Few things fill a junior associate with more dread than a partner beginning a sentence with the following words: “There must be a case that holds….” Much of the time, there is no such case (especially when the issue concerns some annoying e-discovery dispute that no judge would ever want to write about).
But if a partner says to you, “There must be a case addressing whether an insurance company is liable for accidental death benefits when the decedent accidentally kills himself while engaged in masturbation that involves intentional self-electrocution” — well, now there’s a case that’s on all fours. With an electric cattle prod.
Keep reading, to learn about an ERISA opinion that is very… stimulating….
“Review of plan administrator discretion is like the most boring thing on the face of the planet,” said the tipster who brought this opinion to our attention. So this ERISA ruling, issued earlier today by the U.S. Court of Appeals for the Second Circuit, stands out for having a little sex appeal. (The last time the words “ERISA” and “sex appeal” were used in the same sentence was back in 2006.)
The plaintiff-appellant, Mrs. Martin, sued the Hartford Life and Accident Insurance Company after Hartford refused to pay $81,000 in accidental death benefits related to the death of her husband. According to Hartford, Mr. Martin died during “autoerotic activity” that included “appl[ying] household current to his body through [a] homemade wire and switch device” (a “conclusion that is supported by the administrative record,” as the Second Circuit notes).
Given these facts, Hartford denied coverage based on the plan’s exclusion for “intentionally self-inflicted Injury.” As explained in the Second Circuit’s summary order (i.e., a non-precedential ruling):
In its initial letter denying the claim, Hartford wrote, “[T]he Policy does not cover any loss which is caused or contributed to by a self-inflicted injury. The evidence submitted in support of your claim clearly demonstrates that Mr. Martin’s own volitional acts caused or contributed to the injury which resulted in his death.” Hartford’s letter denying Martin’s appeal stated, “Mr. Martin’s death occurred while participating in an autoerotic activity which was a deliberate act on his part. While he may have previously performed this voluntary act without suffering any harm to himself, he should have known or reasonable [sic] anticipated that injury or death could result from his actions.”
These interpretations of the “intentionally self-inflicted Injury” exclusion would exclude injuries resulting from merely negligent acts, even if the insured did not intend to inflict injury upon himself. And tellingly, the evidence submitted by Martin after receipt of such correspondence from Hartford addressed her husband’s alleged negligence — tending to show, for instance, that he had engaged in similar conduct without apparent injury in the past — rather than the question whether his conduct, whenever undertaken, demonstrated an intent to injure himself.
I’m curious about the correspondence Mrs. Martin submitted to establish “that he had engaged in similar conduct without apparent injury in the past.” The Martins must have had quite a sex life.
Unfortunately for Hartford, its interpretation aroused the Second Circuit’s… ire. Here’s the opinion’s climax (citations omitted):
Interpreting an exclusion for “intentionally self-inflicted Injury” to exclude even negligently self-inflicted injury is an abuse of discretion, and Hartford does not attempt to defend such an interpretation. To the extent that Hartford now offers a different rationale for its denial of Martin’s claim after the completion of the claim’s administrative review, Hartford failed to provide Martin with the “adequate notice . . . setting forth the specific reasons for such denial” and the “full and fair review” to which she is entitled. This change in plan interpretations prevented Martin from developing the administrative record regarding whether her claim falls within Hartford’s new interpretation of the exclusion. “A full and fair review concerns a beneficiary’s procedural rights, for which the typical remedy is remand for further administrative review.” ….
Accordingly, the appropriate course here is to remand the case to the district court with instructions to return the case to Hartford for further proceedings in light of this order.
As the GW Law Revue crew might say, the Second Circuit “pimpslapped Hartford’s ass with they Learned Hand.” I hope that, on remand, Hartford rolls over and coughs up the cash.
(I hate it when insurers try to squirm out of paying on policies. Despite the admittedly lurid details, Mrs. Martin did lose her husband. For the love of God, Hartford, just pay the poor woman. Above the Law readers, if you’re thinking of taking out insurance from Hartford, take note of Mrs. Martin’s struggle to get paid.)
To its credit, the Second Circuit panel — consisting of Judges Debra Ann Livingtson, Gerard Lynch, and Christopher Droney — handled this salacious case with delicacy and restraint. You can read the full opinion here. Pay special attention to footnote 3. It’s not every day that you see parentheticals like this: “holding that an ERISA plan administrator did not abuse its discretion in concluding that the decedent’s death, which resulted from autoerotic asphyxiation, was an intentionally self-inflicted injury.”
We close with a public safety announcement. Readers, you cannot do the electric slide with your private parts.
Masturbation: it’s all fun and games until someone… dies.
Martin v. Hartford Life & Accident Ins. Co.: Summary Order [U.S. Court of Appeals for the Second Circuit]