The opinion of the court was delivered by: Kennedy, District Judge.
Plaintiffs James Patrick Hamilton, Jill McLaughlin and Robin
McLaughlin claim that defendant AIG Life Insurance Company
("AIG") violated the Employee Retirement Income and Security Act
(ERISA), 29 U.S.C. § 1001 et seq., by refusing to pay them
benefits they claim they are due as beneficiaries under an
insurance plan that covered the life of Bruce McLaughlin. AIG
moves for summary judgment on the grounds that no benefits are
owed because McLaughlin's death resulted from an "intentionally
self-inflicted injury," a manner of death excluded from the
insurance plan's coverage. Upon consideration of AIG's motion,
the opposition thereto, and the record of this case, the court
concludes that the motion should be granted.
At the time he died, Bruce McLaughlin was an employee of Cisco
Systems, Inc. ("Cisco") and was a participant in Cisco's
Accidental Death & Dismemberment ("AD & D") life insurance plan.
The plan provides benefits for members who die as a result of
injuries suffered while covered by the plan, but excludes
coverage for death caused by, or resulting from, "suicide or any
attempt at suicide or intentionally self-inflicted injury or any
attempt at self-inflicted injury." Def. Mot. for Summ. J.,
Zimmerman Aff., Ex. B, at 7. AIG, the author of Cisco's life
insurance plan, is also the plan's administrator.
McLaughlin named plaintiffs, his partner Hamilton and his
siblings Jill and Robert McLaughlin, as the policy's
beneficiaries.*fn1 Soon after McLaughlin's death, plaintiffs
filed a claim with AIG for death benefits. As part of its claim
investigation, AIG obtained a police report of McLaughlin's
death, an autopsy report, and McLaughlin's death certificate.
Based on these reports, AIG believed that McLaughlin's death
resulted from autoerotic asphyxiation, an act where one seeks to
enhance sexual stimulation by restricting the flow of oxygen to
the brain. AIG determined that when McLaughlin set up his
apparatus, he tied his ropes too tight, causing him to
accidentally choke himself to death while engaging in his act of
sexual gratification. As a result, the insurance company
concluded that McLaughlin was not covered because his death
resulted from the "intentionally self-inflicted injury" of
AIG did not deny the claim immediately, however, but requested
advice from Robert Morris of the law firm of Epstein, Becker &
Green as to whether the law allowed insurance companies with
"intentionally self-inflicted injury" exclusions to deny a claim
arising out of a death by autoerotic asphyxiation. In his review
of the matter, Morris stated that the law was limited and
unclear, but provided some basis for denying plaintiffs' claim.
On March 3, 1998, based on the police report of McLaughlin's
death, the autopsy report, the death certificate, and the outside
legal opinion it obtained, AIG denied plaintiffs' claim on the
ground that it was excluded by the "intentionally self-inflicted
injury" provision of Cisco's life insurance plan.
Plaintiffs appealed the denial through AIG's internal review
procedures, claiming that McLaughlin's death was not the result
of an intentionally self-inflicted injury. In support of their
appeal, plaintiffs submitted an affidavit from Dr. Michael G.
Gelles, a psychologist who claimed extensive experience in
reviewing and investigating autoerotic fatalities. Gelles
suggested that McLaughlin did not intend to cut off the flow of
oxygen to his brain but rather had created a bondage-style
setting that was part of a staged fetishistic masturbation scene.
In other words, McLaughlin's sexual stimulation derived from the
visual pleasure of seeing himself in bondage attire and not from
any self-induced hypoxia.*fn2
Based on the opinions of Dr. Lewis and Frank Morris, AIG denied
plaintiffs' appeal. This suit followed.
II. SUMMARY JUDGMENT STANDARD
Under Federal Rule of Civil Procedure 56, summary judgment
shall be granted if the pleadings, depositions, answers to
interrogatories, admissions on file, and affidavits show that
there is no genuine issue of material fact in dispute and that
the movant is entitled to judgment as a matter of law. Facts
"that might affect the outcome of the suit under the governing
law" are material. Anderson v. Liberty Lobby, Inc.,
477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). The non-movant's
opposition must consist of more than mere unsupported allegations
or denials and must be supported by affidavits or other competent
evidence setting forth specific facts showing that there is a
genuine issue for trial. See Fed.R.Civ.P. 56(e); Celotex Corp.
v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).
The non-movant's evidence must be of a nature "that would permit
a reasonable jury to find" in its favor. Laningham v. Navy,
813 F.2d 1236, 1242 (D.C.Cir. 1987). Evidence that is "merely
colorable" or "not significantly probative," is not sufficient to
sustain a grant of summary judgment. Anderson, 477 U.S. at
249-50, 106 S.Ct. 2505.