A predecessor of MetLife issued an insurance policy in 1996, insuring the life of Fernandez, the president of Florida Tube Corporation and Corus Hardware Corporation. Florida Tube Corporation was named as beneficiary, but Corus Hardware Corporation became the beneficiary in 2003.
The policy's proof of death requirement could be satisfied by providing MetLife with "[A] copy of a certified death certificate; a copy of a certified decree of a court of competent jurisdiction as to the finding of death; a written statement by a medical doctor who attended the deceased; or any other proof satisfactory to us." (Emphasis added.)
Both Florida Tube andt Corus Hardware iled for bankruptcy in the 2000s, and Fernandez and his wife filed for personal bankruptcy in 2004. The policy's death benefit was "an indispensable part" of the proposed plan of reorganization in the Fernandez family's personal bankruptcy.
MetLife received a claim that Fernandez had died on August 18, 2008, when his private airplane allegedly crashed during a 37-minute flight from the Dominican Republic to Puerto Rico. No medical evidence of death was submitted, and no wreckage from the plane was found.
Fernandez's son submitted a death certificate issued by the Central Electoral Board of the Dominican Republic, but it listed a date of death five days before Fernandez allegedly attempted the flight to Puerto Rico. In 2009, the Central Electoral Board issued a second death certificate, this time with the correct date of death, but the Board later declared the second certificate null and void because it was "full of irregularities."
MetLife also received a National Transportation Safety Board report, which described the incident "in uncertain terms," and did not mention Fernandez by name, but stated only that the airplane "presumably collided with coastal water," and that "[t]he pilot ... [is] presumed deceased."
MetLife denied the claim based on insufficient proof of death. When the suit was filed, the federal district court granted summary judgment to MetLife, which was upheld by the Eleventh Circuit on appeal.
In the absence of a death certificate, a judicial decree of death, or a report of death from an attending physician, the Eleventh Circuit concluded that "we are left to construe the 'proof satisfactory to us' provision" of the policy. The provision, the court held was unambiguous.
"The most literal and plain meaning of the 'proof satisfactory to us' policy language is 'proof satisfactory to MetLife,'" the court said. "Applying that meaning, MetLife was within its discretion to deny coverage when the beneficiaries gave it circumstantial proof of death that it deemed unsatisfactory."
The court relied on its decision in Tippitt v. Reliance Standard Life Insurance Company, 457 F.3d 1227 (11th Cir. 2006), a case in which it held that the phrase "satisfactory ... to us" vested an ERISA plan administrator with the discretion to determine whether the evidence provided in support of the claim was satisfactory.
The Eleventh Circuit rejected the argument that Tippitt should not be followed because it was an ERISA case. "Nothing in our holding confined our interpretation of the policy language to ERISA cases," the court stated. "Secondly, the beneficiaries point to no case that explains why we must interpret policy language in non-ERISA plans differently."
The court concluded that the reason for proof of death provisions in life insurance policies is the same in ERISA and non-ERISA policies. "It is to make sure that an insurance company has the facts it needs 'to afford the insurer an adequate opportunity to investigate, prevent fraud, and form an intelligent estimate of its rights and liabilities before it is obligated to pay.'" (Citing Allstate Floridian Ins. Co. v. Farmer, 104 So.3d 1242, 1246 (Fla. 5th DCA 2012).)
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