Shirley M. Critchlow v. First Unum Life Insurance Co. Of America

Citations: 340 F.3d 130; 2003 WL 21805542Docket: 02-7585

Court: Court of Appeals for the First Circuit; August 12, 2003; Federal Appellate Court

Combined Opinion SummaryCombined Opinion Original

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On February 26, 1999, David Critchlow died from autoerotic asphyxiation, a form of strangulation where oxygen deprivation is used to induce sexual arousal. A postmortem photograph showed visible injury on his neck. Dr. Ben Blecker's report indicated that autoerotic asphyxiation is a dangerous practice, resulting in approximately 2,000 deaths annually. David's employer provided a group accidental death insurance policy through First UNUM Life Insurance Company, with Shirley Critchlow as the beneficiary. The policy specified that it would not pay for losses caused by intentionally self-inflicted injuries and required that compensable losses arise directly from accidental bodily injury.

David's actions leading to his death are undisputed. He secluded himself in his bedroom, disrobed, and used a complex harness to create a noose around his neck. Dr. Blecker concluded that he died from practicing autoerotic asphyxiation. The district court, led by Chief Judge Larimer, granted First UNUM's motion for summary judgment, determining that David's death resulted from self-inflicted injury as defined by the policy. The court found the policy's language unambiguous and rejected the argument that David did not intend to die but merely to constrict his windpipe. It reasoned that the intentional act of cutting off oxygen flow directly resulted in his injury and death, and that his mistaken belief in being able to stop the injury before it became fatal did not support the plaintiff's claim.

The decedent's act of strangulation, intended to deprive his brain of oxygen, is classified as an intentionally self-inflicted injury, as supported by case law (Sims v. Monumental Gen'l Ins. Co. and Sigler v. Mutual Benefit Life Ins. Co.). The physiological effects of this act resulted in death, affirming the application of the insurance policy's exclusion clause for intentional self-inflicted injuries. Prior instances of the same activity without severe consequences do not negate the intentionality or the injury's impact. The court agrees with the Fifth and Eighth Circuits that such deliberate actions fall under the exclusionary clause, without needing to address the question of whether the death was 'accidental.' The appellant's additional arguments were found to lack merit, leading to the affirmation of the district court's summary judgment for the appellee and the denial of the appellant's motion for reconsideration. The court determined that the denial was not an abuse of discretion, particularly as the expert affidavits presented were outside the administrative record and conflicted with the policy's language. The judges expressed support for the district court's decisions and noted that dissenting opinions referenced materials not included in the official record, which were appropriately excluded under established law.

The autopsy report of the deceased indicates signs of self-inflicted injury, including blood from the mouth, cyanosis, the presence of masking tape with blue straps in the mouth, and a deep groove around the neck. The autopsy photographs corroborate the findings, suggesting that the injuries were self-inflicted, likely through strangulation, though it is debated whether this was partial or complete. Judge Kearse dissents from the majority's ruling that the death from autoerotic asphyxiation constitutes an "intentionally self-inflicted injury" under the terms of the insurance policy. The dissent emphasizes that the deceased had established safety mechanisms to prevent death from asphyxiation, and had previously engaged in the activity without severe consequences. The insurance policy from First UNUM explicitly excludes coverage for intentionally self-inflicted injuries. Under ERISA, which governs the plan, courts interpret plan language in accordance with federal common law, giving terms their plain meanings and construing ambiguities against the insurer.

The majority opinion references Sims v. Monumental General Insurance Co. and Sigler v. Mutual Benefit Life Insurance Co. to assert that deliberate constriction of the windpipe to deprive the brain of oxygen is considered an intentionally self-inflicted injury under the insurance policy's exclusion clause. However, these cases were not ERISA cases but rather state law diversity actions. The Fifth Circuit, in the ERISA case Todd, stated that state law could only inform ERISA questions to the extent it does not conflict with federal law, choosing not to follow Sims and Sigler in favor of federal common law principles.

The only federal appellate case addressing whether a death during autoerotic asphyxiation constitutes an "intentionally self-inflicted injury" under an ERISA-covered insurance policy is Padfield v. AIG Life Insurance Co. The Padfield court determined that the classification of the physical consequences of the act hinges on whether those consequences were injuries. If they were, and led to death, the insurance exclusion would apply. The court, applying federal common law and a subjective/objective analysis, concluded that autoerotic asphyxiation is not an intentionally self-inflicted injury.

Under this analysis, the court first assesses whether the insured had a subjective lack of expectation of death or injury, considering the reasonable person's perspective and the insured's background. If the subjective expectation is unclear, the court evaluates whether a reasonable person would view the injury or death as substantially certain from the insured's conduct. The Padfield court noted that autoerotic asphyxiation is typically a long-standing behavior where individuals do not intend death, resulting primarily in temporary light-headedness without visible marks. However, accidental deaths can occur due to equipment failure or errors, with statistics indicating one to two deaths per million annually linked to hypoxyphilia, while nonfatal outcomes are more common.

Death by autoerotic asphyxiation is statistically rare. In a relevant case, the Ninth Circuit determined that Mr. Padfield lacked subjective intent to injure himself, as all evidence indicated he anticipated only temporary oxygen deprivation leading to euphoria, not injury. His expectation of survival was reasonable, given both the rarity of fatal outcomes in autoerotic asphyxiation and his history of engaging in such behavior without incident. The court noted that even under an objective analysis, death is not a 'substantially certain' result of autoerotic asphyxiation. Therefore, despite Mr. Padfield's voluntary engagement in risky behavior, his death was deemed a 'fatal mistake' rather than an intentionally self-inflicted injury. This aligns with the purpose of accident insurance, which is to protect against miscalculations. In a related case involving Daniel Critchlow, the district court found that his death was also unexpected and unintended, supported by evidence that his subjective expectation of survival was not objectively reasonable, as noted by First UNUM in their denial of benefits.

Critchlow's subjective expectation of survival during autoerotic asphyxiation was supported by expert opinions, despite First UNUM's assertion that this expectation was not objectively reasonable. The evidence presented by First UNUM included the insurance policy, Critchlow's claim, relevant police and autopsy reports, denial letters from First UNUM, and expert reports from Dr. Robert M. Greendyke and Dr. Stephen J. Hucker. 

Dr. Hucker noted that hypoxia, which Critchlow experienced, does not necessarily lead to death or injury, and he opined that Critchlow reasonably expected to survive based on prior similar experiences. He emphasized that autoerotic asphyxia does not typically result in fatal outcomes. Dr. Greendyke reached a similar conclusion, attributing Critchlow's death to an accidental miscalculation during a risky sexual activity, asserting that individuals often engage in dangerous behaviors without a death wish. 

Both experts pointed out that Critchlow's actions were consistent with previous safe experiences, reinforcing the objective reasonableness of his expectation of survival. They highlighted that death due to autoerotic asphyxiation is statistically rare, contrasting it with other risky activities that do not inherently imply self-destructive intent. The lack of contrary expert opinions from First UNUM further supported the conclusions drawn by Hucker and Greendyke.

The district court's summary judgment favoring First UNUM hinged on the interpretation that "partial strangulation is an injury in and of itself." However, it was established that Critchlow's death was due to total strangulation, not partial strangulation, contradicting the majority's assertion that Critchlow intended total strangulation. Evidence indicated that Critchlow had created an escape mechanism to prevent asphyxiation, which implies a lack of intent to die. The majority's position that any physiological effect from constriction constituted an injury is criticized, as it could broadly redefine injury to include minor physical effects from various activities, potentially absolving insurers from covering less severe accidents. This dissent aligns with the Ninth Circuit's interpretation that nonserious, temporary effects do not meet a reasonable understanding of "injuries" in the context of intentional self-inflicted injuries, and any ambiguity should favor the insured under ERISA principles. The dissent also clarifies that all references were derived from the majority opinion, the district court's opinion, or First UNUM's submitted documents. The district court indicated that even if it had considered the plaintiff's expert opinions, its decision would not change, highlighting that Critchlow's death was an "unintended injury." Therefore, the dissent advocates reversing the summary judgment for First UNUM and granting the plaintiff's cross-motion for summary judgment.