Published by The Pellegrin Firm October 9, 2019

In a ruling issued October 1, 2019, the New Orleans-based U.S. Court of Appeals for the Fifth Circuit found for Securian Life Insurance Company in the case of a Texas teenager who shot himself in the head while hanging out with his friends. The plaintiff is the boy’s father, an employee of Kohls’ Department Stores. The Securian policy offered through Kohl’s covers the father and his dependents and offers benefits for accidental death. Because the policy was provided by an employer, the policy is governed by the Employee Retirement Income Security Act (ERISA), a federal law which governs most employer-provided insurance.  Securian denied the claim, finding that the death is excluded form coverage due to the fact that the medical examiner ruled the death a suicide. The policy excludes deaths due to self-inflicted injuries and suicide.

The ruling is brief, and not designated for publication. The district court below also found for the insurer. The court of appeals found the insurer did not abuse its discretion. The court found that whether or not the teenager intended to kill himself, the exclusion for death due to self-inflicted injuries applies. It is not clear exactly why the teenager did what he did. Neither the district court’s decision nor the court of appeal’s decision parses the conflicting possible explanations for why the deceased did what he did. The family argued the deceased was not depressed. They advanced the possibility that the deceased didn’t know the gun was loaded when he put it to his head and pulled the trigger. Using the language of an early appeal letter from the plaintiff, the court of appeal characterizes the death as one due to Russian Roulette, but it is not evident that this is exactly what happened.

The court of appeal found that the self-inflicted injury exclusion clearly applies, even though the insurance company technically denied the claim on the basis it was a suicide, not that it was a death due to self-inflicted injury. Under ERISA, a beneficiary is supposed to get a clear elucidation of what exclusion the insurance company is relying on and why. Neither the district court nor the court of appeals considered the argument that a very unwise risk such as playing Russian Roulette might not necessarily equate to a self-inflicted injury. In addition, neither court considered whether the deceased’s possible subjective belief that the gun was unloaded or otherwise could not hurt him would render the self-inflicted injury exclusion inapplicable. The case is Freeman v. Securian Life Ins. Co., No. 18-51078__F.App’x___,2019 WL 4855553 (5^th Cir. Oct 1, 2019).