Massachusetts Judge Finds for Insurance Company in ERISA Case After Widow Sues on Denied Accidental Death Insurance Claim

Published by The Pellegrin Firm February 15, 2021

In a recent decision, a judge of the U.S. District Court for the District of Massachusetts found for an insurer in a lawsuit brought by a widow challenging the denial of an accidental death insurance claim. The plaintiff was an employee of PricewaterhouseCoopers LLP, which sponsored the spousal accidental death insurance as an employee benefit. Claims were determined pursuant to a group accident insurance policy issued by National Union Fire Insurance Company of Pittsburgh, PA to PricewaterhouseCoopers.

The group policy excludes payment for death caused by suicide, self-inflicted injury, or attempted suicide. In the present instance, the deceased apparently ran and jumped off a tenth-floor balcony at a Hyatt Regency Hotel in Atlanta. The medical examiner in Atlanta ruled the death to be a suicide. The deceased’s brother, who was travelling with him at the time of his death, submitted a declaration stating that the deceased did not appear to be suicidal or acting strangely and that the fall seemed to be an accident.

The court found that the insurer did not abuse its discretion in finding that the death was excluded from coverage as a suicide. The medical examiner’s report found the death to be a suicide, and the witness reports therein supported that conclusion. There was plenty of evidence that supported the insurer’s conclusion that the death was a suicide. Some conflicting information provided by the plaintiff was not enough to show an abuse of the insurance company’s discretion under the policy. The case is Alexandre v. National Union Fire Insurance Company of Pittsburgh, PA., No. CV 20-10636-FDS, 2021 WL 201319 (D. Mass. Jan 20, 2021).