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COZZIE v. METROPOLITAN LIFE INS. CO.

February 14, 1997

TERRY L. COZZIE, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.



The opinion of the court was delivered by: PALLMEYER

 Plaintiff Terry Cozzie brought this action against Defendant Metropolitan Life Insurance Company ("MetLife") alleging wrongful denial of accidental death benefits under an Ameritech Company ("Ameritech") employee welfare benefit plan, funded in relevant part by a group life insurance policy issued by MetLife. On June 21, 1995, Plaintiff filed a complaint in the Circuit Court of Cook County seeking state law contract and exemplary damages. Because the policy in question is regulated by the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001-1461, Defendant removed the case to federal court pursuant to 29 U.S.C. § 1441 and 1331. On September 14, 1995, Plaintiff filed an amended complaint adding allegations of ERISA violations and seeking contract, exemplary, and punitive damages.

 Both parties filed cross-motions for summary judgment on July 10, 1996, and on August 1, 1996, the case was referred to this court pursuant to 29 U.S.C. § 636(b). Plaintiff argues that she is entitled to the accidental death benefits from her late husband's policy because the insurance plan contains ambiguous language that must be construed in favor of coverage. Alternatively, Plaintiff insists that Defendant's decision to deny the benefits was arbitrary and capricious. Defendant, on the other hand, claims that it reasonably concluded that the decedent's death was not accidental as contemplated by the plan and was, therefore, specifically excluded from coverage. For the reasons set forth below, Plaintiff's motion for summary judgment should be denied and Defendant's motion should be granted.

 FACTUAL BACKGROUND1

 At the time of his death, the decedent was an employee of Ameritech and a participant in the Ameritech Life Insurance Program (the "Plan"). (Jt. 12(M) Statement P 1; Ex. A to Jt. 12(M) Statement, at 22.) The Plan is an employee welfare benefit plan regulated by ERISA and funded primarily by a group life insurance policy issued by MetLife, the Plan's claim fiduciary. (Jt. 12(M) Statement P 1.) Under the Plan's Basic Life Coverage, an employee's beneficiaries receive payments when the employee dies (from any cause) while covered by the program. (Ex. A to Jt. 12(M) Statement, at 7.) Additional coverage is also provided under the accidental death and dismemberment provisions ("AD&D") where death results from injuries caused solely by an accident. (Id. at 8.) These benefits are paid if "the employee [dies] . . . while insured and as a direct result of the accident and independently of all other causes." (Id. at 9.) Accidental death benefits are not available, however, where death is caused by injuries that were "purposely self-inflicted." (Id.)

 The decedent was enrolled in both of these plans (Basic Life and AD&D) in the amount of $ 42,000 each. He designated his wife, Plaintiff Terry Cozzie, as the beneficiary. (Jt. 12(M) Statement P 2.) After his death, Plaintiff submitted a claim for benefits under each policy. (Id.) Shortly after receiving Plaintiff's claim on January 3, 1995, MetLife paid her $ 42,000 in basic life insurance benefits plus applicable interest. (Id. ; Ex. B to Jt. 12(M) Statement, at 50-51.) On or about March 15, 1995, however, MetLife notified Plaintiff that her claim for accidental death benefits was denied. (Jt. 12(M) Statement P 5.)

 MetLife's explanation of the decision to deny Plaintiff AD&D benefits was two-fold. Defendant first reasoned that "the act of driving while so impaired rendered the infliction of serious injury or death reasonably foreseeable and, hence, not accidental as contemplated by the Plan." (Ex. B to Jt. 12(M) Statement, at 2, 26.) In addition, MetLife concluded that the physical and mental impairments caused by the decedent's alcohol consumption were "injuries intentionally self-inflicted" and, therefore, specifically excluded from AD&D coverage. (Id.) MetLife affirmed its decision to deny Plaintiff's claim on or about June 28, 1995. (Jt. 12(M) Statement P 5.) This lawsuit followed.

 DISCUSSION

 A. Summary Judgment Standard

 Summary judgment is appropriate where the court concludes that "there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." FED. R. CIV. P. 56(c). Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48, 91 L. Ed. 2d 202, 106 S. Ct. 2505 (1986). In considering such a motion, the court accepts as true the facts set forth by the non-movant, and draws all justifiable inferences in that party's favor. Wade v. Byles, 83 F.3d 902, 904 (7th Cir. 1996). A party opposing summary judgment may not rest solely upon the pleadings, however, but must set forth specific allegations to demonstrate the existence of a genuine issue for trial. Id. at 904 (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322-24, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986)). This must amount to more than "some metaphysical doubt." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 89 L. Ed. 2d 538, 106 S. Ct. 1348 (1986); Mills v. First Fed. Sav. & Loan Ass'n, 83 F.3d 833, 840 (7th Cir. 1996).

 Where the parties submit cross-motions for summary judgment, the court must consider the merits of each motion and, for each, draw all reasonable inferences in favor of the non-movant. Contreras v. City of Chicago, 920 F. Supp. 1370, 1387 (N.D. Ill. 1996). Courts proceeding under this "Janus-like perspective" will sometimes find that both motions must be denied. CSFM Corp. v. Elbert & McKee Co., 870 F. Supp. 819, 830 (N.D. Ill. 1994); Buttitta v. City of Chicago, 803 F. Supp. 213, 217 (N.D. Ill. 1992), aff'd, 9 F.3d 1198 (7th Cir. 1993). On the other hand, where, as here, the facts are largely uncontested and the issues are legal ones, the parties' cross-motions present an opportunity for resolution of these issues without the need for trial.

 B. Defendant's Denial of AD&D ...


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