Opinion ID: 2745906
Heading Depth: 3
Heading Rank: 2

Heading: Rice’s Accidental Death Benefits

Text: Rice was insured through a group life insurance policy issued by ReliaStar through his employer. The policy provided for basic and supplemental life insurance, and the Rice Plaintiffs, Rice’s beneficiaries under the policy, were entitled to receive accidental life benefits if Rice died as the result of a covered accident. Rice’s policy defined accident as “an unexpected, external, violent and sudden event.” After Rice’s death, the Rice Plaintiffs filed a claim for the $179,000 accidental death benefit. ReliaStar denied the claim, explaining that Rice’s death did not qualify as an accidental death; he put himself in a position in which he should have known that serious injury or death could occur as a result of his actions. The Rice Plaintiffs appealed the denial, and ReliaStar forwarded the appeal to its ERISA Appeals Committee, composed of three people who were not part of the original benefit determination. The ERISA Appeals Committee affirmed the 2 The parties dispute whether Rice still had his gun at the time he exited the vehicle. The deputies claim that Rice still had the gun in his hand while walking toward the kitchen, while the Rice Plaintiffs claim there is a genuine dispute regarding whether Rice still had the gun in his hand while walking toward the kitchen. As we discuss in greater detail below, see infra Part IV(A)(1)(ii), the record demonstrates that any dispute about this fact is not genuine. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986) (“[S]ummary judgment will not lie if the dispute about a material fact is ‘genuine,’ that is, if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.”). 3 Case: 13-30639 Document: 00512815979 Page: 4 Date Filed: 10/27/2014 No. 13-30639 denial of the claims. After the Rice Plaintiffs complained about the ERISA appeals process, ReliaStar agreed to provide a second appeal. As part of this second appeal, the committee interviewed Brandon Rice (“Brandon”), Rice’s son who was outside the home on the day of his father’s death. Brandon stated he heard his father ask the deputies to leave. But he also acknowledged that he was not in the house, did not know what happened, and had not spoken to his father before or during the incident.