United States District Court, D. Massachusetts
ORDER ON PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT
ON THE AGREED RECORD (DOC. NO. 33)
Sorokin, United States District Judge.
action arises out of a claim for accidental death and
dismemberment benefits, under a group policy issued by Zurich
American Insurance Company, following the death of Kelly
McGuiggin's son from acute fentanyl intoxication. Zurich
rejected McGuiggin's claim after determining that the
death was not accidental and, in any event, was excluded from
coverage under the policy. McGuiggin sued Zurich in
Massachusetts state court; Zurich removed the action to this
Court. The parties seek entry of judgment on an agreed-upon
record. For the reasons set forth below, McGuiggin's
motion for summary judgment is DENIED, and judgment is
ENTERED in favor of Zurich.
is a Massachusetts resident and an employee of Sysco
Corporation. She is insured by Zurich under a Group Accident
Policy (“the Policy”) issued to Sysco on January
1, 2013. Doc. No. 32 at 231. The Policy provides an
accidental death benefit in the event a covered person
suffers a “Covered Injury” and
dies. Id. at 237. A “Covered
Injury” is “an Injury directly caused by
accidental means which is independent of all other causes,
results from a Covered Accident, occurs while the Covered
Person is insured under this Policy, and results in a Covered
Loss.” Id. at 235. A “Covered
Loss” is “a loss which meets the requisites of
one or more benefits or additional benefits, results from a
Covered Injury, and for which benefits are payable under this
Policy contains “General Exclusions, ” one of
which is relevant:
A loss will not be a Covered Loss if it is caused by,
contributed to, or results from: . . . (8) being under the
influence of any prescription drug, narcotic, or
hallucinogen, unless such prescription drug, narcotic, or
hallucinogen was prescribed by a physician and taken in
accordance with the prescribed dosage.
Id. at 242. The Court will refer to this provision
as “Exclusion 8.”
January 2016, McGuiggin's son, Colin Gear, was a
twenty-year-old student at the University of Massachusetts
Dartmouth. Campus police conducted a wellness check at
Gear's dorm room on January 29, 2016, sometime after
10:00 p.m. Id. at 49. After gaining entry to his
locked room, the officers discovered Gear alone, lying naked
on his bed, “unresponsive and cold to the touch.”
Id. He was pronounced dead by paramedics who arrived
on the scene soon thereafter. Id. On a desk in
Gear's room, officers observed “a single
‘line' of a tan powdery substance, ” along
with a “rolled-up twenty dollar bill, ”
“the knotted portion of a clear plastic baggie, ”
and a school identification card with “a powdery
substance along its edge.” Id.
roommates had last seen him the previous evening.
Id. They reported to police that “they had
suspected that [Gear] used some type of drug, ” as
“they could hear snorting/sniffing sounds coming from
[his] room” at times, and he had “appeared to be
under the influence of something” on several occasions.
Id. Gear's father, who had requested the
wellness check, told police that Gear had admitted a heroin
addiction to him the previous spring. Id.
on these circumstances, the initial police report regarding
Gear's death described the “possible manner of
death” as “heroin overdose.” Id.
at 50. A medical examiner performed an autopsy. Both the
autopsy report and the death certificate reflect the medical
examiner's conclusion that the cause of Gear's death
was “acute fentanyl intoxication, ” and the
manner of death was an “accident” that occurred
due to “substance abuse” or “snorting
illicit drugs.” Id. at 23, 26. As part of the
autopsy process, Gear's blood was tested for the presence
of various substances; the resulting toxicology report
reflects a positive result for fentanyl. Id. at 30.
notified Zurich of Gear's death on April 20, 2016 and
requested the forms necessary to make a claim under the
Policy. Id. at 14. On June 28, 2016, she
submitted her claim, providing a completed Proof of Death
form, along with copies of Gear's death certificate,
autopsy report, and related police reports. Id. at
16-78. After requesting pharmacy records for Gear and
confirming he had no active prescription for fentanyl,
id. at 163, 169, Zurich denied McGuiggin's claim
by letter dated September 20, 2016, id. at 154-57.
The denial rested on Zurich's conclusion that Gear's
death was “not a Covered Loss due to a Covered Injury,
” and that two coverage exclusions applied: an
exclusion for suicide, and Exclusion 8. Id.
appealed the denial to Zurich on December 9, 2016, arguing
that Gear's death was accidental, that there was no
evidence to suggest suicide, and that Exclusion 8 applied
only to “prescription” drugs and not to
“illicit” drugs. Id. at 8-12.
Zurich's ERISA committee reviewed the claim, meeting at
least twice to discuss it and requesting a legal opinion on
the applicability of Exclusion 8. Id. at 270,
273-75. Ultimately, the committee affirmed the denial of
coverage in a March 29, 2017 letter, citing Exclusion 8 but
no longer invoking the suicide exclusion. Id. at
2017, McGuiggin sued Zurich in the Dukes County Superior
Court, alleging breach of contract, seeking a declaratory
judgment, and claiming violations of state consumer
protection laws. Doc. No. 1-3. Zurich removed the action to
this Court on August 16, 2017, noting the Policy is subject
to the Employee Retirement Income Security Act of 1974
(“ERISA”), and therefore characterizing
McGuiggin's action as one arising under federal
law.Doc. No. 1. McGuiggin concedes that ERISA
governs the Policy, Doc. No. 33 at 1 n.2, and she has not
opposed Zurich's assertion that ERISA preempts the
state-law claims in her original complaint, see Doc.
No. 34 at 18 (citing decisions finding that ERISA preempts
chapter 93A and breach-of-contract claims related to the
denial of benefits under ERISA plans). As such, this Court
considers McGuiggin's action as one to enforce her rights
under the Policy pursuant to 29 U.S.C. § 1132(a).
Wickman v. Nw. Nat'l Ins. Co., 908 F.2d 1077,
1081-82 (1st Cir. 1990).
parties urged the Court to resolve McGuiggin's claims on
the pleadings and an agreed-upon record of relevant
documents, with McGuiggin filing an opening motion and brief,
Zurich responding, and McGuiggin replying. Doc. Nos. 27, 32.
After reviewing those briefs and the record, the Court
requested additional information regarding whether and how
McGuiggin received the Policy. Doc. No. 38. The ...