Hartford denied the plaintiff's appeal and upheld its prior decision to deny accidental death
benefits. (Def. 56.1 Stmt. at § 31.)

On June 26, 2002, the plaintiff filed a complaint in the Circuit Court of Cook County
seeking payment of the accidental death benefits. On July 30, 2001, Hartford removed the
case to federal court pursuant to 28 U.S.C. § 1441.

DISCUSSION

Summary judgment is proper “if the pleadings, depositions, answers to interrogatories,
and admissions of file, together with affidavits, if any, show that there is no genuine issue as to
any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed, R.
Civ. P. 56(c). The party seeking summary judgment carries the initial burden of demonstrating
an absence of evidence to support the position of the non-moving party. Doe v. R.R.

Donnelley & Sons, Co., 42 F.3d 439, 443 (7th Cir. 1994). The non-moving party must then set
forth specific facts showing there is a genuine issue of material fact and that the moving party is
not entitled to judgment as a matter of law. Anderson v, Liberty Lobby, 477 U.S. 242, 252, 106
S.Ct. 2505 (1986). A genuine dispute about a material fact exists only if the evidence is such
that a reasonable jury could return a verdict for the non-moving party. Celotex Corp. v. Catrett,
477 US. 317, 323-24, 106 S.Ct. 2548 (1986).

In making this determination, the Court must draw every reasonable inference from the
record in the light most favorable to the non-moving party and should not make credibility
determinations or weigh evidence. Association Milk Producers, Inc. v. Meadow Gold Dairies,
Inc., 27 F.3d 268, 270 (7th Cir. 1994). The non-moving party must support its contentions with

admissible evidence and may not rest upon mere allegations in the pleadings or conclusory


“circumstance where it is reasonably foreseeable that death will occur.” (Def. Memo at 8-9.)
Hartford insists that this interpretation is consistent with the opinions of numerous courts. See,
e.g., Cozzie v. Metropolitan Life Ins. Co., 140 F.3d 1104 (7th Cir. 1998) (car crash was not an
“accident” because it was a reasonably foreseeable consequence of driving while extremely
intoxicated); Wickman v. Northwestern Nat'l Ins. Co., 908 F.2d 1077 (1st Cir. 1990) (discussing
the difficulties courts have in deciding what constitutes an accident, and finding that death was
not accidental when it was the foreseeable result of voluntary hazardous conduct). Thus,
Hartford maintains that because the decedent knew or should have know that death or serious
bodily injury was substantially likely to occur as the result of his foolhardy pursuits, his demise
was reasonably foreseeable and not accidental.

The plaintiff challenges Hartford’s decision to deny accidental death benefits as arbitrary
and capricious on the grounds that the defendant’s interpretation of the term “accident” was
“downright unreasonable.” Morton, 91 F.3d at 870. Specifically, she has asserted that the
analysis of whether an incident was “accidental” should be much more subjective than what
Hartford has suggested in its papers. Citing the Seventh Circuit’s decision in Santaella v.
Metropolitan Life Ins. Co., 123 F.3d 456 (7th Cir. 1997), she argues that the proper inquiry is
“the subjective expectation or intent of the decedent” when deciding whether a fatal incident can
be classified as an “accident.” As an aside, we note that the court in Santaella was employing a
de novo standard of review, and, as we stated above, the standard of review in this case is the
arbitrary and capricious standard.

In order to resolve the dispute between the parties on the issue of the correct

interpretation of the term “accident” in this case, we turn to the Seventh Circuit’s decision in


forward in the case would center around whether Hartford was justified in its decision to
withhold accidental death benefits after the tragic pipe bomb explosion. The plaintiffs breach of
fiduciary duty arguments are outside the scope of both this agreement and the literal language of
the complaint. Therefore, the breach of fiduciary duty claims will not be addressed by this Court
in considering the cross-motions for summary judgment.

IL. Hartford’s Denial of Accidental Death Benefits

L Standard of Review

In light of ERISA’s governance of the benefit plan at issue in this case, we must look to
that statute’s standard of review. The Supreme Court has held that “a denial of benefits under
[ERISA] is to be reviewed under a de novo standard unless the benefit plan gives the
administrator fiduciary discretionary authority to determine eligibility for benefits or to construe
the terms of the plan.” Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct.
948 (1989) (emphasis added). When, as here, an ERISA benefits plan grants such authority to a
plan administrator, this Court must review the denial of benefits under the arbitrary and
capricious standard. See Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d
771, 773 (7th Cir. 2003); Hess v. Hartford Life & Accident Ins. Co., 274 F.3d 456, 461 (7th Cir.
2001).

It is undisputed that the plan provides that Hartford “has full discretion and authority to
determine eligibility for benefits and to construe and interpret all terms and provisions of the
Group Insurance Policy.” (Hartford Insurance Benefits Plan at 3.) Because this language clearly
gives Hartford the discretion to make benefits determinations and construe the terms of the plan,

the plaintiff can only prevail if Hartford’s decision to deny accidental death benefits was arbitrary



statements in affidavits. Celotex, 477 U.S. at 324, The plain language of Rule 56(c) mandates
the entry of summary judgment against a party who fails to establish the existence of an element
essential to its case and on which that party will bear the burden of proof at trial. The production
of only a scintilla of evidence will not suffice to oppose a motion for summary judgment.
Anderson, 477 U.S. at 252. In situationsy such as here, when the facts are largely uncontested
and the issues are legal ones, the parties’ cross-motions present an opportunity for resolution of
these issues without the need for trial.
I. Preliminary Issues

In her complaint, the plaintiff has essentially brought an ERISA claim against Hartford
for the recovery of accidental death benefits which she feels the estate is entitled to receive. In
her initial brief in support of her cross-motion for summary judgment, however, the plaintiff for
the first time raised two breach of fiduciary duty claims against the defendant. Specifically, she
has alleged that Hartford breached its fiduciary duty to the plaintiff by misrepresenting the self-
inflicted injury exclusion in its original denial of the accidental death benefits claim. She also
has asserted that Hartford breached its fiduciary duty by failing to administer the benefit plan in
accordance with the plan documents. However, it is settled law in this circuit that, on a motion
for summary judgment, it “is too late in the day to be adding new claims.” Auston v. Schubnell,
116 F.3d 251, 255 (7th Cir. 1997); see also Greisz v. Household Bank, 8 F. Supp. 2d 1031,
1041-42 (N.D. Ill. 1998) (refusing to consider new allegations for the first time at the summary
Judgment stage), Teall v. City of Chicago, 986 F. Supp. 1098, 1101 (N.D. Ill. 1997) (holding that
a new claim raised on a motion for summary judgment is “not properly before th[e] court” and

refusing to consider that claim). The parties agreed in open court that the only legal issues going


B. Review of Hartford’s Decision

We now address whether Hartford’s decision to deny the plaintiff’s accidental death
benefits claim can be sustained under the arbitrary and capricious standard of review. Under this
standard, we evaluate the following factors that the Seventh Circuit set forth in Chalmers v.
Quaker Oats Co,, 61 F.3d 1340, 1340, 1344 (7th Cir. 1995):

[T]he impartiality of the decision making body, the complexity of the issues, the
process afforded the parties, the extent to which the decision makers utilized the
assistance of experts where necessary, and finally the soundness of the fiduciary’s
ratiocination.
The first four factors require us to examine the detail in which the administrator examined the
facts surrounding the decision. In this case, there is little disagreement about the factual situation
involved or the opportunity for Komperda to address Hartford regarding the reasons for its
decision. While it is true that the plaintiff has argued in her motion that Hartford either
disregarded or failed to properly consider the determination of the coroner’s jury that the cause of
death was “accidental,” the undisputed evidence shows that Hartford reviewed the entire claim
file, including the coroner’s reports and jury findings, before rendering its final decision. (Def.
56.1 Stmt. at § 24.) Thus, the central dispute between the parties in this case revolves around the
last Chalmers factor — the soundness of Hartford’s “ratiocination” to deny Komperda’s claim for
accidental death benefits based on its interpretation of the term “accidental injury.”

Hartford argues in its motion for summary judgment that the decedent’s death was not an
“accident” within the terms of the plan because he voluntarily drilled into a metal pipe packed
with gunpowder. Further, as stated in its motion, Hartford determined that Komperda’s death

was not an “accident” because it was not “an unforeseeable event,” but instead was a


Zs

Minute Order Form (06/97)

United States District Court, Northern District of Illinois

ned Judge Wayne R. Andersen Sitting Judge if Other
rate Judge than Assigned Judge
CASE NUMBER 02 C 5359 DATE $/13/2003
CASE Komperda vs. Hartford Life and Accident Ins.
TITLE

[in the following box (a) indicate the party filing the motion, e.g., plaintiff, defendant, 3rd party plaintifT, and (b) state briefly the nature
of the motion being presented.

ay

MOTION:

DOCKET ENTRY:

qa) im Filed motion of [ use listing in “Motion” box above.]

(2) a Brief in support of motion due

(3) im Answer brief to motion due . Reply to answer briefdue___-

(C3) QO Ruling/Hearing on set for at

(5) G Status hearing{held/continued to] (set for/re-set for] on setfor at _

(6) a Pretrial conference[held/continued to] [set for/re-set for] on setfor at

(7) a Trial[set for/re-set for]on at

(8) Oo [Bench/Jury trial] [Hearing] held/continued to at

(9) im} This case is dismissed [with/without) prejudice and without costs[by/agreement/pursuant to]
QFRCP4(m) C Local Rule 41.1 OO FRCP4i(a)(1) OO FRCP41(a)(2).

| {Other docket entry] Enter memorandum opinion and order. Defendant’s motion for summary

judgment pursuant to Federal Rule of Civil Procedure is granted. The plaintiff's motion for summary
judgment is denied. Judgment is hereby entered on behalf of the defendant. This case is terminated.

a {For further detail see order attached to the original minute order.]

No notices required, advised in open court. [

No notices required.

Notices mailed by judge’s stat.
Notified counsel by telephone.
Docketing to mail notices,

Mail AO 450 form.

Copy to judge/magistrate judge,

courtroom
mm deputy’s
initials

Document:
Number.

nuniber of notices Lateran te

Date/time received in
central Clerk's Office

datepocketed

docketing deputy initials

May t 4 9p03

date mailed notice

mailing deputy initials



Undoubtedly aware of the court’s ruling in Cozzie, Hartford in this case used the
discretionary authority granted it under the terms of the plan to define the term “accident” in a
way that is virtually identical to that approved by the Cozzie court. In both Cozzie and the instant
case, the plan administrators interpreted the term “accident” to be an event that is “not reasonably
foreseeable” and they determined that a death resulting from an act in which death is a reasonably
foreseeable consequence is not an “accident independent of all other causes” under the terms of
the policies. Such a determination is certainly rational given the factual situation Hartford was
presented with when it considered this accidental death benefit claim.

The undisputed facts in this case demonstrate that Mr. Komperda had a fascination with
homemade explosives. He would fill a pipe, either metal or plastic, with gunpowder, place a
long wick into the end of the device, set it in the middle of a field, and watch it blow up. On the
day in question, things did not work out as planned. While he was in his garage trying to drill
into the metal casing of the pipe to insert the wick, a spark apparently ignited the gunpowder and
the device exploded in his face. We do not need an expert’s report to tell us that drilling into
anything filled with gunpowder without the proper training and safety equipment is an extremely
dangerous, if not potentially lethal, endeavor. We agree with Hartford that death is a reasonably
foreseeable consequence of engaging in such behavior. Thus, we find that Hartford’s decision to
deny accidental death benefits in this case was based on “a ‘rational connection’ between the
issue to be decided, the evidence in the case, the text under consideration, and the conclusion
reached.” Exbom, 900 F.2d at 1143.

On the other side of the equation, the plaintiff offers an alternative definition for the term

“accident.” She contends that whether something is an accident is inherently a subjective

11


Cozzie. In that case, the court was faced with an analogous fact pattern and its analysis of the
applicable standard of review with respect to those facts is dispositive of the issues presented
here. In Cozzie, the defendant, MetLife, denied the plaintiff's ERISA claim for the recovery of
accidental death benefits after the plan participant died as the result of an alcohol-induced car
crash. Cozzie, 140 F.3d at 1106. At the time of the crash, the decedent’s blood alcohol level was
more than twice the legal limit. Jd. MetLife denied the claim for accidental death benefits on the
basis that the car crash was not an “accident” under the terms of the plan because “it was
reasonably foreseeable that [the plan participant], having ingested the quantity of alcohol that he
did ingest, would suffer a fatal injury if he got behind the wheel of an automobile in such a state
of inebriation.” Jd. at 1108.

Since the plan in Cozzie gave MetLife discretionary authority to construe the plan’s
terms, the Seventh Circuit applied the “extremely deferential” arbitrary and capricious standard
of review to MetLife’s decision. Id. at 1111. Accordingly, the Seventh Circuit acknowledged
that the plan gave MetLife the discretion to define the term “accident.” Specifically, the court
stated that “the definition given the term ‘accident’ by MetLife is not incompatible with the
interpretation that has been given that term in other insurance contexts.” Jd. at 1109. Using the
approach articulated in the First Circuit, the Seventh Circuit stated that “[i]f the insured did not
believe that the result would occur, we must consider whether such an estimation can be
considered reasonable. If the expectations of the insured were objectively reasonable, then
injuries or death resulting therefrom are not accidental.” Jd. at 1110. (citing Wickman, 908 F.2d
at 1088). The court concluded that, “in light of the reasoning underlying the definition,”

MetLife’s definition of “accident” was not “downright unreasonable.” Id.

10



and capricious.

The Seventh Circuit has described the arbitrary and capricious standard as “the least
demanding form of judicial review of administrative action.” Trombetta y. Cragin Fed. Bank
First Sav. Employees Stock Ownership Plan, 102 F.3d 1435, 1438 (7th Cir. 1996). The standard
necessitates a deferential review of the administrator’s decision that is limited to the
administrative record. See Perlman v. Swiss Bank Corp. Comprehensive Disability Prot. Plan,
195 F.3d 975, 981-82 (7th Cir. 1999). An administrator, empowered with such a high level of
authority, enjoys a “broad, unchanneled discretion to deny claims.” Herzberger v. Standard Ins.
Co., 205 F.3d 327, 333 (7th Cir. 2000). Consequently, an administrator’s decision must be more
than “clearly incorrect, but downright unreasonable” to be deemed arbitrary and capricious.
Mortion v. Smith, 91 F.3d 867, 870 (7th Cir. 1996) (citation omitted).

In evaluating an administrator’s action, the Seventh Circuit has urged that the judicial
focus be on whether the decision of the administrator can be characterized as a rational one. See
Exbom y. Central States S.E. & S.W. Areas Health & Welfare Fund, 900 F.2d 1138, 1143 (7th
Cir. 1990). If the administrator has made “‘a ‘rational connection’ between the issue to be
decided, the evidence in the case, the text under consideration, and the conclusion reached, then
the [administrator’s] decision is final.” Jd. In the context of this case, we need not determine
whether we would have come to the same conclusion as Hartford or even have depended on the
same authority on which the company relied. See James v. General Motors Co., 230 F.3d 315,
317 (7th Cir. 2000). Instead, we need only find that Hartford’s decision was not so “downright

unreasonable” to be deemed arbitrary and capricious. Morton, 91 F.3d at 870.


beneficiaries receive payments when the participant dies (from any cause) while covered by the
program. Additional coverage is also provided under the accidental death, dismemberment
and loss of sight provision when death occurs from injuries caused solely by “accident.”

These benefits are paid if the participant dies while insured and the “loss results directly from
such injury, independent of all other causes... .” (Def. 56.1 Stmt. at {9.) Accidental death
benefits are not available, however, when death is caused by injuries that were “intentionally
self-inflicted ....” (Def. 56.1 Stmt. at { 10.)

The decedent was enrolled in both of these plans in the amount of $10,000 each. He
designated his wife, the plaintiff in this case, as the beneficiary. On February 13, 2001,
Central Steel and Wire Company submitted a claim to Hartford for life insurance benefits in
the amount of $10,000 and accidental death benefits in the amount of $10,000, payable to the
plaintiff. On June 8, 2001, Hartford notified the plaintiff in writing that her request for
accidental death benefits had been denied. (Def. 56.1 Stmt. at { 24.) Hartford’s explanation
of the decision to deny the accidental benefits was two-fold. Hartford first reasoned that
Komperda’s death was a reasonably foreseeable consequence of his construction of a pipe
bomb andy thus, his death was not the result of an accidental injury independent of all other
causes. (Def. 56.1 Stmt. at § 27.) In addition, Hartford concluded that because Komperda
constructed the pipe bomb of his own volition, the intentionally self-inflicted injury exclusion
precluded recovery of accidental death benefits under the policy. .

On July 25, 2001, the plaintiff appealed Hartford’s denial of accidental death benefits.
On August 21, 2001, according to the terms and conditions of the policy, Hartford paid
general life insurance benefits to the plaintiff in the amount of $10,000. On October 19, 2001,

3


fact exploded, blowing him up.
(Def. 56.1 Stmt. at § 13.)

During their investigation, the Will County Sheriff's Department interviewed Mike
Jajkowski, a fried of Komperda, who stated that he was with Komperda when Komperda
started making pipe bombs a month before the explosion. Initially, Komperda made the pipe
bombs by filling PVC pipes with black powder, capping the ends of the pipe, and inserting a
cannonball wick after drilling a hole in the end cap. (Def. 56.1 Stmt. at 415.) The first bomb
that Komperda made had a wick approximately 15 to 20 feet long “so they could be a safe
distance away from the bomb before it blew up.” (Def. 56.1 Stmt. at §16.) After the two
men detonated the first pipe bomb, Jajkowski was “somewhat scared because of the large
explosion.” (Def, 56.1 Stmt. at 4.17.) In addition, Jajkowski “further advised that one of the
PVC pipe bombs was partially completed at his residence by himself and James [Komperda],
however, he did not want to have any of that stuff at his house so he never allowed James to
finish any of the bombs at his home again.” (Def. 56.1 Stmt. at § 18.) Apparently, this
statement forced Komperda to continue his bomb making in his own garage, eventually
concluding with the explosion that took his life in October 2000.

At the time of his death, the decedent was a participant in Central Steel and Wire
Company’s employee welfare benefit plan. The plan is an employee welfare benefit plan
regulated by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §
1001 et seq., through its purchase of group insurance issued by defendant Hartford Life and
Accident Insurance Company (“Hartford”) to Central Steel and Wire Company’s health plan
trust. (Def. 56.1 Stmt. at 5.) Under the plan’s basic life insurance coverage, a participant’s

2


IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS F | fea
EASTERN DIVISION L =D
PATRICIA KOMPERDA, Special ) flay 1 3 2003
Administrator for James J. Komperda, _) Micu,
Deceased, ) CLERK, U.S. Die DOBBINs
) RICT Coury
Plaintiff, ) No. 02 C5359
)
v. ) Wayne R. Andersen
) District Judge oy
HARTFORD LIFE AND ACCIDENT ) vanes eS ~ °
INSURANCE COMPANY, ) eo
) F ageuettd
Defendant. ) g

wr 3 4 2003

MEMORANDUM, OPINION AND ORDER
This case is before the Court on the cross-motions for summary judgmeng bggyetivd 9" ~ _
plaintiff Patricia Komperda and defendant Hartford Life and Accident Insurance Company
pursuant to Federal Rule of Civil Procedure 56. For the following reasons, the defendant’s
motion for summary judgment is granted and the plaintiffs motion for summary judgment is
denied.
BACKGROUND
On October 1, 2000, the plaintiff’s decedent, James Komperda, died as the result of
multiple injuries he suffered when a pipe bomb he was constructing exploded prematurely. An
investigation by the Will County Sheriff's Department determined that the pipe bomb
explosion that caused Komperda’s death occurred when he was
putting the pipe bomb together having the end caps and the gunpowder into the
pipe bomb itself and then [bringing] the drill press down in this type fashion

(indicating), the drill bit coming into the head of the cap of the end cap of the
bomb; and at that time with the friction and the gunpowder, the pipe bomb in

ol


analysis. To her, an accident is an event the result of which is unintended from the perspective of
the participant. With respect to this case, the plaintiff has argued that the explosion was an
accident because her husband did not intend to die when he drilled into the explosive laden pipe.
While we agree with the plaintiff that her definition of “accident” is a reasonable one (and, in
fact, has been adopted by some courts), our job in this case is not to decide which definition of
“accident” is best. In fact, our opinion on that question is irrelevant. Instead, our role in this case
is solely to decide whether Hartford’s definition was “downright unreasonable,” given the facts
and evidence, under the arbitrary and capricious standard of review. As we have already stated
above, we find that Hartford’s interpretation of the plan term “accident” was reasonable and,
therefore, we conclude that its decision to deny accidental death benefits was neither arbitrary nor
capricious.

Finally, as a result of this conclusion, it is not necessary for us to address whether the
decedent’s injury was “intentionally self-inflicted” within the meaning of the plan.

CONCLUSION

For the foregoing reasons, the defendant’s motion for summary judgment pursuant to
Federal Rule of Civil Procedure 56 is granted. The plaintiff's motion for summary judgment is
denied. Judgment is hereby entered on behalf of the defendant. This case is terminated. This is
a final and appealable order.

it is so ordered.

O. Cz

Wayne R. Andersen —
United States District Judge

Dated:

12