Wolf v. Life Insurance Company of North America

CourtDistrict Court, W.D. Washington
DecidedMay 25, 2021
Docket3:20-cv-05684
StatusUnknown

This text of Wolf v. Life Insurance Company of North America (Wolf v. Life Insurance Company of North America) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wolf v. Life Insurance Company of North America, (W.D. Wash. 2021).

Opinion

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5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT TACOMA 7 SCOTT C. WOLF, CASE NO. C20-5684 BHS 8 Plaintiff, ORDER ON PARTIES’ CROSS- 9 v. MOTIONS FOR JUDGMENT 10 LIFE INSURANCE COMPANY OF NORTH AMERICA, 11 Defendant. 12

13 This matter comes before the Court on Defendant Life Insurance Company of 14 North America’s motion for judgment under Rule 52, Dkt. 16, and Plaintiff Scott C. 15 Wolf’s motion for summary judgment, Dkt. 17.1 The Court has considered the pleadings 16 filed in support of and in opposition to the motion and the remainder of the file and 17 hereby denies LINA’s motion and grants Wolf’s motion for the reasons stated herein. 18 19 20 21 1 Both Wolf and his deceased son are named “Scott Wolf.” The Court refers to Plaintiff 22 as “Wolf” and his deceased son as “Scott” for clarity. 1 I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY 2 A. Overview 3 Wolf’s son Scott died in a car accident. Scott had consumed alcohol and was

4 driving at high speed the wrong way down a one-way road. He hit a speed bump and lost 5 control of his car. The car hit large rocks on the side of the road and flipped over, landing 6 upside down in the bay adjoining the road. Tragically, Scott drowned. He was 26 years 7 old. 8 Wolf claimed accidental death benefits under his LINA insurance policy. LINA

9 denied benefits, contending that because Scott was intoxicated and driving recklessly, the 10 death was foreseeable and thus not a covered loss. 11 B. Background Wolf has LINA Accidental Death and Dismemberment insurance coverage 12 through his employer. Dkt. 15-1 at 76.2 His son Scott was insured under the policy for 13 $50,000 in AD&D benefits. The policy requires that a “Covered Loss” be “the result, 14 directly and independently of all other causes, of a Covered Accident.” Id. at 181. The 15 policy defines a “Covered Accident” as “[a] sudden, unforeseeable, external event that 16 results, directly and independently of all other causes, in a Covered Injury or Covered 17 Loss.” Id. 18 The car accident at issue occurred at 4:00 am in Clearwater, Florida. Id. at 146. 19 According to two witnesses, Scott was driving at approximately 70–80 miles per hour 20 21 2 Dkt. 15-1 contains the sealed administrative record. The Court cites the ECF page 22 numbering. 1 with his hazard lights on, going the wrong way down a one-way causeway with a posted 2 speed limit of 10 miles per hour. Id. at 114, 148. He hit a speed bump, lost control of the 3 car, overcorrected, and his car left the road and struck tree stumps. Id. at 114, 152. The

4 car then went over large rocks between the road and the bay, striking one and landing 5 upside-down in the water. Id. at 152. Scott was wearing his seatbelt. Id. at 150. A police 6 officer pulled him from the vehicle and gave first aid. Id. He was transported to the 7 hospital where he was pronounced dead. Id. 8 The Hillsborough County Medical Examiner performed an autopsy. Id. at 156.

9 The cause of death was drowning, and the manner of death was “[a]ccident – (Drove 10 automobile off roadway into bay while intoxicated).” Id. Scott had an ocular fluid alcohol 11 level of .17% and a blood alcohol level of .20%. Id. 12 Wolf submitted a claim for accidental death benefits under his insurance policy. 13 Id. at 77–78. LINA denied coverage, concluding that Scott’s death “was a foreseeable

14 outcome of his voluntary actions, and thus, the loss was not a result of a Covered 15 Accident.” Id. at 53. Wolf appealed, contending that if LINA “wanted to exclude 16 coverage for accidental deaths arising from negligent or even reckless conduct on behalf 17 of the deceased they should have stated so in plain English,” and emphasizing that the 18 death certificate indicated death by accident and drowning. Id. at 48.

19 Theodore Siek, Ph.D, a Forensic Toxocologist, reviewed the records for LINA as 20 part of its review of the appeal. Id. at 36. He concluded that Scott’s “driving ability, his 21 attitude about safety, and ability to rescue himself from drowning were all significant 22 factors in his accident and drowning death.” Id. LINA upheld its denial of benefits, 1 explaining that a reasonable person with a background and characteristics similar to 2 Scott’s “would have viewed the resulting death as a probable consequence substantially 3 likely to occur.” Id. at 26–28.

4 Wolf sued LINA for benefits under the Employee Retirement Income Security Act 5 of 1974, 29 U.S.C. §§ 1132(a), (e), (f) and (g). Dkt. 1. Wolf also seeks pre- and post- 6 judgment interest and attorneys’ fees and costs. Id. 7 The parties informed the Court that they would file simultaneous cross-motions 8 and responsive briefs and proposed that the Court’s judgment be entirely on the trial

9 briefs and the Administrative Record. Dkt. 8 at 4. 10 On March 1, 2021, LINA moved for judgment under Federal Rule of Civil 11 Procedure 52, Dkt. 16, and Wolf moved for summary judgment under Federal Rule of 12 Civil Procedure 56, Dkt. 17.3 On March 22, 2021, the parties filed response briefs. Dkts. 13 18, 19. On March 24, 2021, LINA filed a surreply and motion to strike, Dkt. 22, and on

14 March 29, 2021, Wolf filed a brief opposing the motion to strike, Dkt. 23. 15 II. DISCUSSION 16 The parties dispute whether Scott’s death was a “sudden, unforeseeable, external 17 event”—i.e., a Covered Accident. Wolf contends that the majority of ERISA cases 18 holding a death is not accidental are cases where the insured’s conduct amounts to

19 committing or attempting to commit suicide. LINA did not invoke a suicide exclusion. 20

21 3 Though the parties moved under different Federal Rules, they agree that the de novo standard of review for denial of benefits in an ERISA case applies. Firestone Tire & Rubber Co. 22 v. Bruch, 489 U.S. 101, 115 (1989) 1 LINA contends that the great weight of authority “recogniz[es] that the dangers of drunk 2 driving are ‘well known,’ and that deaths occasioned by drunk driving are often not 3 unforeseeable accidents in the AD&D policy context.” Dkt. 19 at 2 (emphasis in

4 original). 5 A. Standard of Review 6 “The district court reviews a challenge to an ERISA plan’s denial of benefits de 7 novo ‘unless the benefit plan gives the administrator or fiduciary discretionary authority 8 to determine eligibility for benefits or to construe the terms of the plan.’” Opeta v. Nw.

9 Airlines Pension Plan for Cont. Emps., 484 F.3d 1211, 1216 (9th Cir. 2007) (quoting 10 Firestone Tire, 489 U.S. at 115). If the plan “confer[s] discretionary authority as a matter 11 of contractual agreement, then the standard of review shifts to abuse of discretion.” 12 Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc) (citing 13 Firestone Tire, 489 U.S. at 115).4

14 The parties agree that de novo review applies here. When de novo review applies, 15 “[t]he court simply proceeds to evaluate whether the plan administrator correctly or 16 incorrectly denied benefits.’” Opeta, 484 F.3d at 1217 (quoting Abatie, 458 F.3d at 963). 17 The difference in the standards is significant. See HCA Health Servs. of Ga., Inc. v. 18 Employers Health Ins. Co., 240 F.3d 982, 994 (11th Cir. 2001), overruled in part on

19 other grounds by Doyle v. Liberty Life Assur. Co. of Bos., 542 F.3d 1352 (11th Cir.

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Wolf v. Life Insurance Company of North America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wolf-v-life-insurance-company-of-north-america-wawd-2021.