Plan Administrator Can Rule Death Was Not Accidental Based Upon Blood Tests Taken At Time of Death

Stamp v. Met. Life, ___F.3d___(1st Cir. June 30, 2008), is an important Employee Benefits decision. The court held that a plan administrator of an employee benefits plan governed under ERISA may reasonably conclude that an insured, killed in a one-car collision with a tree while driving with BAC of 3 times the legal limit, did not die as a result of an "accident" for purposes of his Accidental Death and Dismemberment life insurance policies. This decision spans 35 slip opinion pages, is well reasoned and generated an important dissent.

The majority analysis was as follows:

The Wickman analysis thus began with an inquiry into the
expectations of the insured at the time of the incident that caused
his death. However, this subjective inquiry was not determinative.
We held that even if "the fact-finder determines that the insured
did not expect an injury similar in type or kind to that suffered,
the fact-finder must then examine whether the suppositions which
underlay that expectation were reasonable." Id. at 1088. We
further observed that "'the subjective state of mind of the insured
cannot be generally known.'" Id. at 1087-88 (quoting Hoffman v.
Life Ins. Co., 669 P.2d 410, 419 (Utah 1983)). Thus, in the usual
case, where the fact-finder will find "the evidence insufficient to
accurately determine the insured's subjective expectation," the
fact-finder "should then engage in an objective analysis of the
insured's expectations." Id. at 1088. We framed this objective
analysis as an inquiry into "whether a reasonable person, with
background and characteristics similar to the insured, would have
viewed the injury as highly likely to occur as a result of the
insured's intentional conduct." Id. This reasonable person
analysis, "when the background and characteristics of the insured
are taken into account, serves as a good proxy for actual
expectation." Id.

By contrast, the dissent felt that death caused by driving under the influence of alcohol was the result of an accident because DUI involves accidental or negligent conduct.

Both sides have good arguments. However, it is hard to challenge the rationale of the majority.

Mitchell H. Rubinstein