Johnson suffered fatal injuries while driving during the early morning hours when he lost control of his vehicle, traveled off the roadway, struck a highway sign, and overturned several times. The roadway was illuminated by streetlamps and was dry under clear weather conditions. The responding officer determined that Johnson was driving too fast, estimating that he was exceeding the speed limit by 15 miles per hour.
The coroner concluded that Johnson died from internal injuries resulting from the crash. As part of the investigation, it was determined that Johnson’s blood had an alcohol level of 0.289%, and that his ocular fluid had an alcohol level of 0.311%.
Johnson was a participant in an employee welfare benefit plan as defined by ERISA, providing life and accidental death benefits funded by insurance policies issued by American United Life ("AUL"). AUL promptly paid life insurance benefits to Johnson’s wife, but denied her claim for accidental death benefits on the basis that the death was not accidental due to the intoxicants found in Johnson’s system. AUL upheld its decision on administrative appeal, and litigation ensued.
AUL was not conferred decision-making discretion under the plan, so the federal district court applied the de novo standard of review. Because the policies required their terms to conform to North Carolina law, the court applied N.C. Gen. Stat. § 58-3-30 to determine "the meaning of the term ‘accident’" in the policies.
Under that statute, "‘Accident’ . . . shall be defined to imply ‘result’ language and shall not include words that establish an accidental means test." Although the statute does not identify the "‘result’ language" to which it refers, the court noted that "under a results test, if death is the unanticipated and unexpected result of an intentional, voluntary act, then the death is an accident."
Thus, Mrs. Johnson had the burden to "prove that the crash was ‘unanticipated and unexpected.’" Rather than affirmatively pointing to evidence in the record to support such a finding, Mrs. Johnson relied "on the alleged absence of evidence that Mr. Johnson did anticipate or expect to die or, more accurately, to crash."
Because Mrs. Johnson "failed to point to any evidence that would establish what her husband expected or anticipated when he drove a vehicle down a highway at an unlawful speed while severely intoxicated," her motion for summary judgment was denied. Her failure to point to record evidence on a matter for which she bore the burden of proof authorized summary judgment in AUL’s favor.
"Where (as here) an individual with an intoxication level approaching four times the legal limit drives a car down a highway 30% above the speed limit," the court said, "a crash is in no commonly understood sense an ‘unanticipated and unexpected result,’ unless some unusual circumstance (absent here) would make it so." The court noted, however, that "[o]n another record, e.g., one involving a driver with a lower intoxication level that nevertheless exceeded the limit, a car crash might fall within the definition of ‘accident’ under § 58-3-30 …."
Click Here to view the full May 2012 Edition of the ERISA and Life Insurance News.