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

Heading: The Rice Plaintiffs’ Claims against ReliaStar

Text: Finally, the Rice Plaintiffs argue that the district court erred when it granted summary judgment for ReliaStar on the Rice Plaintiffs’ claim that ReliaStar improperly denied them accidental death benefits. This Court has previously held that whether a death is accidental for purposes of an accidental death benefit policy is a question of fact. Todd, 47 F.3d at 1456. The fact question has both an objective and a subjective component. We consider 21 Case: 13-30639 Document: 00512815979 Page: 22 Date Filed: 10/27/2014 No. 13-30639 whether (1) the decedent had a subjective expectation of survival and (2) if so, was the expectation objectively reasonable. Id. at 1456. The Rice Plaintiffs claim the district court’s decision was wrong for several reasons. First, they argue that under ERISA, there is a federal common law presumption in favor of accidental death. Second, they argue that because ReliaStar both pays death benefits and evaluates claims for those benefits, there was an inherent conflict of interest that the district court failed to consider. Finally, the Rice Plaintiffs argue that the district court improperly deferred to ReliaStar’s factual determinations; the district court should only have deferred to ReliaStar’s factual determinations if they reflected a “reasonable and impartial judgment,” and here, they did not. Essentially, they argue the evidence does not support ReliaStar’s determination that Rice’s death was not accidental. We need not decide whether there is a federal common law presumption in favor of accidental death, because even if there were, we would affirm the district court’s grant of summary judgment for ReliaStar. Assuming arguendo that the presumption the Rice Plaintiffs allege exists, based on the facts in this case, ReliaStar did not abuse its discretion in determining that Rice’s death was not accidental. ReliaStar relied on an administrative record that supported finding Rice’s death was not accidental. Rice was suicidal and had been drinking heavily on the day he was shot. Rice took eleven prescription pills while drinking, and he told the bartender at the bar where he had been drinking that he left his pills behind because “it’s over.” Rice was also heard revving the engine in his truck while the garage was closed, suggesting he may have been trying to kill himself through carbon monoxide poisoning. Further, Rice approached police officers with a loaded weapon even after the officers told him to put his gun down; he told the officers “I want to commit suicide”; 22 Case: 13-30639 Document: 00512815979 Page: 23 Date Filed: 10/27/2014 No. 13-30639 and after Rice’s death, the sheriff’s investigation committee found a note Rice left his sister that appeared to be a suicide note. The Rice Plaintiffs do not dispute the accuracy of these facts. Instead, they point to facts that, they claim, show Rice’s expectation of survival was objectively reasonable: he did not ask the officers to come to his home, and he asked the police officers to leave. But even taking these facts into consideration, ReliaStar did not abuse its discretion in finding that either Rice did not have a subjective expectation of survival or that, if he had that expectation, it was not objectively reasonable. See, e.g., Holland v. Int’l Paper Co. Retirement Plan, 576 F.3d 240, 247 (5th Cir. 2009) (“Our review of the administrator’s decision need not be particularly complex or technical; it need only assure that the administrator’s decision fall somewhere on a continuum of reasonableness—even if on the low end.” (citation and internal quotation marks omitted)). Thus, ReliaStar did not abuse its discretion in finding that Rice’s death was not accidental, that is, not an “unexpected, external, violent and sudden event.” Moreover, while the Rice Plaintiffs correctly point out the structural conflict of interest issue, that is just one factor courts consider in evaluating ReliaStar’s decision to deny benefits. As this Court explained in Holland, In addressing how such a conflict must be accounted for under an abuse of discretion review, the Supreme Court in [Metropolitan Life Insurance Co. v.] Glenn[, 544 U.S. 105, 128 S.Ct. 2342 (2008)] eschewed “special burden-of-proof rules, or other special procedural or evidentiary rules, focused narrowly upon the evaluator/payor conflict.” 128 S.Ct. at 2351. In particular, the Court held that weighing a conflict as a factor in the abuse of discretion analysis does not “impl[y] a change in the standard of review, say, from deferential to de novo review.” Id. at 2350. Quite simply, “conflicts are but one factor among many that a reviewing judge must take into account.” Id. at 2351. 23 Case: 13-30639 Document: 00512815979 Page: 24 Date Filed: 10/27/2014 No. 13-30639 576 F.3d at 247–48. As discussed above, the administrative record was replete with factual evidence that ReliaStar relied on in determining that Rice’s death was not accidental, demonstrating that ReliaStar could have reached its determination without resorting to the conflict of interest. Thus, we hold the district court did not err in granting summary judgment for ReliaStar.