explaining that district court is not required to remand case to administrator but may do so in order to make benefit eligibility determination
How later courts described this case
- explaining that district court is not required to remand case to administrator but may do so in order to make benefit eligibility determination
- finding that a district court has discretion to either limit the evidence to the record before the plan administrator or consider additional evidence if necessary to make an informed judgment.
- finding that on de novo review of an ERISA benefits claim, the “appropriate proceeding[ ] . . . is a bench trial and not the disposition of a summary judgment motion”
- holding that although the court has the authority to review facts not before the plan administrator, the court should use that authority sparingly
Written by the judges who cited it.
The opinion
MANION, Circuit Judge,
dissenting.
Daniel Casey jumped in front of a train for the purpose of committing suicide. His attempt failed. He lived, but with major injuries. Casey then attempted to collect under his company’s insurance plan, which allowed recovery for injuries “sustained accidentally.” The district court did not allow recovery. This court has reversed and remanded for an evidentiary hearing to consider Casey’s state of mind when he jumped. I do not think that is necessary.
Casey concedes in his brief that he “threw himself’ onto the tracks in an “attempted suicide.” I think those characterizations resolve the coverage question. Casey does not allege that he wandered onto the tracks in some trance-like state brought about by mental infirmity. If he alleged that, we might be permitted to consider his injuries accidental. The reasonable presumption is that Casey waited for the train and jumped at the exact moment the train passed. A suicide attempt is a deliberate act. See Black’s Law Dictionary, Special Deluxe Fifth Edition, 1286 (1979) (suicide is “the deliberate termination of one’s existence”). An accident, on the other hand, is always a chance event. Id. at 14. By definition, if an event is deliberate— like a suicide attempt — it can not be considered an accident. There is no need for an evidentiary hearing to consider whether Casey was insane. By conceding that he “threw himself’ onto the tracks in an “attempted suicide” he admits that he acted deliberately.
Federal courts are in the process of developing federal common law rules of contract interpretation for ERISA cases. Senkier v. Hartford Life & Acc. Ins. Co., 948 F.2d 1050, 1051 (7th Cir.1991). The consensus which has emerged is that we interpret words in an ERISA policy in an ordinary and popular sense as would a person of average intelligence and experience. Meredith v. Allsteel, Inc., 11 F.3d 1354, 1358 (7th Cir.1993). This rule, borrowed from state contract law, makes our task in this case routine: we simply ask whether a suicide attempt can be considered accidental, as the average person understands that word. Unlike the court, I find no ambiguity in the word accidental — it is a term of familiar meaning. “When a man has died in such a way that his death is spoken of as an accident, he has died because of an accident, and hence by accidental means.” Wickman v. Northwestern Nat. Ins. Co., 908 F.2d 1077, 1086 (1st Cir.1990) (quoting Justice Cardozo’s dissent in Landress v. Phoenix Mutual Life Ins. Co., 291 U.S. 491, 499 , 54 S.Ct. 461, 464 , 78 L.Ed. 934 (1934)). I do not believe the average person speaks of attempted suicide as an accident.
If Casey truly attempted suicide, then he expected to die. “If he actually expected the result, even if he did not specifically intend it, then his actual expectations make his death not accidental.” Wickman, 908 F.2d at 1089 . That he did not die may have been fortuitous, but it is no reason to cast his attempt as an accident. Nor is there a reason for an evi-dentiary hearing to assess Casey’s sanity. Even if his intent was informed by insanity, rather than clear reason, he expected to die when he deliberately jumped in front of the train. Therefore, the injuries that resulted from his unsuccessful attempt were not accidental. I would affirm the district court on the ground that a suicide attempt cannot be considered accidental. Daniel Casey’s insanity might mitigate his moral responsibility for his actions, but it certainly does not shift financial responsibility to a monolithic insurer which only agreed to cover injuries “sustained accidentally”.