Opinion
Civil Action No. 04-1432 Section "A" (2).
April 21, 2005
Before the Court are cross Motions for Summary Judgment filed by plaintiff, Mary K. Miles (Rec. Doc. 26) and defendant, AIG Life Insurance Company (Rec. Doc. 25). Both motions are opposed. The motions, taken under submission on Monday, April 11, 2005, are before the Court on the briefs without oral argument. For the reasons that follow, Plaintiff's motion is DENIED and AIG's motion is GRANTED.
I. BACKGROUND
Plaintiff, Mary K. Miles, brought this suit under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001, et seq. to recover accidental death benefits under a group policy offered to employees of Dow Chemical Company. Plaintiff's late husband, Bruce Miles, was an employee of Dow Chemical and AIG Life Insurance Company ("AIG"), the defendant herein, underwrote and administered the policy.
The facts leading up to Mr. Miles' death are as follows. In February 2002, Mr. Miles requested and received a reassignment to a less demanding job. On August 16, 2002, Mr. Miles saw his family physician complaining of depression. (Def. Exh. 5, AIG0068). His physician diagnosed him with an "adjustment reaction" to his change in jobs and prescribed for him the antidepressant drug Zoloft, telling him to take 50mg each day. (AIG0068). The physician's notes indicate that Mr. Miles was not suicidal at the time. (Id.).
On August 21, 2002, Mr. Miles called his physician's office complaining of insomnia. (Def. Exh. 5 AIG0067). Following a conversation with the nurse, Mr. Miles' physician increased the Zoloft dosage to 100mg per day and additionally prescribed Ambien to help him sleep. On August 23, 2002, Mr. Miles called his wife at work and told her that he felt physically ill. He described his head as feeling numb and he told her that he could not think and that his mind was blank. Mr. Miles told his wife that he was taking a half day off from work and that he would meet her at home around lunchtime to talk. When Plaintiff arrived at home she found Mr. Miles in the guest bathroom dead, with a handgun next to him and a bullet wound to the head. He left no note.
Plaintiff filed a claim for accidental death benefits with AIG. AIG denied the claim stating that the evidence indicated that "Mr. Miles' injury was not the result of an accident" because his death "resulted from a self-inflicted gun shot wound to the head." (Id. AIG0350). AIG's ERISA Appeals Committee upheld the denial. (Id. AIG0461). The AIG policy covers injuries, including loss of life, caused by an "accident." (Def. Exh. 1, AIG0465 AIG0469). Losses resulting from "(1) suicide or any intentionally self-inflicted injury" are not covered. (Id. AIG0466). Plaintiff does not dispute that Mr. Miles took his own life but she argues that his injuries were not "intentional" because his use of the antidepressant drug Zoloft deprived him of the intent necessary to take his own life.
Zoloft or sertraline belongs to the SSRI (selectiveserotonin reuptake inhibitors) category of antidepressants. SSRIs increase the level of serotonin in the brain which is believed to help relieve the symptoms of depression. (Def. Memo at 10 n. 3).
Plaintiff has also sued Pfizer, the manufacturer of Zoloft, and that case is pending in the Middle District of Louisiana.
After AIG denied her appeal, Plaintiff filed the instant suit seeking review of that denial. On October 22, 2004, the Court issued an order denying Plaintiff's request to have her claim reviewed de novo because the denial of Plaintiff's claim was based upon factual determinations by the plan administrator which are subject to review under the abuse of discretion standard. (Rec. Doc. 11). On January 21, 2005, the Court issued an order denying Plaintiff's request to conduct discovery aimed at establishing the degree of AIG's "conflict of interest." The Court noted however the undisputed fact that AIG was a conflicted administrator because it acted as plan administrator and insurer on the policy at issue. (Rec. Doc. 20).
Both parties have now submitted the case for determination on summary judgment.
II. DISCUSSION 1. The Parties' Contentions
Plaintiff argues that AIG impermissibly placed the burden on her to prove that the policy's suicide exclusion did not apply. Plaintiff points out that other courts have held that in ERISA claims the plan bears the burden of proving the applicability of a policy exclusion. Plaintiff argues that the policy exclusion is not a broad one excluding suicide whether the victim is sane or insane or self-inflicted injury whether intentional or not. Rather, the policy specifically excludes intentional self-inflicted injury. Plaintiff concedes that Mr. Miles died as a result of a self-inflicted injury, but she points out that without a note or eyewitness there is no direct evidence that Mr. Miles "intentionally" took his own life. Plaintiff contends that Mr. Miles death was not "intentional" because his use of the drug Zolfot drove him to take his own life thereby rendering his death an "accident." Thus, according to Plaintiff, AIG should have been required to demonstrate intent in order to avail itself of the suicide exclusion. Moreover, Plaintiff argues that the administrator should have considered the legal presumption against suicide, and that this presumption, along with the administrator's inability to prove intent, demonstrate that the administrator abused its discretion in denying accidental death benefits.
Second, Plaintiff argues that AIG abused its discretion by failing to have a second medical expert review her claim on appeal. Plaintiff argues that both federal regulations and the terms of the AIG plan required AIG to do so. Plaintiff argues that she was also deprived of a full and fair review of her claim because Dr. Mann, AIG's expert, had already publicly opined that he saw no connection between SSRIs and suicide. Plaintiff argues that Dr. Mann's conclusions are at odds with Mr. Miles' history as well as the opinion of Dr. Miles' treating physician.
In support of its motion for summary judgment and in opposition to Plaintiff's motion, AIG argues that it did not bear the burden of proof to show that Mr. Miles intended to take his own life because the evidence regarding suicide is not in dispute, i.e., there is no dispute that Mr. Miles did in fact take his own life. AIG asserts that Plaintiff should bear the burden of proving that Mr. Miles did not intend to take his own life because she admits that he did in fact kill himself. AIG asserts that the authorities Plaintiff cites regarding the presumption against suicide involve circumstances where the self-inflicted nature of the injury is in dispute. Moreover, according to AIG, the Fifth Circuit has never held that the state law presumption against suicide applies to ERISA cases.
AIG contends that Plaintiff did receive a full and fair review of her claim. AIG argues that the federal regulations Plaintiff refers to do not govern this type of policy. AIG contends that it did not violate its own review procedures because a second medical doctor did in fact participate in the Appeals Committee decision to deny benefits. AIG argues that neither the law nor the plan required AIG to hire a second SSRI expert to review the appeal. AIG argues that Plaintiff has no grounds to challenge AIG's reliance upon Dr. Mann's opinion because it is highly unlikely that an "expert" in the field of SSRIs is not going to have taken a prior position on the effect of SSRIs. AIG asserts that Dr. Mann is not an obscure specialist but rather is an expert in the field of SSRIs.
AIG contends that even if it did bear the burden of demonstrating that Mr. Miles intended to take his own life, the administrative record demonstrates that its denial of Plaintiff's claim was based upon substantial evidence. AIG argues that its decision to deny benefits was not arbitrary and capricious because there was a rational connection between the facts and evidence developed in the claim and the ultimate decision to deny benefits. AIG asserts that delving too deeply into Mr. Miles' intent would require this Court to determine whether Zoloft causes suicide — a determination which is at issue in Plaintiff's suit against the drug manufacturer but not in this ERISA benefits review.
In reply to AIG's arguments, Plaintiff contends that federal regulations requiring review by a second physician do apply to her type of claim. She also argues that there is no factual support in the record to show that a second medical professional participated on the Appeals Committee when her appeal was denied. Thus, Plaintiff persists in her assertion that she was denied a full and fair review of her claim as required by ERISA.
2. Law and Analysis A. Standard of Review
In Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101 (1989), the United States Supreme Court addressed the issue of the appropriate standard of review for claim denials under ERISA. The Court concluded that a denial of benefits challenged under ERISA is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan. Id. at 115. Where the plan does vest the administrator with such authority, judicial review of a denial of benefits is limited to abuse of discretion. See id. The Fifth Circuit considered the reach of Firestone Tire Rubber's holding in Pierre v. Connecticut General Life Insurance Co., 932 F.2d 1552 (5th Cir. 1991). In Pierre, the Fifth Circuit held that de novo review under Firestone Tire Rubber applies only to denials of benefits based upon plan term interpretations. 932 F.2d at 1558. The administrator's factual determinations are entitled to deferential review regardless of whether the plan includes language expressly granting discretionary authority to the administrator to make factual determinations. Id. In applying the abuse of discretion standard to the administrator's factual determinations the Court will analyze whether the administrator acted arbitrarily or capriciously. Meditrust Financial Servs. Corp. v. Sterling Chemicals, Inc., 168 F.3d 211, 214 (5th Cir. 1999) (citingSweatman v. Commercial Union Ins. Co., 39 F.3d 594, 601 (5th Cir. 1994)). When reviewing for arbitrary and capricious actions resulting in an abuse of discretion, the reviewing court will affirm the administrator's decision if it is supported by substantial evidence. Id. at 215. A decision is arbitrary only if "made without a rational connection between the known facts and the decision or between the found facts and the evidence." Id. (quoting Bellaire Gen. Hosp. v. Blue Cross Blue Shield, 97 F.3d 822, 828-29 (5th Cir. 1996)).
Moreover, the presence of a conflicted or self-interested administrator does not transform an otherwise deferential standard of review into a de novo one. See Vega v. Nat'l Life Ins. Servs. Inc., 188 F. 3d 287, 297-98 (5th Cir. 1999) (en banc). However, the presence of a conflict is a factor for the court to consider when determining whether the administrator has abused its discretion. Id. at 297. Courts in the Fifth Circuit employ a sliding scale standard such that the higher the degree of conflict the less deferential the abuse of discretion standard will be. Id. In a conflict situation the court is less likely to make "forgiving inferences" when confronted with a record that arguably does not support the administrator's decision. Id. at 299.
In its order dated October 22, 2004, this Court explained that the denial of benefits in this case was based upon the administrator's determination that Mr. Miles acted intentionally when he took his own life. Such a determination is purely factual in nature and therefore must be accorded deference under the clear law of this Circuit. In its order dated January 21, 2005, this Court noted that the degree of conflict in this case is 100 percent because AIG acted as insurer and administrator of the plan. Thus, the Court will give AIG's decision the least amount of deference allowed under the abuse of discretion standard.
Plaintiff has now also raised certain legal questions which this Court reviews de novo. See Rhorer v. Raytheon Engr's Constructors, Inc., 181 F.3d 634, 639 (5th Cir. 1999).
B. Analysis of Administrative Record
The administrative record establishes that Mr. Miles visited his family physician Dr. Louis Minsky on August 16, 2002, complaining of depression. (Def. Exh. 5, AIG0068). The chart specifically recites, "Recent stress with job changes in 2/02. Over the past months he has had difficulty with transition. He is always worried. He cannot sleep. He is withdrawn. Family is supportive. Has early a.m. wakening. He feels despondent. Libido is diminished. WT is increasing some." (Id. at AIG0068). After examining Mr. Miles, Dr. Minsky noted that he was withdrawn, blue, and depressed. (Id.). These comments are followed by a notation, "ø suicidal," which the parties seem to agree refers to Dr. Minsky's determination that Mr. Miles was not suicidal at the time. (Id.) Dr. Minsky's impression of Mr. Miles's condition was that he was having an "adjustment reaction." (Id.). Dr. Minsky did not elaborate on this diagnosis. Dr. Minsky gave Mr. Miles a 50mg prescription for the SSRI Zoloft. (Id.). Dr. Minsky's notes indicate that Mr. Miles wanted to get well. (Id.).
The medical record indicates that Mr. Miles contacted Dr. Minsky's office on August 21, 2002, complaining of insomnia due to the Zoloft. (Id. at AIG0067). Mr. Miles spoke with Dr. Minsky's nurse. (Id. AIG0066). Dr. Minskey increased the Zoloft dosage to 100mg and also prescribed Ambien. (Id.).
On August 23, 2002, Mr. Miles called his wife at work and told her that he felt physically ill. He described his head as feeling numb and he told her that he could not think and that his mind was blank. Mr. Miles told his wife that he was taking a half day off from work and that he would meet her at home around lunchtime to talk.
At approximately 12:24 p.m. the Baton Rouge police responded to Plaintiff's call after she found Mr. Miles lying on the bathroom floor with a bullet wound to the head and a gun lying next to him. (Id. at AIG0099). It is undisputed that the gunshot wound was self-inflicted and "intentional" in the traditional sense. Mr. Miles died on the scene. (See id.).
On August 26, 2002, Dr. Minksy talked with Plaintiff about Mr. Miles' death. (Def. Exh. 5, AIG0066). Dr. Minky's notes from that conversation reflect that Plaintiff did not believe that Mr. Miles' suicide was premeditated because he left no note. (Id.). In his notes Dr. Minksy reconfirms his belief that Mr. Miles was faced with an "adjustment reaction" and that the Zoloft prescription was appropriate because Mr. Miles had no history of depression. (Id.). Dr. Minsky surmised that Mr. Miles must have become much more depressed in the days following their visit. (Pla. Exh. 3, AIG0066).
When Plaintiff submitted her claim for accidental death benefits she advised AIG that Mr. Miles had no motive to take his own life because he had a good marriage, a good family, and a good job. (Def. Exh. 6, AIG 0123). Plaintiff argued that Mr. Miles' actions on the day of his death were "the result of a severe, unanticipated and unintended side effect of the Zoloft medication" that Dr. Minsky had prescribed. (Def. Exh. 11, AIG0184). Plaintiff asserted that Mr. Miles' conduct was not "intentional." (Id.).
Plaintiff and AIG each retained experts. Plaintiff retained Ronald Maris, Ph. D, a suicide expert who teaches Psychiatry and Family Medicine at the University of South Carolina. Dr. Maris concluded that Mr. Miles did not fit the profile of a typical suicide because Mr. Miles had only two or three of the fifteen predictors that Dr. Maris had developed during his years of suicide research. (Def. Exh. 10, AIG0135). In Dr. Maris's opinion, Mr. Miles was not having a major depressive episode when he presented to Dr. Minksy but was only mildly depressed. (Id. AIG0136). Dr. Maris believed that Mr. Miles' good marriage, success at work, and Catholic religion were all facts that militated against suicide. (Id.). Dr. Maris concluded that Mr. Miles would not have taken his own life without some type of "unusual painful stimulus which he just could not stand." (Id.). According to Dr. Maris, nothing in Mr. Miles' life history could account for his suicide which was totally out of character for him. (Id. AIG0137). Dr. Maris conceded that Mr. Miles was having some emotional problems but that these conditions absent Zoloft would not have provoked such a violent, out of character suicide. (Id.). Dr. Maris concluded that Mr. Miles "would not have `committed suicide' (or had a [sic] accident) on 8/23/02" if he had not taken Zoloft. (Id. AIG0138).
AIG retained Dr. John Mann, a medical doctor and Professor of Psychiatry and Radiology at Columbia University, and Chief of the Division of Neuroscience. Dr. Mann believed that the records showed that Mr. Miles had met at least four of the five criteria required for a diagnosis of major depression. (Def. Exh. 13, AIG0380). Dr. Mann found it more probable than not that additional criteria would have been met if they had been "systematically inquired about." (Id. AIG0380). Dr. Mann believed that Mr. Miles's request for a less stressful job months earlier might have been related to the onset of a mood disorder and that the symptomatology had so interfered with his ability to function that he finally sought medical help from Dr. Minsky. (Id.). Dr. Mann thought that perhaps a family physician conducting a brief examination might underestimate the severity of the symptomatology. (Id.). Dr. Mann noted that Mr. Miles had a family history of mood disorders and that mood disorders are the most common cause for suicide. (Id. AIG0381). Dr. Mann noted that a middle-aged man committing suicide with a gun at home is probably the most common scenario for suicide in the United States. (Id.).
Dr. Mann noted that the blood level of sertraline was higher than average but not unusually high and well within the range found in most individuals. (Id.). Dr. Mann did not believe that the amount of Zoloft in Mr. Miles' system was sufficient to produce, in and of itself, an adverse reaction of some sort. (Id.). Dr. Mann concluded that Mr. Miles committed suicide most likely as the consequence of an episode of major depression that had not been treated long enough with an antidepressant to achieve a therapeutic response. (Id.).
AIG concluded that Mr. Miles' injury was not the result of an accident. (Def. Exh. 14, AIG0350). AIG noted that the psychiatric and medical community acknowledge a "controversy" concerning a causal relationship between Zoloft and suicide but that the relationship is "speculative." (Id. AIG0351). AIG advised that none of the medical articles submitted by Plaintiff, or those reviewed independently by AIG, established a definitive link between the use of SSRIs, such as Zoloft, and deliberate self-harm and/or suicide. (Id. AIG0352).
The Court has reviewed the portions of the administrative record provided by the parties and concludes that AIG did not abuse its discretion in denying this claim because Plaintiff failed to establish that Mr. Miles' death was an "accident." AIG implicitly recognizes that Mr. Miles' death could qualify as an "accident" under the terms of its policy if Mr. Miles did not intend to injure himself or if he was "insane" when he shot himself. Plaintiff contends that AIG bears the burden of proving suicide and intent but she fails to recognize that she bears the initial burden of establishing coverage under this specific policy. The AIG policy covers "accidental" death so in order to qualify for benefits the insured must demonstrate her entitlement to contractual benefits by showing that death resulted from an accident. Once coverage is demonstrated and the insurer invokes a policy exclusion to deny benefits, the insurer bears the burden of proving that the exclusion precludes coverage. Dugas v. Travelers Ins. Co., 785 F.2d 550, 551 (5th Cir. 1986); Schleunes v. Am. Cas. Co., 528 F.2d 634, 638 (5th Cir. 1976); Wickman v. N.W. Nat'l Ins. Co., 908 F.2d 1077, 1084 n. 2 (1st Cir. 1990); McAfee v. Transamerica Occidental Life Ins. Co., 106 F. Supp. 2d 1331, 1337 (N.D. Ga. 2000). Given that Mr. Miles' gunshot wound was self-inflicted and was not inadvertent, it would be erroneous to require AIG to disprove accidental death, i.e., "require defendant to prove the converse of the facts upon which plaintiff relies for recovery." Laventhal, 40 F. Supp. at 160. Therefore, in order to receive benefits Plaintiff must show that Mr. Miles' suicide was in fact an accident due to his use of the drug Zoloft.
The policy does not expressly exclude suicide while insane and refers to "intentional" self-injury. Most areas of law recognize that suicide attributable to "an insane impulse" or committed when the decedent's "reasoning faculties are so far impaired by insanity that he is unable to understand the moral character of his act," is deemed "accidental" or "unintentional."See Voris v. Tx. Employer's Ins. Assoc., 190 F.2d 929 (5th Cir. 1951) (Longshoremen's Harbor Workers' Compensation Act); Harris v. Gen. Am. Life Ins. Co., 902 F. Supp. 1007 (E.D. Mo. 1995) (ERISA); Ray v. Federated Guar. Life Ins. Co., 381 So.2d 847 (La.App. 1st Cir. 1980) (Louisiana state law).
Further, the legal presumption against suicide is not applicable under the facts of this case. The presumption against suicide recognizes that human beings possess an instinct of self-preservation. Laventhal, 40 F. Supp. at 159. Thus, where it is uncertain whether death occurs accidentally or intentionally, the law will presume death was not intentional.Schleunes, 528 F.2d at 638. The Court has found no case where the presumption was applied in a situation where it was factually undisputed that the decedent's self-inflicted injury was "intentional" in the traditional sense. The legal presumption is not "evidence" of an accident and it only comes into play when the facts are consistent with either accidental or suicidal death. Laventhal v. N.Y. Life Ins. Co., 40 F. Supp. 157, 159 (E.D. Mo. 1941)
For instance, in Schleunes v. American Casualty Co., the decedent was found shot dead in his bedroom. 528 F.2d at 636. There were no witnesses and he left no note. However, there was an issue in the case as to whether the rifle had discharged accidently while the decedent was handling it. Because the plaintiff had presented evidence showing death under circumstances that left suicide in doubt, she was then entitled to the presumption and the burden shifted to the insurer to overcome the presumption by ruling out suicide. Id. at 639.
In contrast to Schleunes, no one contends that Mr. Miles's death might have been "accidental" in the traditional sense such as by having a loaded gun inadvertently discharge. Instead it is undisputed that Mr. Miles' purposely took his own life — only his state of mind is at issue. The presumption against suicide, to the extent that it would apply in the ERISA context, is not implicated under the facts of this case.
AIG argues that the Fifth Circuit has never held that the state law legal presumption against suicide applies in the ERISA context. Because the Court finds the legal presumption inapplicable under these facts, the Court merely assumes arguendo that the legal presumption would apply. TheSchleunes case, supra, was decided strictly on state law and did not involve ERISA.
The arguments that Plaintiff raises in support of "accidental" death do not persuade the Court that AIG, even as a conflicted administrator, abused its discretion in rejecting them. Plaintiff asserts that AIG acted arbitrarily in refusing to recognize an established causal link between using Zoloft and committing suicide. Assuming arguendo that there is a causal link between Zoloft and suicide, to the Court's knowledge no one has suggested that ingesting Zoloft always leads to suicide. As one other court noted many people who take Zoloft do not commit suicide and many people who commit suicide have never taken Zoloft. Miller v. Pfizer, Inc., 196 F. Supp 2d 1095, 1125 (D. Kan. 2002). Thus, even if AIG had conceded generally a link between Zoloft and suicide, in order to recover benefits under AIG's policy Plaintiff would still have to establish that Zoloft played such a role in Mr. Miles' suicide so as to render this self-inflicted injury an "accident."
The crux of Plaintiff's case is that Mr. Miles' suicide can only be explained by his use of the drug Zoloft. But shortly before his death Mr. Miles presented to his family doctor complaining that he was depressed. Clearly his symptoms were significant enough to seek medical help. Dr. Minksy determined that Mr. Miles was not suicidal at the time of his visit on August 16, 2002, but he also recognized the possibility that Mr. Miles had become much more depressed in the days following his visit. The Court has no reason to doubt that Mr. Miles had a good life by all accounts but suicide is a tragedy that is undoubtedly not reserved for those individuals who by society's judgment really have no reason to live. For the foregoing reasons the Court concludes that AIG did not abuse its discretion in denying accidental death benefits.
C. Full and Fair Review
The ERISA statutory scheme requires that every benefit plan "afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim." 29 U.S.C.A. § 1133(2) (West 1999). Department of Labor regulations pertaining to group health plans and disability plans require that the plan fiduciary consult with a health care professional who has appropriate training and expertise in the field of medicine involved in the medical judgment in order to satisfy the "full and fair review" requirement. 29 C.F.R. § 2560.503-1(h) (3) (iii), (h) (4). This health care professional cannot be the same one consulted in connection with the adverse benefits determination nor can he be the subordinate of any such individual. Id. § (h) (3) (v). Moreover, in the section entitled "Appealing a Denial of Plan Benefits," the Summary Plan Description for the AIG policy provides that:
If the denial is based on medical judgment, the Claims Administrator will consult a health care professional with appropriate training and experience in the field of medicine. This healthcare professional will not be the same person consulted for the initial determination, and will not be a subordinate who reports to the person who was consulted in the initial determination.
(Pla. Exh. B. at 25).
The Court is not persuaded that the federal regulations cited above apply to this plan because it is not a group health plan, and even though the plan does provide for a lump sum payment for permanent total disability, disability benefits are not at issue in this case. Nevertheless, AIG voluntarily chose to incorporate these regulations into its plan and the above quoted plan language applies specifically to death benefits. Thus, AIG's own plan procedures required it to submit Plaintiff's appeal to two healthcare professionals for review. AIG submitted the claim to Dr. Mann for review but there is no support in the administrative record for AIG's assertion that a second medical profession participated on the Appeals Committee. Thus, AIG's review of the initial denial of benefits was procedurally flawed.
Procedural violations of ERISA do not entitle the plan beneficiary to a substantive remedy of benefits. Duncan v. Assisted Living Concepts, Inc., No. 03-1931N, 2005 WL 331116, at *4 (N.D. Tex. Feb. 10, 2002); Steinberg v. R.R. Maint. Indus. Health Welfare Fund, No. 03-C-4539, 2004 WL 1151619, at *5 (N.D. Ill. Apr. 13, 2004). Rather, where procedural violations are so pervasive as to render a decision arbitrary and capricious the appropriate remedy is to remand to the plan administrator for further proceedings in compliance with procedures. Duncan, 2005 WL 331116, at *4. Therefore, the Court could remand this case to AIG's Committee for another review but that review will undoubtedly land Plaintiff right back in this Court following a second denial. If the Court were convinced in the slightest that Plaintiff had been denied full and fair review as required by ERISA, the Court would remand this case to AIG for a second review. But Plaintiff was represented by counsel when pursuing her benefits claim, she retained the expert of her choice, and she submitted all of the documents that she contended proved her case. AIG held the claim file open so that blood analysis results could be obtained from the State Police Crime Laboratory. There is no evidence that AIG withheld documents or information. The Court cannot discern any basis in the record upon which a second medical expert could reasonably opine that Mr. Miles' death was an accident. The Court finds that Plaintiff was afforded a full and fair review of her claim.
Accordingly;
IT IS ORDERED that the Motion for Summary Judgment (Rec. Doc. 26) filed by plaintiff Mary K. Miles should be and is hereby DENIED;
IT IS FURTHER ORDERED that the Motion for Summary Judgment (Rec. Doc. 25) filed by defendant AIG Life Insurance Company should be and is hereby GRANTED.