United States District Court, E.D. Michigan, Southern Division
ORDER GRANTING DEFENDANT'S MOTION TO AFFIRM THE
ADMINISTRATOR'S DECISION [DKT. NO. 9], DENYING
PLAINTIFF'S MOTION FOR REVERSAL OF ADMINISTRATIVE DENIAL
OF CLAIM FOR BENEFITS [DKT. NO. 10] AND DISMISSING
PLAINTIFF'S CAUSE OF ACTION
Page Hood Chief Judge.
Robert Smith is an intended beneficiary of his late wife
Debra T. Smith (“Mrs. Smith”) pursuant to the
terms and provisions of the Dependant Life Insurance
(“DLI”) and the Voluntary Accidental Death and
Dismemberment (“AD&D”) Insurance Plan Policy
No. 73903 purchased by his employer FCA L.L.C.
(“FCA”). Following the tragic death of Mrs.
Smith, Plaintiff made a timely claim for disbursement of DLI
and AD&D benefits with the Policy administrator,
Defendant Metropolitan Life Insurance Company (hereinafter
“Defendant”). Defendant paid Plaintiff's
claim for DLI benefits, but denied his claim for AD&D
benefits because of the manner of Mrs. Smith's death.
Plaintiff filed a breach of contract suit in Oakland County
Circuit Court. Defendant removed the case to this Court
because the pertinent issues of Plaintiff's claims are
governed by the Employment Retirement Income Security Act
and Plaintiff filed cross-dispositive motions on February 16,
2017 [Dkt. Nos. 9, 10], and Defendant filed a response to
Plaintiff's motion. The Court, having concluded that the
decision process would not be significantly aided by oral
argument, ordered that the motions be resolved on the motion
and briefs submitted by the parties. E.D. Mich. L.R.
7.1(f)(2). [Dkt. No. 13] For the reasons that follow, the
Court grants Defendant's motion, denies Plaintiff's
motion, and dismisses Plaintiff's cause of action.
participated in the Voluntary Group Accident Insurance
Program (“Plan”) available to FCA employees, and
he insured Mrs. Smith under Dependent Life Insurance
(“DLI”) and Voluntary Accidental Death and
Dismemberment Insurance (“AD&D) policies. Mrs.
Smith died on February 28, 2016. According to the Death
Certificate, Mrs. Smith died after she “Ingested washer
fluid in craving for alcoholic beverage.” [Dkt. No. 9,
Ex. A] The Death Certificate includes a section for
identifying the manner of death, with the following options:
“Accident, Suicide, Homicide, Natural, Indeterminative
or Pending.” Id. The Death Certificate
reflects that the medical examiner determined that Mrs.
Smith's manner of death was “Accident.”
March 15, 2016, Plaintiff applied for DLI and AD&D
benefits under the Plan because of his wife's death. The
Plan defines the eligibility criteria for AD&D benefits
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
If You or a Dependent sustain an accidental injury that is
the Direct and Sole Cause of a Covered Loss described in the
SCHEDULE OF BENEFITS, Proof of the accidental injury and
Covered Loss must be sent to US. When We receive such Proof
We will review the claim and, if We approve it, will pay the
insurance in effect on the date of the injury.
Direct and Sole Cause means that the Covered Loss occurs
within 12 months of the date of the accidental injury and was
a direct result of the accidental injury, independent of
We will deem a loss to be the direct result of an accidental
injury if it results from unavoidable exposure to the
elements and such exposure was a direct result of an
[Dkt. No. 9, Ex. B] The Plan does not define
Plan provides that some events preclude an award of AD&D
benefits. In relevant part, the Exclusions section provides:
We will not pay benefits under this section for any loss
caused or contributed to by:
1. physical or mental illness or infirmity, or the diagnosis
or treatment of such ...