Mountaineer Falls to Death

This was originally posted on the SGR Blog.

Was Demise an Accident or Suicide?

The brothers Levi and Benjamin Goldfarb, as beneficiaries of an insurance policy issued by Reliance Standard Insurance Company (Reliance), sued to recover under the Employee Retirement Income Security Act a $500,000 accidental death benefit because of the insured, Dr. Alexander Goldfarb’s, death while mountain climbing. Reliance sought summary judgment affirming the plan administrator’s decision to deny the “accidental death” benefit. The beneficiaries sought summary judgment, claiming that the plan administrator’s denial of the “accidental” death benefit was arbitrary and capricious. [1]

Dr. Goldfarb, an avid mountain climber, attempted to climb a dangerous mountain in Pakistan under dangerous winter conditions about which he was warned. Despite those warnings, Dr. Goldfarb insisted on climbing the mountain and went missing on January 16, 2021.

Aerial photographs of a body believed to be Dr. Goldfarb and of his gear led the governmental authorities of the United States and Pakistan to presume Dr. Goldfarb dead and to issue death certificates.

Reliance paid a $500,000 “basic death benefit,” but refused to pay an additional $500,000 “accidental death benefit” contained in the policy, arguing that there was no proof of an “accident.” Thus, the Court was required to decide whether or not Dr. Goldfarb’s death was an accident.

Under the controlling test, the Court engaged in two steps to determine whether Dr. Goldfarb’s death was “accidental.” First, the Court had to determine whether Dr. Goldfarb subjectively expected his actions to cause death or serious injury and; second, if the Court could not ascertain his subjective thoughts, the Court had to objectively determine whether a reasonable person (with similar background and experience) would have anticipated injury or death in the circumstances.

At oral argument, the Court inquired from counsel for Reliance whether there was a dispute that Dr. Goldfarb was dead or whether there was a suggestion that he committed suicide. Defense counsel conceded that Dr. Goldfarb was dead and not as a result of a suicide, yet maintained that it was not an “accident.”

Since Reliance paid the basic death benefit, the question was: What is an accident? The policy did not have an exclusion for “mountain climbing” as an unacceptable risk. The Court concluded that Dr. Goldfarb’s decision to conduct an activity not excluded as a covered risk in the policy did not lead a reasonable person to conclude that his death was not an “accident.”

Dr. Goldfarb was dead. Reliance paid a basic death benefit. That death was not an intentional suicide. In retrospect, Dr. Goldfarb should not have taken the risk to climb the mountain, but having done so resulting in his death did not make his death not an “accident.”

The sons as beneficiaries were, under the evidence submitted, entitled to the additional death benefit under the policy. The denial of such accidental death benefit was arbitrary and capricious and not reasonable. The Goldfarb brothers’ motion for summary judgment was granted and Reliance’s cross-motion for summary judgment was denied.

[1] The Goldfarbs are represented by my brother, Lawrence M. Metsch. CUNY Queens College (1963).  Yale Law School (1966). USAF JAG. Clerk, U.S. Fifth Circuit. Lt. Col. (ret.) USAF Reserves. Actively practicing law in the State and Federal Courts of Florida. And celebrating his 80th birthday this week.

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