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MCLAIN v. METROPOLITAN LIFE INS. CO.

March 26, 1993

JENNIFER MCLAIN, Plaintiff,
v.
METROPOLITAN LIFE INSURANCE COMPANY, Defendant.



The opinion of the court was delivered by: LECHNER

 LECHNER, District Judge

 This is an action by plaintiff Jennifer McLain ("McLain") against defendant Metropolitan Life Insurance Company ("MetLife") to recovery "Accidental Death and Dismemberment" benefits under the Employment Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 et seq. A verified complaint was originally filed in the Superior Court of New Jersey, Law Division, Hudson County on 2 October 1992. Pursuant to 28 U.S.C. § 1441 (a) and (b), MetLife removed this action to Federal court on 4 November 1992. Jurisdiction is alleged pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e).

 Currently before the court are the cross motions for summary judgment of McLain and MetLife. *fn1" For the reasons set forth below, summary judgment is granted in favor of MetLife.

 Facts

 Mclain is the widow of John McLain ("J. McLain") who died 10 June 1990. Joint 12G statement, PP 1, 8. J. McLain was a management level employee with the American Telephone and Telegraph Company ("AT&T") until his death. Id., P 1. He was also a participant in the AT&T Benefits Plan (the "AT&T Plan"), which is governed by ERISA. Id.

 MetLife is the claims administrator of the life insurance benefits of the AT&T Plan. AT&T, as the plan administrator (the "Plan Administrator"), has vested in MetLife the discretionary authority to determine life insurance benefit claim eligibility and entitlement, conduct the evaluation and the review of such denied claims, construe the Plan's terms and conduct the administration of the AT&T Plan's life insurance claim procedures. Id., P 2.

 As Plan Administrator, AT&T has distributed to eligible AT&T Plan participants a Summary Plan Description ("SPD") which constitutes one of the AT&T Plan's documents. Id., P 4; Ex. J-1. MetLife also issued a contract of insurance (the "Insurance Contract") to AT&T in relation to the AT&T Plan life insurance benefits. The Insurance Contract also constitutes one of the AT&T Plan documents. Joint 12G Statement, P 5; Ex. J-2.

 One of the benefits of the AT&T Plan is the Accidental Death and Dismemberment benefit for which J. McLain was eligible at the time of his death. Joint 12G Statement, P 6; Exs. J-1, J-2. The AT&T Plan provides, in relevant part:

 
Upon receipt of notice and satisfactory proof . . . that any Employee . . . shall have sustained accidental bodily injuries, and within ninety days thereafter shall have [died] . . . as a direct result of such bodily injuries independently of all other causes, the Insurance Company shall pay, subject to the terms and limitations hereof, the amount of insurance specified . . ., however, that in no case shall any payment be made for death . . . which is . . . (4) caused by or resulting from suicide, attempted suicide or intentionally self-inflicted injury.

 Joint 12G Statement, P 7; Ex. J-2.

 J. McLain died on Sunday, 10 June 1990 at 6:30 p.m. at Greenville Hospital (the "Hospital") in Jersey City, New Jersey. He was thirty-three years old at his death. Joint 12G Statement, P 8. The Jersey City Police Department Investigation Report (the "Lyons Report") of J. McLain's death states that on 10 June 1990, at 5:15 p.m., Jersey City Police Officer Peter Lyons ("Lyons") was flagged down by Robert Fahrion ("Fahrion"). Fahrion advised Lyons that J. McLain was sitting in the passenger seat of Fahrion's automobile and was ill and unconscious after playing golf. Fahrion indicated that J. McLain required hospitalization. Id., P 9. The Report indicates Lyons escorted Fahrion's automobile to the Hospital where emergency personnel treated J. McLain for cardiac arrest. J. McLain died at the Hospital. Id.; Ex. J-4.

 On the evening of 10 June 1990, at or around 6:40 p.m., the Jersey City Police Department notified the Hudson County Prosecutor's Office of J. McLain's "suspicious death." According to the report of the Prosecutor's Investigator, John Bartucci ("Bartucci"), J. McLain, while playing golf, "complained of shortness of breath and not feeling well." Joint 12G Statement, P 10; Ex. J-5. When J. McLain reached Gimbert's Tavern in Jersey City, he "passed out." Joint 12G Statement, P 10; Ex. 3-5.

 Bartucci states he spoke with McLain about her husband. McLain "stated that she has been separated from her husband for about one week" and "that her husband was on cocaine on Friday evening June 8, 1990 and was also drinking heavy. She also remembered that [J. McLain] had been using cocaine on a regular basis for a long period." Joint 12G Statement, P 11; Ex. J-5.

 On 11 July 1990, Dr. Sunandan B. Singh ("Dr. Singh"), Assistant Essex County Medical Examiner, performed an autopsy upon J. McLain's body and complied an autopsy report (the "Autopsy Report"). In the Autopsy Report, Dr. Singh stated that

 
as per details given by the wife of the decedent, . . . [J. McLain] had gone to the Y.M.C.A. in the a.m. . . . Had his exercise, came back home and complained of not feeling well. He picked up his golf clubs and left home . . . [J. McLain] had no past medical history of problems and per the wife he is in the habit of doing cocaine and was drinking alcohol prior to his death.

 Joint 12G Statement, P 12; Ex. J-6.

 The Autopsy Report include pathological finds regarding J. McLain:

 
(1) Hemorrhagic pulmonary edema.
 
(2) Chronic laryngitis and bronchitis.
 
(3) Erosive esophagitis and hemorrhagic gastritis.
 
(4) Mitral incompetence.
 
(5) History of ethanol and cocaine abuse ...

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