Pursuant to 5 T H C IR . R. 47.5, the court has determined that thi s opinion should not * be publishe d and is not precedent except under the limited circu mstance s set forth in 5 T H C IR . R. 47.5 .4. 

### INTHE UNITED S TATESCOU RT OFAPPEALS

FORTHEFIFTH CIRCU IT

N o. 09- 50853 Su m m ar y Cal endar
T O B I D AV IS , P l a i n tiff - A p p ell a n t v. L IF E IN S U R A N C E C O M P A N YO F N O R T H AM E R IC A , D efen da n t- A pp el l ee

A p p ea lf

rom the U n i tedS tates D i stri ct C ou rt f or th e W est ern D i st ri ctof T exas U SD C N o. 6: 08- C V

- 230
B e fo r e H IG G IN B O T H A M , C L E M E N T , a n dS O U T H W IC K , C ir c u it J u d g e s . P E R C U R IA M: * T obiD avis al l eges t h at th e L i fe I n suran ce C om pa n y of N ort h A m eri ca (“ L IN A” ) w rongful l y den i ed ben ef i t s un der a pl an covered by t h e E m pl oyee R e tir e m e n t In c o m e S e c u r ityA c t o f 1 9 7 4
. S ee 29 U
. S. C. § § 1 00 1- 14 61
. Af t e rt he den i al , M s. D avis sough trelief in di st ri ctcourt , w h i ch gran t ed su m m ary j u dg m en ti n favor of L IN A
. S h e a pp eal s, cl ai m i n g w rongfulden i alof ben ef i t s. F in d in gn o a b u s e o f d is c r e tio n , w e A F F IR M
. United States Court of App eals Fifth Circuit 

### F I L E D May 26, 2010 Lyle W . Cayce Clerk Case: 09-50853 Document: 00511122444 Page: 1 Date Filed: 05/26/2010N o. 09- 50853

2 FA CT S AND PR OCEDURAL HI S TORY The unde r l yi ng fac t s of t hi s ca s e ar e noti n di s put e . Tob iD av i s ’ s hus ba nd, C ar lC hes t erD avi s, w as k i l l ed w hen hi s m ot or c yc l e cr as hed on O c t obe r7, 2006. A tt h e t i m e of

t h e cr ash , M r. D avis w as operati n g t h e m ot o rc y cl e w i t h a bl ood al c o ho ll e ve la bo vethe s t at e l i m i to f 0
. 08 %
. M r . D av i s w as dr ivi ng ab ove t he
s ix ty -m ile s -p e r -h o u rs p e e dlim it, a n dh is m o to r c y c le le ft th e r o a da t acu rv e in t he r oad. N o o t herve h i cl es w ere i nvolved. The c ause of death w as l i st ed as

“ m ul t i pl e bl unt f

o r c e i nj ur i e s . ” The c r as h o c c ur r e d i n da yli ght , w i t h c l ear or c lo u d yw e a th e ra n dad r yro a ds u r fa c e . T h e f ore n sict oxi col ogi sthi red by L IN Adeter m i n ed M r. D avis ’ s bl ood al coholcontent t o be betw een 0. 28% an d 0. 368 %
. H e rep ort ed t h at at th i s l evel of i nt oxi c at i on, M r . D avi s w oul d have a del ayed r esp on se t i m e a nd w oul d be
m ore li kely t o t ak e great er ri sks. F u rt h er, an i n divi du alw i t h t h at bl ood alc oh ol l e ve lw o ul d ha vei m pa i r e d s e ns o r y- m o t o rs kil l s , a t t e nt i o n, j udg m e nt , a nd control , as w el las “redu ced vi sua la cui t y, red u ced peri ph eralvi si on , i n creased rea cti on ti m e, a n ddistu rb a n ces o f p erce p ti on of m oti on an ddim en sion s. ” T h e t oxi col ogi stconsi dered l ay w i t n ess st atem en t s th at M r. D avis di d n ot ap pea r i n t oxi cat ed, concl u di n g t h at “regardl ess of t ol eran ce [t o t h e ef fect s of al c o ho l , ] a taBA C of 0. 28 % M r . D av i s w o ul d ha veb e e n i m pa i r e d t o t he e xt e nt th a t it li k ely w a s a ca u sa tive fa ctor i n h i s cra sh l ea d i n g to h i s d ea th
. ” T h rough hi s em pl oyer, M r. D avis ha d grou p l i fe an d acci den ti n suran ce w i t h LIN A
. H e had l i fe i nsur ancecov er age, as w ellas t hre e t ypes of ac c i dent al de ath and di s m e m be r m e nt (“AD & D ” ) c o ve r ag e – ba s i c , vo l unt ary, and suppl em ent al
. The bas i cbe nef i t s w er e pai d f

orby M r . D avi s’ s em pl oye ras an em pl oyee ben ef

i t , an d M r. D avis ha d op t ed to pa y f or th e add i t i on alvol u n t ary a n ds u p p le m e n ta l co v e r a g e . A f t er her hu sban d’ s death, M s. D avis fi l ed a ti m el y cl ai m w i t h L IN Af or life in s u r a n c e b e n e fits a n dth e th r e e ty p e s o f A D & D b e n e fits
. L IN Ap a id Case: 09-50853 Document: 00511122444 Page: 2 Date Filed: 05/26/2010N o. 09- 50853

3 $ 1 0 5 ,0 0 0 inlife i n s u r a n c e b e n e fits , b u t d e n ie da ll A D & D b e n e fits
. T h e b a s ic A D & D b e ne f

i t s w e r e de ni e d b e c aus e t he po l i c y c o nt ai ne d a n e xp l i c i te xc l us i on f or i n t oxi cat i on . T h e vol u n t ary an d s u pp l em en t al ben ef i t s w ere denied becau se th e d e a th d idn o t m e e t t h e d e fin itio n o f a“C o v e r e dL o s s ” u n d e rth e p o lic y . M s. D avi s t w i c e a ppeal ed the de n i alof t he vo l untary and s uppl em ent al AD &D b e n e f

i t s , a n dL I NA a g a i n d e n i e dc o v e r a g e . I n e a c h de n i a l , L I NA exp l ai n ed that M r. D avis ’ s death did not m eet t h e d e fini t i on of a “ C overed Acc i de nt” und e rthe po l i c y. I n o ne o f t het hr e e de ni all e t t e r s , LI N A al s o c i t e d the
s e l f

- i nf l i c t e d i nj ur y e xc l us i o n. A fter L IN A ’ s f

i n alden i alof

coverage, M s. D avis f i l ed su i ti n t h e U n i t ed St at e s D i s t r i c tC o ur tfo rt he W e s t e r n D i s t r i c tof T e xa s . O n A ugu s t25, 2 00 9, t he d is tr ic t c o u r t g r a n te dL IN A ’ s m o tio n fo rs u m m a r yju d g m e n t. DI S CUS S I ON W e rev i ew the distri ct cou rt’ s gra n t of su m m a ryj u d gm en t de no vo a nd
a p p lyth e s a m e s ta n d a r d s a s th e d is tr ic t c o u r t. Cooper v. Hew let t
- Packa rd Co. , 59 2 F. 3d6 45 , 6 51 ( 5th Ci r . 2 00 9)
. W he n a n i ns ur anc e pl an has g r ant e d the ad m i n i st rat or di scr et i on ary au t h orit y t o con st rue t h e pl an ’ s t erm s, t h e st an da rd is o n e o f e x a m in in gfo ra n a b u s e o f d is c r e tio n . I d. a t 6 5 1 -5 2
. T h e di st ri ctcourti den t i f i ed the t w o- st ep i n qu i ry f or th i s r evi ew , w h i ch first i s to ex a m i n e w h eth er th e plan a d m i n i strato r’ s d ecisi on w a s l eg a l l y co rrect, and i f itw as not , t hen t o e val uat e w het hert he adm i n i st r at or ’ s di sc r et i on w as a b u s e d
. St o nev. U

NO CA L Te r m i nat i o n A l lo w anc ePlan , 57 0 F
. 3 d25 2 , 25 7 ( 5 th Cir . 2 0 0 9 )
. Whe n wema ymo r e r e a d i l ye v a l u a t e t h e e x e r c i s e o f d i s c r e t i o n , we m a ys k ip th e fir s t s te p inth e a n a ly s is
. Ho l land v . I nt ’lPape rCo. Ret i r e m e nt Plan , 5 76 F. 3d2 40 , 2 46 n. 2 ( 5t h Ci r . 2 00 9)
. W e t ak e t he l at t e ra ppr o ac h.

“Abus e of

di s c r e t i o n re vi e w i s sy no nym o us w i t h a rbit r ary andc ap r i c i o us rev i ew . ” Cooper , 592 F. 3d at652 (c i t i ng Me di t r us tFi n. Se r v s . Cor p. v . St e r l i ng Ch em s. , Inc. , 1 68 F. 3d2 11 , 2 14 ( 5th Ci r . 1 99 9) )
. W e w i l la f f i r m t he Case: 09-50853 Document: 00511122444 Page: 3 Date Filed: 05/26/2010N o. 09- 50853

4 a d m i n i strato r’ s d ecisi on if i t i s su p p ortedby“su b s ta n ti a lev i d en ce.” I d. E vi denc e i s c ons i der ed s ubst ant i alw her e iti s “ m or e than a sc i nt i l l a, l es s t han a pr e po nde r anc e , a nd i s s uc h r e l e vant evidenc e a s ar e as o nab l e m i nd m i ght
a ccep t a s a d eq u a te to su p p ort a co n cl u sion
. ” E l l i s v. L i berty L if e A ssuran ce Co. of B ost on , 3 94 F. 3d2 62 , 2 73 ( 5th Ci r . 2 00 5) (c i t at i o n o m i t t e d)
. An arbit r ary de c i s i o ni s o ne “ m ad e w i t ho utar at i o nalc o nne c t i o n b e t w e e n t he kno w n fac t s a nd th e d ecisi on . ” Medit rust , 1 6 8 F .3da t 2 1 5 (qu o ta tion m a rk s a n dcita tion om itted ).

“Apl an adm i n i st rat or abu ses i t s d iscr e tion w h ere th e deci si on i s not basedon e v id e n c e , e v e n if d is p u ta b le , th a t c le a r lys u p p o r ts th e b a s is fo rits d e n i a l.” Ho l land , 5 7 6 F .3 da t 2 4 6 (q u o ta tio n s m a r k s a n dcit a tio n s o m itt e d). Aconf l i ctof i n t erestocc u rs w h ere, as here, t h e sam e e n ti t y bears
r e s p o n s ib ilityfo rd e te r m in in ge lig ib ilitya n dfo rp a y in gb e n e fits
. Me t ro po l i t an Lif eIns . Co. v . G le nn , 554 U
. S
. 105 , 128 S
. C t . 234 3, 234 9 ( 200 8)
. T h at c on f l i ct i s w e i ghe d a s a fac t o ri n de c i di ng i f t he a dm i ni s t r at o rha s a bus e d it s di s c r e t i o n. I d. at2350. M s. D avi s c ont ends t hatt he adm i ni st r at or’ s i nt er pre t at i on o f t he pl an contradi ct s it s pl ai n m ean i n g an d constit u t es an ab u se of di scr et i on . Sh e cit es T o d dv . AIG L ifeIn s u r a n c eCo mp a ny , 47 F. 3d 1448 ( 5t h C i r . 1995)
. Though Toddin v o lv e ds im ila rco v e r a g e , th e re le v a n t t e r m s w e r e d iffe r e n t. T h e co u r t in Toddin te r p r e te dth e te r m “ a c c id e n ta l” in a n A D & D p o lic y . I d. at 145 2. O t h er c ite dA D & D ca s e s a ls o in v o lv e d iffe r e n t t e r m s . E
. g. , Wi ckm an v. Nw . Nat’ lI n s. Co. , 9 0 8 F .2 d1 0 7 7 (1 s t C ir . 1 9 9 0 ). H e r e , t he AD & D po l i c y pr o vi ded co ve r ag e t o a“ Cov e r e d Lo s s r e s ul t i ng dir e c t l y andi nde pe ndent l y o f a l lo t he rc aus e s f

r o m aCov e r e d Ac c i de nt . ” The po l i c y de f

i ne s a “ Cov e r e d A c c i de nt” as a “ s udd e n, unf o r e s e e ab l e , e xt e r nale ve nt t h at r esul t s, di rect l y an d i n dep en den t l y of al lot h er c au ses, i n a C overed Inj u ry or C ov ere dL oss . . . . ” Case: 09-50853 Document: 00511122444 Page: 4 Date Filed: 05/26/2010N o. 09- 50853

5 The po l i c y do e s no tde f i ne t he t e r m “ unf

o r e s e e ab l e . ” W e c o nc l ude t hatt he ad m i ni s t r at o rha s i nt e r pr e t e d “unf o r e s e e ab l e ” i n am anne rc o ns i s t e ntw i t h t he te r m ’ s p la in m e a n in g . See, e . g. , B l ac k’ s Law D i c t i onar y 649 ( 8th e d. 2004) ( defi n i n g f

oreseeabi l i t y as a “ qu al i t y of bei n g reasona bl y an t i cipa ta b le”). M r. D av i s w as dr ivi ng w i t h ab l o o d a l c o ho lc o nt e ntt hatw as , a ccor di ng t o t he to x ic o lo g is t’s e s tim a te s , so m e w h e r e b e tw e e n th r e e a n d ah a lf a n dfo u ra n dah a lf t i m es the l egal l i m i t . C on si deri n g t h e t oxi col ogi st ’ s f i n di n gs as t o t h e ef

fect s of
s u c h s e v e r e in to x i c a tio n , it w a s re a s o n a b le to d e c id e th a t a fo r e s e e a b le con seq u en ce of ri d i n g a m otorcy cl e in th a t con d i ti on w ou l d b e a seriou s ac ci d en t. T h e a d m in is tr a to r ’ s co n flic t o f in te r e s t d o e s n o t a lte ro u rc o n c lu s io n . W e t ak e i nt o a c c o untv ar i o us fac t o r s i n j udg i ng t he r e as o nab l e ne s s o f t he de c i s i o n. G le nn , 1 2 8 S . C t. a t 2 3 5 1
. W e f in dt h e a d m in is tr a to r ’ s c o n c lu s io n are a s o n a b le
on e for w h i ch n o ev i d en ce ori n feren ce ex i sts tha t it w a s affectedbya co n fli ct. Bec aus e w e ho l d the a dm i ni s t r at o r di d no ta bus e it s di s c r e t i o n i n de nyi ng c o ve r ag e b e c aus e t he de ath was no ta“ Cov e r e d Acc i de nt , ” w e do no t ad dr e s s t he ap pl i cabi l i t y of

an y ot h er pol i cy excl u si on s. AF F I RMED. Case: 09-50853 Document: 00511122444 Page: 5 Date Filed: 05/26/2010