Finney v. Metropolitan Life Insurance Company

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

BRITTANY FINNEY,

Plaintiff,

v. Case No. 1:22-cv-1046-CLM

METROPOLITAN LIFE

INSURANCE COMPANY,

Defendant.

MEMORANDUM OPINION

Selena Anderson worked for the Social Security Administration when

she fell and broke her leg and ankle while exiting a vehicle. Anderson

suffered a pulmonary thromboembolism and died six days later.

The Federal Employees’ Group Life Insurance Act of 1954 (“FEGLIA”),

5 U.S.C. § 8701 et seq., establishes a life insurance program for federal

employees. Through FEGLIA, Anderson had both life insurance and

accidental death insurance. Anderson’s daughter Brittany Finney submitted

a claim to Metropolitan Life Insurance Company (“MetLife”) for both

benefits. MetLife paid Finney’s claim for FEGLI life insurance benefits but

denied her claim for accidental death benefits.

Finney challenges MetLife’s denial of accidental death benefits here.

She alleges that MetLife breached an insurance contract (Count I) and denied

her claim in bad faith (Count II). (Doc. 1). Both parties move for judgment on

the administrative record. (Docs. 11, 15). For the reasons stated within, the

court WILL GRANT MetLife’s motion for judgment (doc. 15) and WILL

DENY Finney’s motion for judgment (doc. 11). The court will thus dismiss

with prejudice Finney’s complaint (doc. 1).

BACKGROUND

As explained below, this case turns on whether Anderson’s death was a

“direct result” of her fall, independent of “all other causes,” including a

preexisting “physical or mental illness.” The court starts by explaining where

this language comes from, then explains how Anderson’s pre-fall health

condition factored into MetLife’s decision.

A. FEGLIA

FEGLIA entitles federal employees to be insured for group life

insurance, 5 U.S.C. § 8704(a), and group accidental death and

dismemberment insurance, 5 U.S.C. § 8704(b). The Office of Personnel

Management “may prescribe the time at which and the conditions under

which an employee is eligible for coverage under” FEGLIA. See 5 U.S.C.

§ 8716(a) and (b). Relevant here, OPM defines accidental death and

dismemberment to mean “the insured’s death . . . that results directly from,

and occurs within one year of, a bodily injury caused solely through violent,

external, and accidental means.” 5 C.F.R. § 870.101.

OPM’s FEGLI handbook elaborates on when accidental death and

dismemberment benefits are generally payable:

ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) BENEFITS

When Are Benefits Payable?

Accidental death and dismemberment (AD&D) benefits are payable when you-sustain-_bodi

injury solely through violent, external, and accidental means, and 4s-a direct result of the bodil

injurycindependently of all other causes >and within one year afterwards, you lose your life, limb

(hand or foot), or eyesight.

« Loss of hand means loss by severance at or above the wrist joint, or equivalent loss, as

determined by OFEGLI.

« Loss of foot means loss by severance at or above the ankle joint, or equivalent loss, as

determined by OFEGLI.

* Loss of eyesight means total and permanent absence of any usable vision in one eye.

Accidental death benefits, if payable, are payable in addition fo “regular’* FEGLI benefits.

(Doc. 13-2, p. 60).

But several exclusions apply to claims for FEGLI accidental death and

dismemberment benefits:

Exclusions

AD&D benefits will not be paid if your death or loss in any way results from, is caused by, or is

contributed to by:

physical or mental illness;

« the diagnosis of or treatment of a physical or mental illness;

* ptomaine or bacterial infection. However, accidental death and dismemberment benefits

will be paid if the loss is caused by an accidentally sustained external wound;

* awar (declared or undeclared), any act of war, or any armed aggression against the

United States, in which nuclear weapons are actually being used;

* awar (declared or undeclared), any act of war, or any armed aggression or insurrection in

which you are in actual combat at the time bodily injury is sustained;

* suicide or attempted suicide;

* injuring yourself on purpose;

« illegal or illegally obtained drugs that you administer to yourself; or

« driving a vehicle while intoxicated, as defined by the laws of the jurisdiction in which

you were operating the vehicle.

(Id.; see also doc. 16-9, p. 29). Relevant here is the circled exclusion for a

“death or loss” that “in any way results from, is caused by, or is contributed to

by physical or mental illness.”

Under the FEGLI contract, MetLife’s determination that a claim for

accidental death benefits isn’t payable because the death doesn’t fall within

the definition of accidental death or does fall within an exclusion “is to be

given full force and effect, unless it can be shown that the determination was

arbitrary and capricious.” (Doc. 16-9, p. 27).

B. Anderson’s Death

On June 24, 2021, Anderson fell in a parking lot while exiting a motor

vehicle and suffered multiple fractures to her right leg below the knee. (Doc.

13-1, pp. 80-31). Anderson was promptly taken to Marshall Medical Center

in Boaz, which discharged Anderson to return home to Birmingham for

orthopedic consultation and likely surgery. (Ud., p. 31). Six days later,

Anderson died. (/d., 29-30).

According to Anderson’s death certificate, the cause of her death was

pulmonary thromboembolism caused by the multiple fractures she suffered in

the motor vehicle accident. (Id.). Anderson’s original death certificate listed

her manner of death as a result of “natural causes,” but a supplemental death

certificate issued around four months after Anderson’s death changed the

manner of death to “accident.” (Id.). Anderson’s autopsy report noted that

Anderson “had complex medical problems including heart failure” and

described her as “a 59-year-old woman with a past medical history of

interstitial lung disease on steroids and home oxygen, COPD, chronic smoker,

heart failure,” and other preexisting conditions. (Id., p. 70). The autopsy

report found that Anderson’s “cause of death was pulmonary embolism in a

patient with underlying interstitial lung disease. The right lower extremity

fractures were likely responsible for the final event.” (Id., pp. 70–71).

C. Finney’s Claim for Benefits

Anderson had around $57,000 in FEGLI accidental death and

dismemberment coverage when she died. MetLife, which has a contract with

the United States Office of Personnel Management, administers claims for

FEGLI benefits through its Office of Federal Employees Group Life

Insurance (“OFEGLI”) in accordance with the requirements of FEGLIA and

the FEGLI contract.

After her mother’s death, Finney submitted a claim to MetLife for

FEGLI accidental death proceeds her mother had enrolled in before she died.

(Id., pp. 2–10). During a December 29, 2021 call, a MetLife claims consultant

advised Finney that Anderson’s medical history possibly contributed to her

passing and that her case would be “reviewed with our medical dept to

confirm there was no contributors as exclusions state that the accident must

be solely through accident with no contributing factors.” (Doc. 13-2, p. 6).

MetLife then had Dr. Neil K. Gupta review Anderson’s medical records

and provide a Peer Review Report. (Doc. 16-3, pp. 45–47). In Dr. Gupta’s

opinion, Anderson’s death was not a direct result of an injury, independent of

other causes. (Id., p. 45). In support of this opinion, Dr. Gupta stated that

“[t]he documentation indicates that the claimant was noted to have

pulmonary thromboembolism involving the main pulmonary artery and

proximal and left arteries.” (Id., pp. 45–46). He then said that “[t]here were

various contributors that led to the decedent’s death related to the pulmonary

embolism, including her known history of interstitial lung disease, on home

oxygen, as well as COPD” and that Anderson “had poor reserve, which likely

increased the severity of her pulmonary embolism.” (Id., p. 46).

Dr. Gupta also found that Anderson’s death “was contributed to by

physical illness.” (Id.). Dr. Gupta supported this opinion with his earlier

reasoning that “there were various contributors that led to the decedent’s

death related to the pulmonary embolism, including her known history of

interstitial lung disease, on home oxygen, as well as COPD” (Id.). Dr. Gupta

then emphasized that Anderson had poor reserve, was on oxygen at home,

and “likely had decreased ability to clear her pneumonia in the context of her

known COPD and ILD.” (Id.).

D. MetLife’s Denial of Finney’s Claim

On January 7, 2022, MetLife wrote Finney to inform her that it was

denying her claim for accidental death benefits. (Doc. 13-1, pp. 149–50).

Consistent with Dr. Gupta’s report, MetLife stated that Anderson’s autopsy

report “indicates there were various contributors that led to the decedent’s

death related to pulmonary embolism, including her known history of

interstitial lung disease, on home oxygen, as well as COPD.” (Id., p. 149).

MetLife also noted that Anderson “had poor reserve, which likely increased

the severity of her pulmonary embolism.” (Id.). MetLife then stated that to

receive accidental death benefits the “insured’s death must have been caused

solely by violent, external and accidental means, and that an insured must

have died as a direct result of such bodily injuries independently of all other

causes.” (Id., p. 150). Finally, MetLife explained it could not “pay accidental

means death benefits because the cause of death was contributed to the

insured’s medical history which is excluded due to her physical illness.” (Id.).

Finney obtained counsel, appealed MetLife’s denial of benefits, and

requested more time to submit information in support of her appeal. (Id., pp.

139–40).1 In support of her claim for benefits, Finney provided MetLife with a

1 MetLife denies that it allowed Finney to appeal, asserting that FEGLIA does not provide

for an appeal of claim determinations. But MetLife admits that it allowed Finney to submit

peer review report from forensic pathologist Dr. James R. Lauridson, M.D.

pp. 158-65). Dr. Lauridson’s report stated:

March 28, 2022

l have been asked by Clay Williams Esq., to review the death of Selina Anderson who was

injured on June 24, 2021 and died on June 30, 2021 after surgical and medical therapies

initiated to repair the initial injury.

The medical legal certification of death properly attributes the cause of death as the avant that

initiates any subsequent events, usually therapeutic. This is called the proximate cause of

death.

In some cases, the events following the initial event may culminate in death. Even if this is the

outcome, the initial event is legally the cause of death (also known as the proximate cause of

death).

In the case of Selina Anderson the proximate cause of death was the accident causing the

fractures of her leg. The treatment of the fractures let to a series of medical complications that

resulted in her death. The autopsy report trom UAB Medicine lists a pulmonary

thromboembolism as the cause of death. This was a complication that occurred during

treatment for the fractures.

lam a board certified forensic pathologist and medical examiner with 30 years of experience in

medical legal death certification. My resume in included.

Se R. Lauridson, M.D.

p. 158).

MetLife again denied Finney’s claim for benefits based on two

“independent and separate reason[s].” (Doc. 13-2, pp. 21-23). First, MetLife

found that it was “unable to pay FEGLI accidental death benefits because the

record does not support that the decedent sustained bodily injuries solely

through violent, external and accidental means, and died as a direct result of

such bodily injuries independently of all other causes, as would be required

for such benefits to be payable.” (/d.). Second, MetLife found that “the record

supports that here, FEGLI accidental death benefits are not payable because

at minimum, physical illness contributed to the death, and such benefits are

not payable if in any way the death or loss resulted from, was caused by, or

was contributed to by physical illness.” (d.).

new information in support of her claim and that it reviewed this information after

receiving it.

STANDARD OF REVIEW

The parties agree that the court should apply the standard of review

that the Eleventh Circuit uses in ERISA cases to Finney’s claims. See (Doc.

12, pp. 16–18) (citing ERISA cases); (Doc. 18, pp. 7–8) (same).

Under this standard, six steps guide the court’s review of the denial of

a claim for benefits. See Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350,

1355 (11th Cir. 2011). Those steps tell the court to:

1. Apply the de novo standard to determine whether the claim

administrator’s benefits-denial decision is “wrong” (i.e., the court

disagrees with the administrator’s decision); if it is not, then end

the inquiry and affirm the decision.

2. If the administrator’s decision in fact is “de novo wrong,” then

determine whether he was vested with discretion in reviewing

claims; if not, end the judicial inquiry and reverse the decision.

3. If the administrator’s decision is “de novo wrong” and he was

vested with discretion in reviewing claims, then determine

whether reasonable grounds supported it (hence, review his

decision under the more deferential arbitrary and capricious

standard).

4. If no reasonable grounds exist, then end the inquiry and reverse

the administrator’s decision; if reasonable grounds do exist, then

determine if he operated under a conflict of interest.

5. If there is no conflict, then end the inquiry and affirm the

decision.

6. If there is a conflict, the conflict should merely be a factor for the

court to take into account when determining whether an

administrator’s decision was arbitrary and capricious.

Id. at 1355.

DISCUSSION

As explained, MetLife denied Finney’s claim for accidental death

benefits for two reasons. First, MetLife found that Anderson’s death didn’t

meet the definition of accidental death as defined in the OPM regulations,

OPM handbook, and FEGLI contract because Anderson’s death did not result

directly from an accidental bodily injury. Second, MetLife found that Finney’s

claim fell within the physical illness exclusion to accidental death benefits.

The court finds that MetLife had at least reasonable grounds to deny

Finney’s claim under the physical illness exclusion. So the court needn’t

decide whether MetLife also had reasonable grounds to determine that

Anderson’s death didn’t meet the definition of an accidental death.

I. How to interpret the FEGLI contract?

The Benefits Payable section of the accidental death policy requires

that the death be “a direct result of the bodily injury, independent of all other

causes[.]” (Doc. 13-2, p. 60) (highlight added). Later, the Exclusion section

excludes accidental death benefits coverage “if the death or loss in any way

results from, is caused by, or is contributed to by . . . the insured having

physical or mental illness.” (Doc. 16-9, p. 29) (highlight added).

a. Exclusion’s plain language: Combined, these highlighted provisions

exclude coverage if a preexisting physical condition played any part in

Anderson’s death.

Starting with the exclusion provision, a condition ‘contributes to’ an

event if the condition has a part in making the event happen. See Contribute,

Oxford English Dictionary Online, https://www.oed.com/dictionary/ contribute

(last visited Sep. 10, 2024) (“5.b. More usually intransitive. to contribute to

. . .: to do a part in bringing (it) about; to have a part or share in producing.”);

Contribute, Merriam-Webster Dictionary Online, https:// www.merriam-

webster.com /dictionary/ contribute (last visited Sep. 10, 2024) (“3

intransitive: to play a significant part in making something happen”). And

the exclusion’s use of the phrase “in any way” to modify “is contributed to by”

shows that the exclusion is intended to apply when a physical illness played

any part in the death or loss.

The Benefits Payable section’s use of the phrase “a direct result of

bodily injury, independent of all other causes” bolsters the court’s

interpretation of the exclusion provision. “Independent of all other causes”

can be read only to mean that a preexisiting condition cannot cause the death

in any way. Or, put another way, the preexisiting condition can play no part.

For these reasons, the court finds that the physical illness exclusion

applies if a physical illness played any part in producing Anderson’s death.

b. Caselaw: Finney says this plain interpretation of the physical illness

exclusion contradicts Eleventh and Fifth Circuit caselaw. According to

Finney, the cases below provide that she is entitled to accidental death

benefits if Anderson’s fractured leg was the proximate cause of her death, and

MetLife cannot show that Anderson’s preexisting physical conditions

substantially contributed to—rather than played any part in—her death.

o Dixon: Finney first cites Dixon v. Life Ins. Co. Of N. Am., 389 F.3d

1179, 1180 (11th Cir. 2004), an ERISA accidental death benefits case in

which Mr. Dixon’s group policy covered accidents “which, directly and from no

other causes, result in a covered loss.” After Mr. Dixon died in a single car

accident, his widow claimed accidental death benefits under the policy. See

id. Life Insurance Company of North America (“LINA”) denied Mrs. Dixon’s

claim, finding that Mr. Dixon died of a heart attack and that heart disease at

least contributed to his death. See id. at 1181–82.

In reviewing the district court’s grant of summary judgment to LINA,

the Eleventh Circuit adopted as part of the “federal common law” of ERISA

the rule that in ERISA cases “a pre-existing infirmity or disease is not to be

considered as a cause unless it substantially contributed to the disability or

loss.” Id. at 1184. The circuit court reasoned that interpreting the “directly

and from no other causes” language in Mr. Dixon’s policy this way advanced

“ERISA’s purpose to promote the interests of employees and their

beneficiaries.” Id. So the court said that it would not consider Mr. Dixon’s

“pre-existing heart disease as a cause unless it substantially contributed to

his death.” Id. Even so, the circuit court affirmed the district court’s grant of

summary judgment to LINA, finding that Mr. Dixon’s “heart failure was

directly due to his atherosclerotic and hypertensive heart disease.” Id. at

1184–85. Thus, “Mr. Dixon’s pre-existing heart condition ‘substantially

contributed’ to his death, regardless of whether the auto accident was the

immediate cause in that it triggered his heart attack.” Id.

o Bradshaw: Thirteen years later, in Bradshaw v. Reliance Standard

Life Insurance Company, 707 F. App’x 599 (11th Cir. 2017), the Eleventh

Circuit applied Dixon to an ERISA policy’s preexisting condition exclusion

that’s like the physical illness exclusion in the FEGLI contract. Plaintiff

Bradshaw “had a healthy pregnancy and no other pre-existing medical

conditions when she bought a disability-insurance policy” from Defendant

Reliance. Id. at 600. At 38 weeks pregnant, Bradshaw was diagnosed with

mild preeclampsia and gave birth to a healthy baby girl. Id. at 601. A week

after giving birth, Bradshaw suffered a debilitating stroke that left her

totally disabled. Id. at 601–602. So Bradshaw filed a claim with Reliance for

long-term disability. Id.

Reliance denied Bradshaw’s claim for benefits under its policy’s

preexisting condition exclusion, finding that her pregnancy was a preexisting

condition that precluded coverage. Id. at 602. That exclusion provided that

Reliance would not pay benefits for a total disability (1) caused by, (2)

contributed to by, or (3) resulting from a preexisting condition. Id. And the

policy defined preexisting condition as a sickness or injury the insured

received medical treatment for “during the three (3) months immediately

prior to the Insured’s effective date of insurance.” Id.

Applying Dixon, the circuit court interpreted the preexisting condition

exclusion as excluding coverage “for only those losses substantially caused by,

substantially contributed to by, or substantially resulting from a pre-existing

condition.” Id. at 608. The court reasoned that “[t]his interpretation of the

Policy language not only comports with our precedent but it also advances

ERISA’s clear purpose to provide greater coverage to beneficiaries.” Id. And

the court held that it was unreasonable for Reliance to find that Bradshaw’s

pregnancy, the only condition she had during the relevant look-back period,

substantially contributed to her total disability. See id. at 609–10. In

reaching this result, the court reasoned that Bradshaw did not suffer from

high blood pressure, preeclampsia, or symptoms of a stroke during the look-

back period and that stroke is not a condition normally associated with a

healthy pregnancy. Id. at 609.

o Wells: In Wells v. Minnesota Life Insurance Company, 885 F.3d 885,

887 (5th Cir. 2018), Plaintiff Wells was the widow of Melton Dean Wells who

died after being bitten by a mosquito carrying the West Nile Virus. After

Minnesota Life Insurance Company denied Mrs. Wells accidental death

benefits, she sued Minnesota Life for breach of contract under Texas state

law. Id. at 888–89. The Fifth Circuit reversed the district court’s grant of

summary judgment on Mrs. Wells’ breach of contract claim finding genuine

disputes of material fact over (a) whether the policy’s insuring clause covered

Mrs. Wells’ claim for accidental death benefits, and (b) whether Mr. Wells’

preexisting conditions of obesity, diabetes, and hypertension excluded

coverage under a policy exclusion. See id. at 895–96.

Relevant to the physical illness exclusion, is the Fifth Circuit’s holding

that the Minnesota Life policy’s exclusion for death that “is caused directly or

indirectly by, results from, or there is contribution from . . . bodily or mental

infirmity, illness, or disease . . .” applies “only to conditions existing when the

accident happened.” Id. at 895. The circuit court then found that there was a

genuine dispute of material fact about whether Mrs. Wells’ claim for benefits

fell within this exclusion because her expert had testified that neither Mr.

Wells’ obesity, age, diabetes, nor hypertension “was a contributing factor to

his demise.” See id.

—

If these cases controlled, the court would agree with Finney that her

mother’s preexisting health conditions must have substantially contributed to

her death, rather than played any part in her death. But two of these cases

applied federal common law to ERISA, and the other applied Texas state law.

None looked at FEGLIA, the controlling statute here.

c. FEGLIA: Congress provided that a FEGLI contract’s provisions

“supersede and preempt any law of any State or political subdivision thereof

. . . to the extent that the law . . . is inconsistent with the contractual

provisions.” 5 U.S.C. § 8709(d)(1). So the court must apply a FEGLIA

contract’s plain terms, even if doing so contradicts federal common law on

ERISA or applicable state law.

FEGLIA states that eligibility for payment of accidental death benefits

is “[s]ubject to the conditions and limitations approved by the Office of

Personal Management which are contained in the policy purchased by the

Office.” 5 U.S.C. § 8704(b). So in breach of contract cases based on the denial

of FEGLI benefits, courts have interpreted unambiguous provisions in the

FEGLI contract according to their plain meaning. See, e.g., Belcher v. Metro.

Life Ins. Co., 943 F.2d 251 (6th Cir. 1991) (applying plain language

interpretation to phrase “accidental means” and noting that “this reading of

the policy is not affected by the possibility that similar language might be

construed differently under state law”). Because FEGLIA specifically

conditions the payment of accidental death benefits on satisfying the

conditions and limitations in the FEGLI contract, and the payable benefits

and exclusion provisions are unambiguous, the court finds that the

‘substantially contributed to’ test doesn’t apply to Anderson’s accidental

death benefits. Instead, the plain language of the contract says that benefits

are not payable if a physical illness had a part in causing Anderson’s death.

II. Did reasonable grounds support MetLife’s determination?

Under the FEGLI contract, MetLife is vested with discretion in

reviewing claims for benefits. See (Doc. 16-9, p. 27) (“The Contractor’s

determination as to the entitlement to payment of Benefits is to be given full

force and effect, unless it can be shown that the determination was arbitrary

and capricious.”)). So the court can reverse MetLife’s claims determination

only if MetLife’s decision to deny Finney’s claim for accidental death benefits

was arbitrary and capricious. See Blankenship, 644 F.3d at 1355. “In

applying the arbitrary and capricious standard, this Court’s role is limited to

determining whether [MetLife’s] interpretation was made rationally and in

good faith-not whether it was right.” Guy v. Se. Iron Worker’s Welfare Fund,

877 F.2d 37, 38 (11th Cir. 1989) (quotations omitted). Thus, MetLife’s

determination “need not be the best possible decision only one with a rational

justification.” Griffis v. Delta Fam.-Care Disability, 723 F.2d 822, 825 (11th

Cir. 1984).

a. Plain language interpretation: Applying the physical illness

exclusion’s plain language, the court finds that MetLife had reasonable

grounds to deny Finney’s claim for accidental death benefits. Anderson’s

death certificate explained that she suffered a pulmonary embolism after

suffering fractures from a motor vehicle accident. But Anderson’s death

certificate is silent about whether any underlying health conditions made her

susceptible to pulmonary embolisms or increased the severity of the

embolism. The autopsy report, however, connects the pulmonary embolism to

Anderson’s past medical history of interstitial lung disease by saying “cause

of death was pulmonary embolism in a patient with underlying interstitial

lung disease.” (Doc. 13-1, pp. 70–71). The autopsy report also describes

Anderson’s “right lower extremity fractures” as “responsible for the final

event” that led to her pulmonary embolism, which suggests that other factors

also played a part in the embolism. (Id. (emphasis added)). And it was Dr.

Gupta’s opinion that “various contributors” led to Anderson’s death, including

“her known history of interstitial lung disease, on home oxygen, as well as

COPD.” (Doc. 16-3, p. 46). To support this opinion, Dr. Gupta said that

Anderson “had poor reserve, which likely increased the severity of her

pulmonary embolism” and that Anderson “likely had decreased ability to

clear her pneumonia in the context of her known COPD and ILD.” (Id.).

Dr. Lauridson’s opinion says that the proximate cause of Anderson’s

death “was the accident causing the fractures of her legs” and that the

pulmonary thromboembolism was “a complication that occurred during

treatment for the fractures.” (Doc. 13-1, p. 158). But Dr. Lauridson’s opinion

does not address the effect Anderson’s preexisting conditions had on her

pulmonary embolism. As the other record evidence suggests that Anderson’s

health conditions did play a part in her death, the court finds that MetLife

reasonably found that accidental death benefits weren’t payable because

physical illness contributed to Anderson’s death.

b. Substantially contributed test: The court would also find that

MetLife’s claims determination was reasonable even if the ‘substantially

contributed to’ test applied to Finney’s claim for benefits under the FEGLI

contract. See Dixon, 389 F.3d at 1184–85 (applying substantially contributed

to test and affirming denial of claim for benefits even though insurance

company didn’t apply test in reviewing claim for accidental death benefits).

Again, Dr. Gupta found that Anderson’s interstitial lung disease and

COPD contributed to her death. (See Doc. 16-3, p. 46). According to Dr.

Gupta, Anderson (a) had poor reserve, which likely increased the severity of

her pulmonary embolism, and (b) likely had decreased ability to clear her

pneumonia because of her COPD and interstitial lung disease. (Id.). Dr.

Lauridson’s opinion doesn’t contradict these findings or state the degree to

which Anderson’s preexisting conditions contributed to her death. Instead, he

merely identifies the accident that caused Anderson’s fractures as “the

proximate cause of death” and the pulmonary embolism as a complication

from treatment for the fractures. (Doc. 13-1, p. 158).

More importantly, the autopsy report described Anderson’s cause of

death as “pulmonary embolism in a patient with underlying interstitial lung

disease. The right lower extremity fractures were likely responsible for the

final event.” (Id., pp. 70–71). Based on this description of Anderson’s death, it

is reasonable to determine that while Anderson’s injuries from her accident

were the immediate cause of the pulmonary embolism, Anderson’s underlying

interstitial lung disease substantially contributed to her death. See Dixon,

389 F.3d at 1184–85 (“Mr. Dixon’s pre-existing heart condition ‘substantially

contributed’ to his death, regardless of whether the auto accident was the

immediate cause in that it triggered his heart attack.”). So the court finds

that MetLife had reasonable grounds to deny Finney’s claim for benefits.

—

In sum, the court finds that under either the plain language of the

FEGLI contract or the ‘substantially contributed to’ test, MetLife had

reasonable grounds to determine that the physical illness exclusion applied to

Finney’s claim for accidental death benefits. And Finney hasn’t shown that

any conflict of interest that MetLife may have affected its decision to deny

her claim for benefits. So the court will grant MetLife’s motion for judgment

and will deny Finney’s motion.

CONCLUSION

For these reasons, the court WILL GRANT MetLife’s motion for

judgment (doc. 15) and WILL DENY Finney’s motion for judgment (doc. 11).

The court will enter a separate order that dismisses with prejudice

Finney’s complaint (doc. 1) and closes this case.

Done on September 10, 2024.

any MAZE

UNITED STATES DISTRICT JUDGE

15