United States District Court, E.D. Virginia, Norfolk Division
OPINION AND ORDER
This matter comes before the Court on Summary Judgment Motions filed by both the plaintiff, Jennifer Collins ("Ms. Collins" or "Plaintiff), and the defendant, UNUM Life Insurance Company of America ("Unum" or "Defendant"). ECF Nos. 30, 32. For the forthcoming reasons, the Court GRANTS Defendant's Motion for Summary Judgment, ECF No. 32, and DENIES Plaintiffs Motion for Summary Judgment, ECF No. 30.
This case arises from the unfortunate death of David M. Collins ("Mr. Collins"), a former Navy SEAL, who took his own life on March 12, 2014. AR033. At the time of his death Mr. Collins was insured under a Supplemental Life Group Life Insurance Policy funded and administered by the defendant Unum. Mr. Collins' widow, Jennifer Collins, was the named beneficiary of the policy. Unum denied Ms. Collins' claim under the policy pursuant to a suicide exclusion within the policy. Ms. Collins now appeals this denial. This case is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. ("ERISA").
Mr. Collins served in the United States Navy as a SEAL for seventeen years, during which he was deployed to Iraq, Afghanistan, and Kuwait. AR173-75. Mr. Collins served in dangerous and stressful situations. AR198-200, 202-03. He was exposed to enemy gunfire and blasts from mortar fire. AR199, 202. During his deployments, he was frequently sleep-deprived, a condition his colleagues linked both to the stresses of deployment, especially in enemy areas, and to his specific duties, which required him "to be constantly on guard." AR200, 202-03, 220-21.
After retiring from the Navy, on or around September 9, 2012, Mr. Collins began working for Blackbird Technologies ("Blackbird"). AR023, 123, 221. Through Blackbird, Mr. Collins enrolled in two life insurances policies: a basic life insurance policy with $104, 000 in coverage that was part of his group benefit plan, and a supplemental life insurance policy with an additional $500, 000 in coverage. AR024. The underlying insurer of both plans was Unum Life Insurance Company of America ("Unum"). AR050. It is the supplemental policy, Supplemental Group Life Insurance Policy No. 212563 ("Supplemental Policy"), that is contested in this litigation. Id. As will be discussed, benefits have been paid under the Basic Life Insurance Policy, Policy No. 218750 ("Basic Policy"). See Compl. ¶¶ 90-94, ECF No. 1.
Coverage under the Supplemental Policy began on February 1, 2013. AR130. The policy contained an exclusion for death by suicide, which states in the relevant part:
Your plan does not cover any loses where death is caused by, contributed to by, or results from:
- suicide occurring within 24 months after your or your dependent's initial effective date of insurance; and
- suicide occurring within 24 months after the date any increases or additional insurance becomes effective for you or your dependent.
The suicide exclusion will apply to any amounts of insurance for which you pay all or part of the premium.
AR087-88. The Supplemental Policy also delegates to UNUM "discretionary authority to make benefit determinations under the Plan." AR113. Within the Plan, "[b]enefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan." Id.
Ms. Collins began to notices changes in her husband in the years before his death. AR232. According to her, he became less social and more irritable. Id. He could not concentrate as well as he could before and began to forget things. Id. His friend and co-worker, Herbart "Ali" Gordon Jr. has also noticed changes in Mr. Collins in these years. AR221. Mr. Gordon served as a SEAL alongside Mr. Collins and worked with him at Blackbird. Id. According to Mr. Gordon, Mr. Collins began his employment at Blackbird as his normal "jovial hard working perfectionist self." Id. However, "over time [he] started to see changes." Id. Mr. Collins seemed to Mr. Gordon to be confused and indecisive. Id He was depressed and withdrawn. Id. Mr. Collins also confided in Mr. Gordon that he was having trouble sleeping. Id. According to Mr. Gordon, these problems were affecting Mr. Collins life at home and at work. Id.
In the beginning of 2014, Mr. Collins sought treatment for these afflictions. He cut short a work trip that began on January 24, 2014 after he was unable to sleep. AR461. He returned home to "figure out what was going on." Id. On February 4, 2014, he went to the emergency room at the Naval Medical Center in Portsmouth, Virginia and complained of anxiety and insomnia. AR438. In response to questioning he answered in the affirmative that he "felt down, depressed, or hopeless, " that he had "less pleasure in doing things, " and that he had been "losing track of his thoughts." AR440. He was given a mental status exam and found to be "alert and oriented in all spheres, " "open, cooperative, and friendly and maintained good eye contract." AR463.
Mr. Collins was admitted overnight to the inpatient psychiatric ward and given a voluntary psychiatric evaluation. AR438-9, 464. During interviews with psychiatric professionals, he "reported severe anxiety about being able to do his job." AR461. One doctor wrote that "it appears that his anxiety is provoked by work related stresses in the context of... suffering a slow decline in memory." AR465. Mr. Collins acknowledged "anxiety about losing his job because he came home from his most recent trip prior to the trip's conclusion." AR476. He also discussed the connection between his work schedule, anxiety about his work, and his insomnia: "I recently doubled shifts this past trip and I keep focusing on work when my friends tell me to take some time to myself... I get good sleep when I'm at home though, but I keep telling myself to focus on work." AR483. He hoped that an MRI would give the doctors what they needed to diagnosis him. Id.
The doctors there acknowledged that Mr. Collins had been exposed to "hundreds of subconcussive explosions, " which raised concerns of "TBI [traumatic brain injury] with early onset dementia. AR464. They found that his "[m]emory and cognition were impaired, " AR463, and that he was "having increasing cognitive difficulties which do not appear to be entirely due to sleep deprivation." AR465. An MRI was performed, which showed that his brain was "within normal limits." AR446. There was a "single nonspecific focus of T2 hypersensitivity in the left frontal lobe." AR482.
Mr. Collins was discharged on February 5, 2014. AR446. Upon release the hospital staff concluded that he was "not considered dangerous to self or others and there was no basis for to refer for involuntary hospitalization." Id He was "not suicidal, homicidal, or psychotic." Id. Throughout his hospitalization he had denied suicidal thoughts. Id.; see also AR440, 441, 445, 461.
On February 24, 2014, Mr. Collins began two weeks of treatment at the Carrick Brain Center ("CBC") in Irving, Texas. AR039. The Medical Director of the CBC, Dr. Andre Fredieu, M.D., in a letter authored after Mr. Collins' death on March 31, 2014, reports that Mr. Collins went to the CBC "for treatment of his insomnia, anxiety, [and] difficulties with focus and memory." Id Dr. Fredieu identified insomnia as one of Mr. Collins' "most significant symptoms." Id Dr. Fredieu also identified other neurological abnormalities such as tremors, poor coordination, headaches, and hypomania. Id.
While in Texas, on February 27, 2014 and March 6, 2014, Mr. Collins attended two therapy sessions with Drs. Deborah Wade and Tracie Kaip, licensed psychologists at Lifeworks Counseling Center. AR234-38. Dr. Wade diagnosed Mr. Collins with Post-traumatic Stress Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder. AR236. Dr. Wade noted that during their initial meeting Mr. Collins "admitted that he felt an overwhelming sense of sadness, distress ...." AR234. He told her that "he has great worry and concern that his job is at risk, that this will burden his family financially ...." Id He had "churning thoughts" of "self-condemnation" that he could not control. AR234-35. He felt that his inability to control these thoughts interfered with his ability to do his job. AR234. Dr. Wade recommended some coping strategies at this first session. AR235. At the second session, Mr. Collins was "visibly improved." AR235. They "continued to address tools which will help to organize his thoughts ...." Id The session ended with "a sense of hopefulness, " although "underlying the hope was a wealth of trauma/pain/irrational thought processes that continued to need work to unlock and manage."AR235-36.
On March 10, 2014, Mr. Collins visited Dr. Glenn McDermott, a primary care physician at the Minor Emergency and Family Care Center in Virginia Beach, and complained of insomnia and anxiety. AR415-16. Mr. Collins had previously been seen by Dr. McDermott on January 31, 2014 and February 18, 2014. AR413-14. Mr. Collins told Dr. McDermott that he was only sleeping two to three hours a night. AR416. Dr. McDermott proscribed for him Sonata for insomnia and Lexapro for anxiety. Id.
Mr. Collins took his own life two days later on March 12, 2014. AR209-10, 214. He was found dead in the driver's seat of his car with a gunshot wound to his head and a handgun lying between his legs. Id The death was ruled a suicide by the Office of the Chief Medical Examiner for the City of Virginia Beach. AR214-16. That day Mr. Collins had sent a text to his wife that read "Pick up Sam.....so sorry baby I. Love u all." AR282. He also had emailed Mike Mansfield, another retired Navy SEAL, writing "I'm in bad times bro.. .please make sure my lovely wife Jennifer and children Sam and Grace are taken care of please... .hate to do this to you but you know how to get things done. Take care friend." AR278.
On April 3, 2014, Ms. Collins filed a claim for benefits under both the Supplemental Policy and the Basic Policy. AR018-21, 023-31. Included with the claims were (1) Mr. Collins' Death Certificate, AR033, and (2) the aforementioned March 31, 2014 letter from Dr. Fredieu, AR039-40.
The following entries are contained in the Death Certificate: (1) "Immediate Cause (due to or as a consequence of): Gunshot wound to the head;" (2) "Describe how injury relating to death occurred: Shot self in head with handgun;" and (3) "I certify that I took charge of the remains above, viewed the body, made inquiry and in my opinion death resulted ... from ... [x] suicide." AR033.
Dr. Fredieu's letter described the treatment that Mr. Collins received at the CBC after he was admitted on February 24, 2014. AR039-40. It explains that Mr. Collins went to CBC to treat his "insomnia, anxiety, [and] difficulties with focus and memory." AR039-40. After a short summary of testing Mr. Collins performed, Dr. Fredieu stated that his "personal history and clinical exam demonstrated cerebral and cerebellar dysfunction secondary to TBI [Traumatic Brain Injury] with associated manifestations of anxiety disorder and poor sleep architecture." AR039. Dr. Fredieu then briefly summarized the treatment Mr. Collins received at CBC. AR039-40.
At the conclusion of the letter, Dr. Fredieu expressed an opinion on Mr. Collins mental state at the time of his death. AR040. Dr. Fredieu noted that Mr. Collins denied any intention to commit suicide while he was at CBC. Id Mr. Collins said that he would never do that to his family. Id. Dr. Fredieu then cited to a portion of the federal regulation that establishes the standard for determining if a service member's suicide constitutes "willful misconduct." 38 C.F.R. § 3.302. According to the regulation, a suicide is willful misconduct if it is "intentional;" however, "a person of unsound mind is incapable of forming an intent (mens rea, or guilty mind, which is an essential element of crime or willful misconduct)." Id § 3.302(a)(l-2). Dr. Fredieu cited to the portion of the regulation on "Evidence of mental condition." Id. § 3.302(b). According to Title 38 of the Code of Federal Regulations, which govern Pensions, Bonuses, and Veterans' Relief,
[w]hether a person, at the time of suicide, was so unsound mentally that he or she did not realize the consequence of such an act, or was unable to resist such impulse is a question to be determined in each individual case, based on all available lay and medical evidence pertaining to his or her medical condition at the time of suicide.
Id. § 3.302(b)(1). In Dr. Fredieu's opinion, "at the time of [Mr. Collins'] death he was not of sound mind enough to understand the finite nature of his action, at which point he was not cognitively in a position to resist/overcome his impulse to commit suicide." AR040. In support of this opinion, Dr. Fredieu reasoned that
Many of David's exam findings, reports from his counseling sessions, as well as neurological consequences from incidents during his service, properly reported or not, are consistent with Traumatic Brain Injuries specifically decreased frontal and prefrontal function, as well as failure of some of his cognitive and brainstem inhibitory mechanisms. Prefrontal dysfunction is specifically associated with poor judgment, poor planning, preservation, poor executive function, dysregulated limbic (emotional) function, sensory dysfunction (mental and physical) ultimately altering his cognitive capabilities.
Id. Nothing in the letter indicates that Dr. Fredieu ever personally examined Mr. Collins. AR039-40; see also AR273 (a letter from counsel for Plaintiff stating that Dr. Fredieu's formed his opinion after he "reviewed ... the raw data").
On April 8, 2014, Unum denied Ms. Collins' claim for benefits under the Supplemental Policy based on the suicide exclusion in that policy. ARM 1-44. Unum paid under the Basic Policy, which contains an identical exclusion. Compl. ¶ 90. Both exclusions apply to "any amounts of insurance for which [the policyholder] pays all or part of the premium." AR087; Basic Policy at 16, ECF No. 1-1, Ex. 1. Because Mr. Collins' employer, Blackbird, paid the premiums for the Basic Policy, the suicide exclusion in that policy did not apply. See Def.'s Mem. in Supp. of Summ. J. ("Def.'s Mem. in Supp."), ECF No. 33 at 7 n.4. Mr. Collins paid the premiums for the Supplemental Policy, and so Unum denied the claim under that policy.
On July 1, 2014, Ms. Collins through counsel informed Unum that she was appealing the denial of benefits. AR161. The same day, her counsel sent a twelve-page letter with fifty-five pages of exhibits. AR172-244. Ms. Collins made two arguments in support of her appeal: (1) that the suicide provision was invalid under Va. Code §38.2-3106(a), and (2) that because Mr. Collins lacked the mental capacity to commit suicide, the suicide exclusion did not apply. AR173-184.
In support of her claim that Mr. Collins lacked the mental capacity to commit suicide, Ms. Collins submitted the following documents:
• A June 5, 2014 article from the New York Times, War's Elite Tough Guys, Hesitant to Seek Healing, that discusses the incidence of traumatic brain injury and post-traumatic stress disorder among former Special Operations forces. The article discusses the theory that frequent exposure to low-level blasts may cause substantial brain injury. It mentions the trouble that Special Operations soldiers have reentering civilian life and the rising rates of suicides among them. AR187-93.
• A military evaluation of Mr. Collins that rates him highly and marks him as "Must Promote." AR195-96.
• A declaration from Tarey Gettys, Mr. Collins' "Lieutenant and Platoon Commander/Officer in Charge of SEAL Team EIGHT." Mr. Gettys describes Mr. Collins' duties during his deployments. He also describes the high stress nature of Mr. Collins' particular position. He also notes that, while he did not notice Mr. Collins having problems sleeping, none of the SEALs slept very much while deployed. AR198-200.
• A declaration from Jon Fussell, who served with Mr. Collins on SEAL Team 10 from 2002-2004. He describes their deployment together, and Mr. Collins' ...