Green v. Life Insurance Co. of North America
754 F.3d 324
5th Cir.2014Background
- Joshua Green died when his boat struck a concrete piling at night on July 16, 2010; toxicology showed a .243 BAC and empty alcohol containers were found in the boat. The light he struck was not lit. Death certificate listed accidental death with acute alcohol intoxication as a significant condition.
- Green held two employer-sponsored AD&D policies issued and administered by Life Insurance Company of North America (LINA); policies excluded losses caused by "operating any type of vehicle while under the influence of alcohol." "Under the influence" was defined by the law of the state where the accident occurred.
- LINA denied benefits administratively, citing the intoxication exclusion and that the death was a foreseeable result of operating a boat intoxicated and at night without lights. Plaintiffs appealed administratively and then sued under ERISA when benefits were not paid.
- In discovery, the magistrate limited production of historical policies and manuals as overbroad; the district court affirmed the modified discovery order.
- The district court granted summary judgment for LINA; plaintiffs appealed both the discovery-order modification and the grant of summary judgment. The Fifth Circuit affirmed both decisions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review for denial of benefits | SPD language cannot properly confer discretionary review; CIGNA/precedent require de novo review | Plan language (SPD + "satisfactory to Us" proof of loss) confers administrator discretion | Court assumed de novo review but ruled for defendant even under de novo, so outcome unaffected |
| Applicability of intoxication exclusion (does "vehicle" include a boat?) | "Vehicle" ambiguous under Mississippi law and should not encompass a boat; ambiguities construed for insured | Federal/common ordinary meaning of "vehicle" is broad and includes conveyances by water; plan language "any type of vehicle" shows broad intent | Term "vehicle" unambiguous in ERISA plan and includes a boat; exclusion applies |
| Whether death was a "Covered Accident" (foreseeability/independence) | Death was accidental and plaintiffs challenge LINA's foreseeability analysis and causation focus | LINA contends death resulted from intentional risk-taking (drunk boating, no lights), so not "unforeseeable" or independent of intoxication | Court did not need to resolve because exclusion independently justified denial; LINA's reliance on exclusion was proper |
| Discovery scope regarding historical materials & claims | Plaintiffs sought broader materials and older policies to show systemic practice | LINA showed burden and limited relevance; magistrate tailored order to recent materials and similar claims since 2007 | Court affirmed magistrate's modification as non-abusive and not prejudicial |
Key Cases Cited
- Firman v. Life Ins. Co. of N. Am., 684 F.3d 533 (5th Cir. 2012) (distinguished; plan here had explicit alcohol exclusion)
- Atkins v. Bert Bell/Pete Rozelle NFL Player Ret. Plan, 694 F.3d 557 (5th Cir. 2012) (standard for abuse-of-discretion review when plan grants discretion)
- CIGNA Corp. v. Amara, 131 S. Ct. 1866 (U.S. 2011) (on interpretation of plan documents and SPD effects)
- Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (U.S. 2008) (conflict-of-interest affects deference amount under abuse-of-discretion review)
- Wegner v. Standard Ins. Co., 129 F.3d 814 (5th Cir. 1997) (interpret ERISA plan terms by ordinary meaning; contra proferentum only if ambiguous)
- Provident Life & Accident Ins. Co. v. Sharpless, 364 F.3d 634 (5th Cir. 2004) (federal common law governs interpretation of ERISA plan provisions)