REPORT AND RECOMMENDATION
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.
On November 6, 1994, Robert Cozzie (the "decedent") died as a result of a single car crash in Putnam County, Illinois. (The Parties' Joint Local Rule 12(M) Statement of Material Facts as to Which There is No Genuine Issue (hereinafter "Jt. 12(M) Statement") P 2; Ex. B to Jt. 12(M) Statement, at 46, 49.) According to the investigating officer, the decedent drove his vehicle off a rural highway after missing a curve in the road. (Ex. B to Jt. 12(M) Statement, at 33-34.) The vehicle traveled down a ditch, struck an embankment, and rolled over approximately three times, ejecting the decedent from the driver's seat and pinning him underneath the vehicle. (Id. at 34.) The pressure of the car on his chest rendered Mr. Cozzie unable to breathe, and he died of asphyxiation. (Id. at 34, 49.) Toxicology tests performed a short time after the crash revealed that the decedent's blood alcohol content ("BAC") was 0.252 percent, more than two and a half times the legal limit under Illinois law.
(Id. at 35.)
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.
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 Benefits3
1. Standard of Review
As a preliminary matter, the parties dispute the appropriate standard of review to be applied in this case. Defendant contends that because the language of the Plan confers discretionary authority on the claims fiduciary, the court must give deference to its benefit determination and apply the arbitrary and capricious standard of review. (Defendant's Memorandum of Law in Support of its Motion for Summary Judgment (hereinafter "Def.'s Memo"), at 8-10.) The Supreme Court, Defendant notes, has held that actions challenging benefit determinations under § 1132(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), are reviewed de novo "unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 103 L. Ed. 2d 80, 109 S. Ct. 948 (1989). Where the benefit plan grants the administrator or fiduciary such discretion, "the appropriate standard of review is the deferential 'arbitrary and capricious' one." Ramsey v. Hercules, Inc., 77 F.3d 199, 202 (7th Cir. 1996) (citing Firestone, 489 U.S. at 111).
The Plan at issue here, Defendant contends, unequivocally grants MetLife unconstrained discretionary authority over its administration and interpretation. The Plan specifically states:
In carrying out their respective responsibilities under the Program, [MetLife has] full discretionary authority to interpret the terms of the Program and to determine eligibility for an entitlement to Program benefits in accordance with the terms of the Program. With respect to [its] responsibilities under the Program, [MetLife] determines conclusively for all parties all questions arising in the administration of the Program and any decision of [MetLife] is not subject to further review.