In a dispute over the payment of accidental death benefits, Boyer v. Schneider Elec. Holdings, Inc., No. 19-3144, __F.3d__, 2021 WL 1244397 (8th Cir. Apr. 5, 2021), the Eighth Circuit Court of Appeals just issued an upset to an ERISA plan beneficiary.
Plaintiff-Appellee Amber Boyer was the beneficiary of an ERISA-governed accidental death benefits policy covering Eric Boyer, who died in a single-vehicle crash. Defendant-Appellant Unum Life Insurance Company (“Unum”) denied Amber’s claim on the basis that Eric died in the commission of a crime—speeding and passing vehicles in a no-passing zone—which fell under the “crime” exclusion in Eric’s insurance plan. The policy does not cover accidental losses “caused by, contributed to by, or resulting from … an attempt to commit or commission of a crime.” The district court determined that Unum’s interpretation of the crime exclusion was unreasonable and granted summary judgment for Amber. Boyer v. Schneider Elec. Holdings, Inc. Life & Accident Plan, 350 F. Supp. 3d 854 (W.D. Mo. 2018), rev’d and remanded sub nom. Boyer v. Schneider Elec. Holdings, Inc., No. 19-3144, 2021 WL 1244397 (8th Cir. Apr. 5, 2021). The Eighth Circuit disagreed and reversed the judgment.
First, the court determined that Unum’s decision was based on substantial evidence: five witnesses observed Eric’s vehicle weaving into the opposite lane of traffic attempting to pass several vehicles in a no-passing zone. The road was clearly marked as a “no passing zone” and an off-duty police sergeant assessed Eric’s speed as approximately 80 miles per hour where the posted speed limit was 35 miles per hour. Even considering the icy roads and the medical examiner’s determination that Eric’s death was an “accident,” it was reasonable for Unum to conclude that Eric’s speeding and improper passing contributed to the crash.
Second, Unum’s interpretation of the crime exclusion to Eric’s conduct was reasonable. Speeding and improper passing are misdemeanors under Missouri law and punishable by jail time. They are also crimes under the dictionary definition of “crime.” The district court was concerned that the term “crime” does not encompass “traffic violations,” but here Eric was driving recklessly, more than twice the speed limit. It is not a situation where he was driving barely over the speed limit. Even though Unum’s claims manual says the crime exclusion is not intended to apply to activities which would generally be classified as traffic violations, this manual was not provided to Eric and would not have affected his reasonable expectations. Eric’s conduct was classified as a crime under state law; it was not a minor traffic infraction. Even though the Summary Plan Description does not mention traffic violations, an average participant would believe Eric’s violations of law are contemplated by the word “crime.” The court remanded the case with directions to enter judgment for the defendants.
If you have a denied accidental death benefits claim, contact us for a complimentary case evaluation.