Lisa Papotto v. Hartford Life & Accident Insur
731 F.3d 265
3rd Cir.2013Background
- Decedent Frank Papotto died after falling from a golf cart; postmortem toxicology showed a BAL of 0.115% (above New Jersey's 0.08 intoxication standard).
- Papotto was covered by TD Bank’s AD&D policy administered and underwritten by Hartford; the policy excludes losses “sustained while Intoxicated.”
- Hartford denied benefits; the plan administrator upheld the denial relying on the toxicology report and the NJ legal presumption of intoxication.
- Plaintiff (Lisa Papotto, beneficiary) sued under ERISA; district court found Hartford’s interpretation unreasonable and held the intoxication exclusion must include a causation requirement (intoxication must have caused or contributed to the loss).
- The district court remanded to the plan administrator to apply that causation requirement and to consider additional evidence; it administratively closed the case without entering final judgment.
- Hartford appealed the remand order; the Third Circuit sua sponte questioned appellate jurisdiction and ultimately dismissed the appeal for lack of jurisdiction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the intoxication exclusion requires a causal connection between intoxication and death | Papotto: exclusion should be read to bar coverage only if intoxication caused or contributed to the death | Hartford: exclusion is status-based; intoxication alone (meeting legal BAC) excludes coverage, no causation element required | District Court: read causation into exclusion; Third Circuit did not reach merits on appeal (jurisdictional dismissal) |
| Whether the district court’s remand order is an appealable final order under 28 U.S.C. §1291 | Papotto: remand can be reviewed because the court definitively interpreted the policy language | Hartford: appeals from remand are permitted because the legal interpretation affects eligibility and could evade review otherwise | Third Circuit: remand was not final — it required further factfinding and did not eliminate the administrator’s role; appellate jurisdiction under §1291 lacking |
| Whether the remand order meets the Kreider/practical-finality test (finally resolves issue; importance; will foreclose review) | Papotto: the district court’s legal ruling was final and important, justifying review | Hartford: the ruling significantly affects eligibility and could evade review if not heard now | Third Circuit: second prong (importance) met but first and third prongs failed — remand did not finally resolve eligibility and will not foreclose future review because district court retained jurisdiction via administrative closing |
| Whether the collateral-order doctrine permits immediate appeal of the remand | Papotto: remand’s legal ruling is separable and effectively unreviewable, so collateral-order applies | Hartford: same — immediate review is needed to avoid irreparable consequences | Third Circuit: collateral-order test not met — the order is not separate from the merits nor effectively unreviewable on final-judgment appeal; no jurisdiction under the doctrine |
Key Cases Cited
- Cohen v. Beneficial Indus. Loan Corp., 337 U.S. 541 (landmark formulation of the collateral order doctrine)
- Coopers & Lybrand v. Livesay, 437 U.S. 463 (describing collateral-order criteria)
- Kreider Dairy Farms, Inc. v. Glickman, 190 F.3d 113 (3d Cir.) (practical-finality test for remands to agencies)
- Petralia v. AT&T Global Info. Solutions Co., 114 F.3d 352 (1st Cir.) (ERISA remand/retention of jurisdiction discussion)
- Rekstad v. First Bank Sys., Inc., 238 F.3d 1259 (10th Cir.) (remand-to-administrator finality concerns)
- Dickens v. Aetna Life Ins. Co., 677 F.3d 228 (4th Cir.) (remand to ERISA administrator for more evidence is nonfinal)
- Spradley v. Owens-Illinois Hourly Emps. Welfare Benefit Plan, 686 F.3d 1135 (10th Cir.) (remand final where district court left administrator only ministerial task)
- Freeman v. Pittsburgh Glass Works, LLC, 709 F.3d 240 (3d Cir.) (distinguishing administrative closing from dismissal; district court retains jurisdiction)