United States Sixth Circuit

In plaintiff's ERISA suit against an insurance company for denying his claim for dismemberment benefits arising from a drunk-driving motorcycle accident, summary judgment for defendant-plan administrator is reversed and remanded for entry of judgment in favor of the plaintiffs where: 1) defendant's decision to deny benefits to the plaintiffs was contrary to the everyday meaning of the word "accidental" as it would be understood by a typical policyholder, and was based almost entirely on a body of largely distinguishable district court cases; 2) plaintiff's injuries were not "highly likely to occur" as a result of his intoxication, in contrast to the injuries that were highly likely to occur under the facts in Lennon; 3) defendant's interpretation of the Plan's provisions amounts to an additional, unwritten exclusion for all drunk-driving injuries, which is not permitted under even the most deferential standard of review; and 4) defendant's denial of coverage based on plaintiff's injuries being non-accidental was unreasonable, arbitrary and capricious.

Appellate Information

• Decided 11/13/2009
• Published 11/13/2009

Judges

• Before: GILMAN and McKEAGUE, Circuit Judges;  SARGUS, District Judge.

Court

• United States Sixth Circuit

Counsel

• For Appellees:
  
• ARGUED:  Matthew D. Greenwell, Charles V. Longo Co., L.P.A., Beachwood, Ohio, for Appellant.  Rebecca B. Jacobs, Ulmer & Berne LLP, Columbus, Ohio, for Appellees.   ON BRIEF:  Matthew D. Greenwell, Charles V. Longo Co., L.P.A., Beachwood, Ohio, for Appellant.  Rebecca B. Jacobs, Ulmer & Berne LLP, Columbus, Ohio, Richard D. Sweebe, Patricia A. Shlonsky, Ulmer & Berne LLP, Cleveland, Ohio, for Appellees.