD) given to plaintiff.

The document given to plaintiff states only that “benefits will be paid only if the loss results directly from accidental bodily injuries and occurs within 90 days after the date of the accident which caused the loss.” Summary Plan Description at 9, Mulcahy Affidavit, Ex. A. The SPD goes on to state that “no benefits are paid on account of a loss caused or contributed to by” one of four specific exclusions:

1. bodily or mental infirmity, or medical or surgical treatment not made necessary by injuries covered under the plan.
2. disease, ptomaines, bacterial infections.
3. suicide or any attempt thereat, whether sane or insane, or intentionally self-inflicted injuries.
4. war or any act of war ... including resistance to armed aggression.

Id. at 10.

On October 21, 1998, plaintiff requested in writing an administrative review of Aet-na’s decision. In a letter dated November 11,1998, defendant wrote plaintiffs lawyer informing him that the claim was being reviewed. On November 17, 1998, Mary Ellen Kinney, Aetna’s senior medical consultant, wrote Tom Mulcahy, Sr., Investigative Analyst, that she had reviewed the records submitted and that she concurred with the original analysis. On December 18, 1999, defendant wrote to plaintiff stating:

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Bluebook (online)
103 F. Supp. 2d 486, 25 Employee Benefits Cas. (BNA) 2273, 2000 U.S. Dist. LEXIS 9970, 2000 WL 968472, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mullaney-v-aetna-us-healthcare-rid-2000.