Riggs v. Metropolitan Life Insurance

940 F. Supp. 2d 172, 56 Employee Benefits Cas. (BNA) 2793, 2013 WL 1694445, 2013 U.S. Dist. LEXIS 55539
CourtDistrict Court, D. New Jersey
DecidedApril 18, 2013
DocketCivil Action No. 11-3455
StatusPublished
Cited by3 cases

This text of 940 F. Supp. 2d 172 (Riggs v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Riggs v. Metropolitan Life Insurance, 940 F. Supp. 2d 172, 56 Employee Benefits Cas. (BNA) 2793, 2013 WL 1694445, 2013 U.S. Dist. LEXIS 55539 (D.N.J. 2013).

Opinion

OPINION

RODRIGUEZ, Senior District Judge.

This case concerns the tragic death of Mr. Terry Riggs. Plaintiff Argia Riggs, Mr. Riggs’ wife, brought this suit pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., challenging Defendant Metropolitan [174]*174Life Insurance Company’s (“MetLife”) denial of her application for optional life insurance benefits following the death of her husband based on the insurance policy’s “suicide clause.” Before the Court are the parties’ Cross-Motions for Summary Judgment [Dkts. 11, 15]. Ms. Riggs argues that the Court should grant summary judgment in her favor and reverse Met-Life’s decision because the claim administrator abused her discretion when applying the “suicide clause,” as Mr. Riggs’ death was not a “suicide” under the meaning of the insurance policy. MetLife argues that the Court should grant summary judgment in its favor and uphold the claim administrator’s decision because the claim administrator did not abuse her discretion in denying the claim.

The Court considered the parties’ initial submissions and, on June 20, 2012, dismissed without prejudice the parties’ Cross-Motions and gave the parties leave for simultaneous briefing on the definition of “suicide.” The Court has considered the arguments presented by the parties’ supplemental submissions as well as those advanced during oral argument on December 12, 2012. For the reasons stated below, the Court must deny Ms. Riggs’ Motion for Summary Judgment [Dkt. 11] and grant MetLife’s Cross-Motion for Summary Judgment [Dkt. 15].

I. Jurisdiction

This Court has subject matter jurisdiction over this ERISA action pursuant to 28 U.S.C. § 1331. Venue is proper in this Court under 28 U.S.C. § 1391(b).

II. Factual and Procedural History

The facts presented herein are based on the undisputed administrative record1 attached as Exhibit A to Ms. Riggs’ Motion for Summary Judgment, which includes: the NuStar Life Insurance Plan (ML 0001-0058); several Life Insurance Claim Forms and related documents, including the denial letters and copies of Mr. Riggs’ Certificate of Death (ML 0059-0093); Dr. Ronald Maris’ curriculum vitae (ML 0096-0134) and report (ML 0135-0155); Notes from Mr. Riggs’ treating physician (ML 0156-0160); MetLife’s Senior Referral Form used in Ms. Riggs’ appeal of her benefits denial (ML 0161-0163); a letter from MetLife’s Senior Claim Examiner, Group Life Claims Options, addressed to Ms. Riggs’ attorney responding to her attorney’s request for review of the denial of the claim (ML 0164-0165), and a form notifying an Account Manager that Ms. Riggs’ claim was denied (ML 0166).

The events prior to Mr. Riggs’ death are as follows. Dr. Maris’ report indicates [175]*175that for few years prior to 1991, Mr. Riggs took Zoloft, an antidepressant. (ML 0137) On November 17, 2009, Dr. John Wilkes, M.D., gave Mr. Riggs Ability, an antipsychotic. (ML 0137) Because Ability made Mr. Riggs feel “too lethargic,” on March 9, 2010, Mr. Riggs was prescribed Zyprexa, an antipsychotic. (ML 0160; ML 0137) After taking Zyprexa for three days, he told Ms. Riggs that he heard “uncontrollable thoughts and voices” and “it made him feel like killing himself.” (ML 0137) On Monday, March 15, 2010, Mr. Riggs called his physician, who prescribed Cymbalta, an SNRI antidepressant, and was told to visit the ER if he continued to feel suicidal. (ML 0137) That evening, Mr. Riggs telephoned a family friend and told her that he had negative thoughts, could not concentrate, and “heard voices telling him to kill himself.” (ML 0138).

At approximately 5:30 a.m. during the morning of March 17, 2010, when Ms. Riggs was preparing to take a shower, she heard a “bang.” (ML 0136) She returned to the master bedroom and found Mr. Riggs bleeding on the floor. (ML 0136; ML 0138) He shot himself in the head with a gun that he had kept under his bed for the previous 19 or more years. (ML 0137) Ms. Riggs called 911 and the emergency responders transported Mr. Riggs to Cooper Hospital in Camden, NJ, where he died approximately five hours later. (ML 0136-37) There was no toxicology report and his body was cremated. (ML 0137).

At the time of his death, Mr. Riggs worked as a maintenance mechanic for NuStar Gp, LLC (“NuStar”) and participated in the NuStar life insurance plan (“the Plan”). (ML 0059-0072; ML 0138) The Plan is funded by a policy of group life insurance issued by MetLife to NuS-tar. (ML 001-0058) Following Mr. Riggs’ death, NuStar submitted an Employer’s Statement to MetLife, indicating the following: Mr. Riggs died on March 17, 2010; Mr. Riggs last worked on March 16, 2010; Mr. Riggs was eligible for basic life insurance in the amount of $5,000 effective April 1, 2008, and Mr. Riggs’ base annual salary was $65, 166.40. (ML 0059-0060; ML 0068-0069) NuStar also submitted a Benefit Enrollment Confirmation form, which stated that Mr. Riggs was enrolled for four times his base benefit salary, or $261,000, in optional life insurance benefits. (ML 0073) Additionally, MetLife received a Beneficiary Designation form, indicating that Mr. Riggs’ primary beneficiary was Ms. Riggs, who was eligible to receive 100% of the benefits. (ML 0061).

On May 15, 2010, Ms. Riggs applied to MetLife for life insurance benefits under the Plan. (ML 0064-0066) In a letter dated July 14, 2010, MetLife denied her claim for benefits. (ML 0091) MetLife explained that page 49 of the Plan states:

Suicide
If You commit suicide within 2 years from the date Life Insurance for You takes effect We will not pay such insurance and Our liability will be limited as follows:
• any premium paid by You will be returned to the Beneficiary; and
• any premium paid by the Policyholder will be returned to the Policyholder

(ML 0091) MetLife explained that Mr. Riggs enrolled for Optional Life Insurance on April 1, 2008 and that the Certificate of Death issued by the State of New Jersey states that he died on March 17, 2010 as a result of “gunshot wound to head,” that Mr. Riggs “shot self,” and that the manner of death was “suicide.” (ML 0092) Accordingly, MetLife stated that it denied the claim, as Mr. Riggs “died within 2 years of the effective date as a result of suicide.” (ML 0092).

[176]*176By way of correspondence dated February 17, 2011, Ms. Riggs appealed MetLife’s claim determination. (ML 0095-0160) To support her appeal, she submitted the following documents: medical records from Mr. Riggs’ psychiatrist; the thirty-eight page curriculum vitae of Dr. Ronald Maris, a board-certified forensic suicidologist; and a report issued by Dr. Maris that reviews Mr. Riggs’ case. (ML 0095-0160).

Dr. Maris’ report indicated that “to be classified and certified as a ‘suicide’ requires both the intent and motivation to suicide,” and that “it is well-known that antipsychotics (like Zyprexa and Ability) and antidepressants (like Cymbalta and Zoloft) have side-effects that are associated with increased suieidality.” (ML 0138-0140) Dr. Maris opined that Mr.

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Bluebook (online)
940 F. Supp. 2d 172, 56 Employee Benefits Cas. (BNA) 2793, 2013 WL 1694445, 2013 U.S. Dist. LEXIS 55539, Counsel Stack Legal Research, https://law.counselstack.com/opinion/riggs-v-metropolitan-life-insurance-njd-2013.