Court Opinion

ID: 9498168
Source: CourtListenerOpinion
Date Created: 2023-08-05 17:09:53.638107+00
Date Added: 2024-06-11T17:58:39.646598
License: Public Domain

GRUENDER, Circuit Judge,
with whom LOKEN, Chief Judge, and MORRIS SHEPPARD ARNOLD and RILEY, Circuit Judges, join, dissenting.
Because I conclude that the district court did not err in granting summary judgment in favor of Hartford, I respectfully dissent.
As I analyze it, this case presents one relatively straightforward issue: Whether the Hartford plan administrator abused its discretion when it denied Amber Lynn Schanus’s claim for accidental-death benefits on the basis that her father, Martin Schanus, did not die from an “accidental bodily injury” under the terms of the Hartford insurance policy when he crashed his.motprcyele while driving with a blood-alcohol level of 0.19 g/dl-nearly twice the legal limit.
Our prior decisions provide a workable framework for reviewing decisions of ERISA plan administrators for abuse of discretion. I see no reason to deviate from those decisions in this case. Using our well-established framework, I would conclude that the Hartford plan administrator did not abuse its discretion in deny*1010ing Amber Lynn’s claim. However, before analyzing the plan administrator’s decision, I will explain where I think the Court’s opinion goes astray and how the Court’s decision ultimately deviates from our normal treatment of ERISA abuse-of-diseretion cases.
In my view, the Court has confused the issue in this case with its conclusion that, “by asserting that the Wickman test of ‘highly likely to occur,’ rather than a ‘reasonably foreseeable’ standard, should govern whether Amber Lynn is entitled to ‘accidental death benefits’ under the plan, Hartford effectively concedes that it applied the wrong definition of ‘accidental’ in denying the claim.” First, the Court misreads the test set forth in Wickman v. Northwestern National Insurance Co., 908 F.2d 1077 (1st Cir.1990). Second, the Court reads too much into Hartford’s reliance on Wickman during litigation of this case.
The facts of Wickman are simple and few. Paul Wickman was last seen standing on the outside of the guardrail of a highway bridge and holding on to the guardrail with only his right hand. He fell to his death from the bridge to railroad tracks forty or fifty feet below. His widow, Mrs. Wickman, submitted a claim for benefits under an ERISA-governed, accidental-death insurance policy sponsored by her husband’s employer. Noting that the policy defined accident as “an unexpected, external, violent and sudden event,” the plan administrator denied Mrs. Wickman’s claim.
As a result, Mrs. Wickman brought a suit for benefits under ERISA. Acknowledging that there is no right to a jury trial in an action for benefits under ERISA, the parties consented to a trial before a magistrate judge. The magistrate judge performed a de novo review of the facts8 and concluded that Mr. Wickman’s death was not accidental because he “knew or should have known that serious bodily injury or death was a probable consequence substantially likely to occur as a result of his volitional act of placing himself outside of the guardrail and hanging on with one hand.”. Wickman, 908 F.2d at 1081. Mrs. Wickman appealed the magistrate judge’s ruling.
According to the Court’s opinion in the present case, “the Wickman test” is a definition of accident that excludes injuries that a reasonable person would have viewed as highly likely to occur. See supra at 997. To consider this to be “the Wickman test” misreads the First Circuit’s task in Wickman. The focus of Wickman was not to formulate a generally applicable definition of accident; the term was already defined in the insurance policy, and the court even noted that the “[c]ase law is fairly consistent in defining an accident, using equally ambiguous terms .... ” Wickman, 908 F.2d at 1087. Rather, the central issue in Wickman was whether the magistrate judge erroneously applied the policyls definition of accident-*1011an unexpected event-to the particular facts surrounding Mr. Wickman’s fall from the bridge. Id. at 1088-89.
Faced with the task of resolving this issue, the First Circuit sought to give “substance to a concept which is largely intuitive.” Id. at 1087. The Wickman court rejected the parties’ invitation to analyze the issue in terms of “what level of expectation is necessary for an act to constitute an accident; whether an intentional act proximately resulting in injury or only the 'ultimate injury itself must be accidental.” Id. at 1085-86. Instead, the Wick-man court concluded that the proper starting point in determining whether an injury constitutes an accident under the terms of an insurance policy should be the “reasonable expectations of the insured when the policy was purchased.” Id. at 1088. Noting that “[generally, insureds purchase accident insurance for the very purpose of obtaining protection from their own miscalculations and misjudgments,” the First Circuit proffered a test to use in analyzing accident claims that aims to “prevent unrealistic expectations from undermining the purpose of accident insurance.” Id.
The proffered test has two prongs. First, “[i]f the fact-finder determines that the insured did not expect an injury similar in type or kind to that suffered, the fact-finder must then examine whether the suppositions which underlay that expectation were reasonable.” Id. at 1088. Next, if the fact-finder finds the evidence insufficient to accurately determine the insured’s subjective expectations, “the fact-finder should then engage in an objective analysis of the insured’s expectations.” Id. The Wickman court stated that in conducting such an analysis, “one must ask whether a reasonable person, with background and characteristics similar to the insured, would have viewed the injury as highly likely to occur as. a result of the insured’s intentional conduct.” Id. “An objective analysis ... serves as a good proxy for actual expectation.” Id.
In my view, the Wickman test is an analysis that gives “substance” to a fact-finder’s application of the definition of accident by focusing on the reasonable expectations of the insured. Although the Wickman court used the phrase “highly likely to occur,” when viewed in the context of the entire- opinion, it is apparent that the court’s emphasis was not on the degree of the insured’s expectations but on the reasonableness of the insured’s expectations.
The Wickman court’s focus on reasonableness is evident from its holding. The court upheld the magistrate judge’s decision denying Mrs. Wickman’s accidental-death claim, concluding that “the magistrate appropriately engaged in an objective analysis.” Id. at 1089. The court reasoned that the magistrate judge’s conclusion that Mr. Wickman should have known that death or injury was substantially likely to occur “equates with a. determination ... that a reasonable person in [Mr. Wick-man’s] shoes would have expected the result, and that any other expectation would be unreasonable.” Id. (emphasis added). Furthermore, the First Circuit’s own'application of the objective analysis to Mrs. Wickman’s claim is devoid of any discussion about whether a reasonable person in Mr.'Wickman’s shoes would have viewed -death as “substantially” or “highly” likely to occur. Id.' Rather, the Wickman court simply explained, “Objectively, he reasonably should have expected serious injury when he climbed over the guardrail and suspended himself high above the railroad tracks below by hanging 'on to the guardrail with only one hand.” Id.
As I read Wickman, the First Circuit did not adopt a specific definition of accident. Hartford has recognized this subtlety. Before -both the district court and this Court, Hartford has relied on the.analyt*1012ical framework of Wickman to support.its argument that the plan administrator’s application of its interpretation of the term “accidental” to the facts of Amber Lynn’s claim was reasonable. In its brief to this Court, Hartford argued: “Appellant seems to argue that the Wickman test is chiefly relevant to determining whether Hartford reasonably defined plan terms. Hartford contends the Wickman framework is principally relevant to reviewing Hartford’s evaluation of the facts.” Brief of Appellee at 13. Specifically, Hartford argued: “[T]he evidence supports Hartford’s determination that Mr. Schanus’ expectations were manifestly unreasonable ....” Id. at 27-28. In' addition, I do not believe Hartford has conceded that the “highly likely to occur” reference in Wickman should be the proper interpretation of the term “accidental” in the Hartford insurance policy. In fact, Hartford asked this Court to reject “a strained interpretation of the second prong of the Wickman test (that is, whether a reasonable person would view the injury as ‘highly likely to occur.’)” Brief of Appellee at 30.
Based on .the foregoing, I must respectfully disagree with the Court that Hartford has defended its denial of Amber Lynn’s claim by invoking a Wickman-like “highly likely to occur” definition of “accidental.” Therefore, I would proceed by reviewing the Hartford plan administrator’s claim denial for an abuse of discretion, using the analytical framework provided by the case law of this Circuit. However, at this point I think it is necessary to explain that even if I agreed with the Court that Hartford “effectively concede[d]” the plan administrator used the wrong definition of “accidental” in denying Amber Lynn’s claim, I would disagree that the proper course of action in such a situation is to return the claim to the plan administrator for reevaluation using “the Wickman standard that Hartford asserts should be applied” and considering evidence that was not before the plan administrator in the first instance. See supra at 1005-1006.
I believe the Court would be obliged to “ignore ERISA plan interpretations that did not actually furnish the basis for a plan administrator’s benefits decision,” Marolt v. Alliant Techsystems, Inc., 146 F.3d 617, 620 (8th Cir.1998), and make an up or down call, based solely on the record that was before the plan administrator, on one simple issue: Whether the Hartford plan administrator abused its discretion in denying Amber Lynn’s claim. This approach is consistent with the idea that ERISA claimants should not be “sandbagged by after-the-fact plan interpretations devised for purposes of litigation,” Marolt, 146 F.3d at 620, and with “ERISA’s purpose of streamlining and shortening the timeframe for disposing of claims,” Schadler v. Anthem Life Ins. Co., 147 F.3d 388, 396 (5th Cir.1998). The Court’s decision today undermines these important ERISA concepts.
Moreover, the Court’s decision potentially allows an ERISA defendant to usurp the reviewing court’s role in determining whether and how a plan administrator may have abused its discretion in denying a claim for benefits. The rule adopted by the Court-“when an administrator abandons in litigation its original basis for denying benefits, the better course generally is to return the case to the administrator”makes it possible for an ERISA defendant fearing defeat in litigation to return the proceedings to the plan administrator for another bite at the apple simply by abandoning its administrative position and advancing a new interpretation or reason during litigation.9 See supra at 1005.
*1013The Court cites several cases in support of its decision not to engage in the normal abuse-of-discretion review of the Hartford plan administrator’s denial of Amber Lynn’s claim and, instead, to opt for the unusual course of remanding the claim to the plan administrator for reevaluation based on what the Court claims Hartford’s attorney now says is the correct definition of “accidental.” See supra at 1005. However, I would submit that some of these cases actually lend support to the proposition that where, as here, the plan administrator has been given discretion to interpret plan terms and, in fact, has done so, it is the court’s responsibility to review the administrator’s interpretation for an abuse of discretion. See, e.g., Jones v. Metro. Life Ins. Co., 385 F.Sd 654, 661-66 (6th Cir.2004) (remanding claim to plan administrator for reconsideration in light of the court’s opinion, after determining plan administrator’s interpretation of plan term was arbitrary and capricious); Saffle v. Sierra Pac. Power Co. Bargaining Unit Long Term, Disability Income Plan, 85 F.3d 455, 460-61 (9th Cir.1996) (remanding case to plan administrator for a decision on the merits of the participant’s claim consistent with the court’s opinion, after determining plan administrator abused its discretion by misconstruing plan language); Miller v. United Welfare, Fund, 72 F.3d 1066, 1072-74 (2d Cir.1995) (remanding case to fiduciary after determining fiduciary acted arbitrarily and capriciously in denying plan benefits). If the reviewing-court determines that there has been an abuse of discretion, then remand may be necessary to allow the plan administrator to reevaluate the claim in light of the court’s opinion on how the administrator’s decision was unreasonable. Compare Jones, Saffle, and Miller, with Marolt, 146 *1014F.3d at 620-21 (remand unnecessary where court ignored post hoc interpretation devised for litigation and determined plan administrator’s legally erroneous claim denial was an abuse of discretion).
The other cases cited by the Court are distinguishable from the present case because they involve situations where remand was necessary because the plan administrator either did not 'give reasons for its decision or had not yet interpreted the plan; thus, it was the plan administrator’s role to develop the administrative record and decide the claim in the first instance, not the court’s. See, e.g., Shelton v. ContiGroup Cos., Inc., 285 F.3d 640, 644 (8th Cir.2002) (remanding case to plan administrator 'for a decision on the merits of the participant’s claim after determining plan administrator abused its discretion by abdicating its duty under the terms of the plan to make disability determinations); Caldwell v. Life Ins. Co. of N. Am., 287 F.3d 1276, 1288-90 (10th Cir.2002) (remanding “any occupation” disability claim to claims administrator because denial letter failed to specify a reason for the decision); Schadler, 147 F.3d at 397-98 (remanding claim to plan administrator because in the unique circumstances of the case, “the administrator never had occasion’ to exercise any discretion to interpret the terms of the Plan”); Gallo v. Amoco Corp., 102 F.3d 918, 922-23 (7th Cir.1996) (noting that if, hypothetically, there were some requirement that an' ERISA claim denial contain a “reasoned elaboration of its basis” and. the administrator fails to give “the reasoning behind the reasons,” the court would not decide the plaintiffs benefits claim but instead would remand the claim to the plan administrator for further explanation).
Because I do not think Hartford advanced a Wickman-like “highly likely to occur” definition of “accidental,” and because I would ignore any post hoc rationales even if I agreed with the Court that Hartford advanced a different definition during ■ litigation, I now turn to what I believe is the only issue in this case: Whether the Hartford plan administrator abused its discretion in denying Amber Lynn’s claim.
As the Court explains, because the Hartford policy gives ■ the plan administrator the discretionary authority to decide eligibility questions or to construe the terms of the policy, the administrator’s denial of Amber Lynn’s claim is reviewed for an abuse of discretion. Firestone, 489 U.S. at 115, 109 S.Ct. 948. The abuse-of-discretion standard of review is a “deferential standard [which] reflects our general hesitancy to interfere with the administration of a benefits plan.” Layes v. Mead Corp., 132 F.3d 1246, 1250 (8th Cir.1998). “Under this standard, an administrator’s decision to deny benefits will stand if reasonable.” Farley v. Ark. Blue Cross & Blue Shield, 147 F.3d 774, 777 (8th Cir.1998).
In this Circuit, two tests are relevant in analyzing whether the Hartford plan administrator’s denial of Amber Lynn’s claim was reasonable. First, in determining whether the plan administrator’s interpretation of the term “accidental” was reasonable, the five-factor test set forth in Finley v. Special Agents Mutual Benefit Ass’n, Inc., 957 F.2d 617, 621 (8th Cir.1992), is applied.10 Next, in determining whether *1015the plan administrator reasonably applied its interpretation of the term “accidental” to the facts of Amber Lynn’s claim, the test is whether the decision is “adequately supported by the evidence on record.” Donaho v. FMC Corp., 74 F.3d 894, 900 (8th Cir.1996). In other words, if the plan administrator “offer[s] a reasoned explanation, based on the evidence, for a particular outcome,” the decision must not be disturbed, even though a different reasonable decision could have been made. Id. at 899 (quotation omitted); see also Cash v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.1997).
Given the deferential standard of review governing this case and applying the two relevant tests, I cannot- say that the Hartford plan administrator reached an unreasonable decision. Consequently, I would affirm the decision of the district court.
The Hartford plan administrator’s interpretation of the word “accidental” was reasonable under the Finley fíve-factor test.11 I think it is necessary first to explain that, in my view, the administrator - has interpreted the word “accidental” consistently. There is no evidence that the plan administrator somehow deviated from a standard definition of “accidental” applied in the past, see Cash, 107 F.3d at 644 n. 7, but the Court seems to express some concern over whether the plan administrator consistently interpreted the word “accidental” from the first denial letter to the second denial letter. See supra at 1001-1002. The initial denial letter defines “accidental” in terms of being “unexpected,” and the second denial letter defines “accidental” in terms of being “unforeseen.” At this juncture, it is appropriate to look to the dictionary to give the words “unexpected” and “unforeseen” their ordinary meanings. See Cash, 107 F.3d at 643-44 (noting that it was necessary and reasonable for the Court to use the dictionary to define terms within an ERISA plan’s definition of “pre-existing condition” in determining whether administrator’s claim denial was reasonable). Merriam-Webster’s Collegiate Dictionary defines “unexpected” as “not expected: UNFORESEEN.” Merriam-Webster’s Collegiate Dictionary 1286 (10th ed.2002). It also defines “expect” as “to anticipate;” “foreseeable” as “being such as may be reasonably anticipated;” and “anticipate” as' “to look forward to as certain: EXPECT.” Id. at 407, 456, 50. And finally, it notes that “foresee” is a synonym for “anticipate.” Id. at 50. Based on these dictionary definitions, I would conclude that the Hartford plan administrator’s interpretation of the word “accidental” was consistent because the words “unexpected” and “unforeseen” are synonymous.
Next, the Hartford plan administrator’s interpretation of the word “accidental” to *1016mean “unexpected” or “unforeseen” is not contrary to the clear language of the poli-' ey; This Finley factor is satisfied where the plan administrator has given the words of the plan their ordinary meaning. Hutchins, 110 F.3d at 1344. “Ordinary meaning is determined by the dictionary definition of the word and the context in which it is used.” Id. (“Under ,an abuse of discretion standard we do not search for the best or preferable interpretation of a plan term: it is sufficient if the [administrator’s] interpretation is consistent with a commonly accepted definition.”). The Hartford plan administrator gave ordinary meaning to the word “accidental” by consulting Black’s Law Dictionary, by interpreting the word to mean “unexpected,” and by expounding upon the ordinary meaning of the word “unexpected” in the second denial letter. The Hartford plan administrator’s interpretation of the word “accidental” to mean “unexpected” or “unforeseen” is consistent with commonly accepted definitions and, therefore, is not contrary to the clear language of the policy-
Third, relying on the Seventh Circuit’s decision Cozzie v. Metropolitan Life Insurance Co., 140 F.3d 1104, 1110 (7th Cir.1998), the plan administrator’s interpretation of the word “accidental” to mean “unexpected” or “unforeseen” is consistent with the goals of the Hartford accidental-death policy. The facts and issue in Coz-zie are almost identical to the present case. In Cozzie, MetLife denied a beneficiary’s claim for accidental-death benefits under an ERISA-governed plan on the basis that the employee participant’s death did not result .from an accident when he crashed his car while driving with a blood-alcohol level - of more than twice the legal limit. MetLife defined “accident” in terms of reasonable foreseeability. The.Seventh Circuit concluded that MetLife’s interpretation was rational because it was consistent with the goals of the accidental-death plan. Id. The court explained:
The purpose of this plan is to provide the families ... with insurance against the- tragedy of unexpected death by providing additional benefits for those who experience such a loss and all its consequent tremors. Whenever a plan fiduciary determines that benefits are not owed under particular circumstances, it does, from the perspective of the claimants in that case, frustrate the purpose of providing assistance. However, as with all insurance arrangements, the plan fiduciary or administrator must ensure that payments are reserved for those who truly fall within the terms of the policy. Otherwise, the financial 'health of the -pooled assets is jeopardized and the cost of providing recovery for future applicants owed assistance is escalated.. We cannot say, therefore, that MetLife’s determination that the purposes of the plan are best served by acknowledging a qualitative difference between the ingestion of a huge quantity of alcohol and other tragedies of human life which do not involve such a significant assumption of a known risk by the insured is incompatible with the goals of the plan.
Id: See also Finley, 957 F.2d at 621 (concluding that the administrator’s interpretation of a'term in an aceidental-death-and-dismemberment plan was in accord with the goal of providing additional benefits in certain circumstances).
Next, the Hartford plan administrator’s interpretation of- “accidental” does hot render any language in the policy meaningless or internally inconsistent. Appellant argues, that the interpretation of “accidental” to mean “unexpected”-or “unforeseen” renders meaningless the policy’s “express exclusion” of death by suicide, attempted suicide or intentionally self-inflicted injury, *1017because under such an interpretation, the definition would “already exclude[] any foreseeable risk of injury or death that is the consequence of an intentional act.” Appellant’s Brief at 30. Even though the Plan sets forth a list of “types of injuries [that] are excluded from coverage,” the list is not really a list of exclusions.12 Rather, it is more akin to an illustrative list of non-accidents. Each of the items listed in the Hartford policy would not qualify as an accident under the interpretation afforded to that term by the plan administrator.13 Hartford’s interpretation of the term “accidental” does not render the list of items meaningless; the list is a clarification of the general rule of coverage.
Lastly, the Hartford plan administrator’s interpretation of “accidental” does not conflict with the substantive or procedural requirements of the ERISA statute. Nowhere in ERISA is a plan required to use a specific definition of “accident.” It may be true that a body of common law has developed regarding the definition of “accident” in an ERISA employee benefit plan; courts have had to devise and apply their own interpretations of the term “accident” when conducting de novo review of a plan administrator’s decision where the plan did not give the administrator the discretionary authority to interpret the terms of the plan. See, e.g., Santaella v. Metro. Life Ins. Co., 123 F.3d 456 (7th Cir.1997); Todd v. AIG Life Ins. Co., 47 F.3d 1448 (5th Cir.1995); McElyea v. AIG Life Ins. Co., 326 F.Supp.2d 960 (E.D.Ark.2004); Allow v. Canada Life Assurance Co., No. 3:02-CV-300, 2003 WL 23325805 (D.Conn. Nov.19, 2003). However, in a case such as this where the plan administrator has been given the authority to interpret'the terms of the plan and in fact has done so, it would be improper for a reviewing court to look to the common law and impose upon the plan administrator an interpretation of “accident”' that the court thinks should have been applied. “To do so would be to ignore the appropriate deferential standard of review and impose an improper de novo review.” See Cash, 107 F.3d at 641 (noting that in an ERISA abuse-of-discretion case, “[i]n making its evaluation, the court does not substitute its own weighing of evidence for' that of the [plan administrator]”).
Having concluded that the Hartford plan administrator’s interpretation of “accidental” to mean “unexpected” or “unforeseen” is reasonable under the Finley five-factor test, I now turn to the issue of whether the plan administrator reasonably applied its interpretation to the facts of Amber Lynn’s claim. I conclude that it did.
The plan administrator gave a “reasoned explanation, based on -the evidence,” for denying Amber Lynn’s claim. See Donaho, 74 F.3d at 899. In its final denial letter dated June 14, 2001, the plan administrator explained: “[A] reasonable person would have known that death or serious *1018injury was a reasonably foreseeable result of driving while intoxicated.” As in Wick-man, the Hartford plan administrator gave “substance to a concept which is largely intuitive,” Wickman, 908 F.2d at 1087, by focusing on the reasonable.expectations of a hypothetical person in Mr. Schanus’s shoes. Appellant even admits this in her brief to .the Court: “Hartford.turned immediately to the question of whether Scha-nus’s expectation was ‘reasonable’ from an objective perspective, i.e. whether ‘a reasonable person’ would have known.or appreciated the .consequences of Schanus’s intentional act of intoxication.” Brief of Appellant at 25.
Appellant argues that Mr. Schanus’s “expectation of reaching home ... was not patently unreasonable. since most people who drive after drinking (even with a 0.19 BAC) are not injured or killed on the highway.” Brief of Appellant at 41. For example, she explains that evidence she submitted to the district court “demonstrates that the number of people who died as a result of drunk driving is'less than 1% of all individuals who are arrested for driving under the influence of alcohol.” Brief of Appellant at 35.14 However, Appellant forgets that such evidence was not before the Hartford plan administrator. Based on the record before it, the plan administrator reasonably evaluated the facts from the perspective of an average driver, and not from the perspective of an expert well-versed in crime and highway-safety statistics. Therefore, relevant to the plan administrator’s analysis was the fact that “[t]he hazards of driving while intoxicated are well-known. The public is reminded daily of the risks of driving while intoxicated both in warnings from the media and in motor vehicle and criminal laws.” Walker v. Metro. Life Ins. Co., 24 F.Supp.2d 775, 781 (E.D.Mich.1997).15 The Hartford plan administrator reasonably applied its interpretation of “accidental” to the facts of Amber Lynn’s claim.
In- sum, I would conclude that the Hartford plan administrator did not abuse its discretion. The administrator reasonably interpreted and applied the terms of the policy to the facts of Amber Lynn’s claim for accidental-death benefits. Given the deferential standard of review, the administrator’s decision to deny benefits must not be disturbed even if a different reasonable decision could have been made. Therefore, I would affirm the judgment of the district court.

. As the Court explains in its opinion, in Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court held that.where, as in this case, an ERISA plan gives the plan administrator discretionary authority to decide eligibility questions or to construe the terms of the plan, the administrator's claim decision is reviewed for an abuse of discretion.- The’ Wickman court does not explain why de novo review applied in that case, but the answer can be gleaned from the date of the Wickman decision. Although the First Circuit ultimately decided Wickman in 1990, just one year after Firestone, Mr. Wickman died in 1984, the plan administrator decided Mrs. Wickman's claim prior to Firestone, and the policy that applied to Mrs. Wickman’s claim most likely did not contain the requisite language for deferential review under Firestone.

. While a remand to the plan administrator in this case could work to the benefit of this claimant, the Court's holding today may well *1013work to the detriment of future ERISA claimants. For example, consider the following scenario: An ERISA plan administrator denies a beneficiary’s accidental-death benefit claim, reasoning that the insured, who crashed his motorcycle while driving with a blood-alcohol level nearly twice the legal limit, did not die from an “accidental bodily injury” under the terms of the policy because his death was “highly likely to occur." The claimant appeals the denial and submits statistical evidence that the number of people who die as a result of drunk driving is less than 1% of all individuals who are arrested for driving under the influence of alcohol. The plan administrator ignores the evidence and upholds the denial, using the “highly likely to occur” standard. The claimant files a suit for benefits under ERISA and files a motion for summary judgment. After reading the claimant's brief to the district court, the ERISA defendant concludes that the court will likely hold that the plan administrator abused its discretion in denying the claim. Under today's holding, the defendant may be able to avoid an adverse grant of summary judgment by the district court by abandoning the "highly likely to occur” standard used by the plan administrator and adopting a different standard, in the hope that the district court will remand to the plan administrator for a determination using the new standard. If the new standard is better designed to survive abuse of discretion review, the defendant can prevail in any ensuing litigation despite the fact that the plan administrator may have initially abused its discretion.
With regard to the Court's proviso that remand need not occur if an ERISA defendant changes its litigation position in an attempt to gain a tactical advantage, see supra at 1006 n. 4, I do not share the Court's confidence that a reviewing court will necessarily be able to divine the intent behind a litigation strategy that drifts away from the plan administrator's original position. Apparently, the Court has decided that Hartford is gaming no tactical advantage in this case because Hartford has moved away from "its original, narrower interpretation” of accidental injury. See id. However, on remand, the Hartford plan administrator may not interpret or apply "Wick-man 's more generous interpretation of accidental injury," id., as generously as the Court expects. Regardless of the outcome on remand, the fact remains that "ERISA's purpose of streamlining and shortening the time-frame for disposing of claims,” see Schadler, 147 F.3d at 396; has been unnecessarily frustrated in this case.

. The five factors to be considered are:' (1) whether the Hartford plan administrator's interpretation is consistent with the goals of the policy; (2) whether the interpretation renders any language in the policy meaningless or internally inconsistent; (3) whether the interpretation conflicts with the substantive or procedural requirements of the ERISA statute; (4) whether the Hartford plan administrator has interpreted the word "accidental" consistently; and (5) whether the interpretation is contrary to the clear language of the policy. See Finley, 957 F.2d at 621. "These factors present discrete questions; they need not be examined in any particular order.” *1015Hutchins v. Champion Int’l Corp., 110 F.3d 1341, 1344 (8th Cir.1997).

. The Hartford insurance policy provided that Hartford will pay an accidental-death benefit if the employee participant's death results directly from an "accidental bodily injury.” However, the policy did not define "accidental.” As a result, the plan administrator consulted Black’s Law Dictionary which defined “accidental” as: “Happening by chance, or unexpectedly; taking place not according to the usual course of things; casual; fortuitous." In its initial claim denial letter dated December 26, 2000, the plan administrator denied Amber Lynn’s claim, reasoning: “Given [Mr. Schanus’s] blood alcohol level, his bodily injury can in no way be considered unexpected, happening -by chance or fortuitous. On the contrary, it could be expected that if he drove his vehicle in such a reckless manner and in an intoxicated condition, serious bodily injury could result." Amber Lynn appealed the denial, and on June 14, 2001, the plan administrator upheld the denial, explaining: “[A] reasonable -person would have known that death or serious injury was a reasonably foreseeable result of driving while intoxicated.”

. In an employee benefit plan, an exclusion is a benefit that meets the rule of coverage under the plan (e.g., meets the definition of ''accident”), but nonetheless is not covered under the terms of the plan..

. The policy provides:
What types of injuries are excluded from coverage?
No benefit will be paid for a loss caused or contributed to by:
(1) sickness; or
(2) disease; or (3) any medical treatment for items (1) or (2); or
(4) any infection, except a pus-forming infection of an accidental cut or wound; or
(5) war or any act of war, whether war is declared or not; or
(6) any intentionally self-inflicted injury, suicide, or suicide attempt, whether sane or insane; or
(7) taking drugs, sedatives, narcotics, barbiturates, amphetamines or hallucinogens unless prescribed for or administered to you by a licensed physician.

. It is interesting to note that the same evidence submitted by Appellant also indicates that "[t]here were 16,653 alcohol-related fatalities in 2000-40 percent of the total traffic fatalities for the year.... The 16,653 fatalities in alcohol-related crashes during 2000 represent an average of one alcohol-related fatality every 32 minutes.”

. See also Nelson v. Sun Life Assurance Co. of Canada, 962 F.Supp. 1010, 1012 (W.D.Mich.1997) ("All drivers know, or should know, the dire consequences of drunk driving. Thus, the fatal result that occurred in this case should surprise no reasonable person.”); Schultz v. Metro. Life Ins. Co., 994 F.Supp. 1419, 1422 (M.D.Fla.1997) ("The horrors associated with drinking and driving are highly publicized and well known to the public.”); Fowler v. Metro. Life Ins. Co., 938 F.Supp. 476, 480 (W.D.Tenn.1996) ("[T]he hazards of drinking and driving are widely known and widely publicized.”).