District Court in 11th Circuit Applies Presumption against Suicide When Interpreting Accidental Death and Dismemberment (AD&D) Policy
In Acree v. Hartford Life & Accident Ins. Co., 2013 WL 140097 (M.D. Ga. 2013), Mr. Gwinette was found dead on his porch, with a gunshot wound to his chest. When Mr. Gwinette’s beneficiaries submitted a claim for life insurance and AD&D benefits under the employee benefit plan provided by Mr. Gwinette’s employer, Defendant paid the life insurance benefits, but denied the AD&D benefits. In finding coverage excluded, Defendant relied upon “official” reports from the investigation, including: (1) the Death Certificate, which listed the manner of death as “Undetermined”; (2) the Autopsy, which listed the manner of death as “suicide (self-inflicted)”; and (3) the Incident Report, which provided a narrative of the first responder, who listed the incident type as “suicide.” In their administrative appeal, the claimants alleged Mr. Gwinnett accidently shot himself while cleaning his shotgun. They submitted testimony regarding Mr. Gwinette’s character, state of mind, relative inexperience with guns, and the tendency for the gun to “jam.” They also presented evidence that gun-cleaning materials were beside Mr. Gwinette’s chair on the porch where he was found. Nevertheless, Defendant upheld its determination on appeal, relying on the original “official” reports.
In reviewing Defendant’s determination, the Court held that federal common law “firmly established a negative presumption against suicide.” Under this rule, “the presumption never drop[s] out of the case until the fact finder, [i.e., the Court] becomes convinced, given all the evidence, that it is more likely than not that the insured committed suicide.” Id. at *19, quoting, Horton v. Reliance Standard Life Ins. Co., 141 F. 3d 1038, 1042 (11th Cir. 1998). Here, the Court was not so convinced, and remanded the case for Defendant to investigate further into whether Mr. Gwinette’s “self-inflicted” shooting was simply an accident while he was cleaning his gun. Implicit in the Court’s ruling was its sense that the “official” reports did nothing more than rule out a homicide.
The Court also foreclosed any argument that, even if Mr. Gwinnett had been cleaning his gun, he should have known that serious injury would be a probable outcome in cleaning a gun that tended to jam, thus failing the Wickman test. (Wickman v. Northwestern Nat’l Ins., Co., 908 F. 2d 1077 (1st Cir. 1990) was a landmark case inserting an objective test into evaluating whether a loss was due to an “accident” as a result of risky behavior.) Here, the Court found: “[Mr.] “Gwinette made no more than a fatal mistake,” and that AD&D insurance is “purchased … ‘for the very purpose of obtaining protection from one’s own miscalculations and misjudgments.’” Id.at *28, quoting Padfield v. AIG Life Ins. Co., 290 F. 3d 1121, 1130 (9th Cir. 2002).