## Facts

- Paul Wickman was covered by an employer-provided group life insurance policy that included an accidental death and dismemberment (AD&D) benefit; his wife, Mary Jane Wickman, was the named beneficiary.
- Wickman had a history of psychological difficulties and had, at times, mentioned suicide to a psychiatrist.
- A motorist saw Wickman outside his parked car on a highway bridge, standing on the outside of the bridge guardrail while holding it with one hand; moments later, Wickman fell to the railroad tracks below.
- The bridge was roughly 40–50 feet above the tracks at that location; the guardrail was 3–4 feet high, and there was no safe standing surface outside the rail.
- The trial court found it not reasonable that Wickman ended up outside the guardrail by mistake or inadvertence.
- After the fall, Wickman reportedly told hospital staff “I jumped off,” but told a nurse he had fallen; he later died that night.
- The medical examiner initially classified the death as suicide but later amended the certificate to list the cause as a fall.
- The insurer paid ordinary life insurance benefits but denied AD&D benefits on the ground that the death was not “accidental” under the policy.
- The beneficiary sued under ERISA; after a bench trial before a magistrate judge by consent, judgment entered for the insurer.

## Issues

1. Whether the employer-sponsored group policy and benefits dispute were governed by ERISA, preempting state law.
2. Under an ERISA-governed AD&D policy, how to determine whether a death is “accidental” when the insured voluntarily engages in extremely dangerous conduct and then dies.

## Decision

- The First Circuit affirmed judgment for the insurer.
- The court held the policy was part of an ERISA employee benefit plan and ERISA supplied the governing law.
- The court adopted a federal common-law standard for “accidental” death using a mixed subjective–objective test.
- Applying that standard, the court held the death was not accidental because serious injury or death was substantially certain (highly likely) to result from intentionally placing oneself outside the guardrail of a high bridge.

## Legal Principles

- ERISA preempts state-law claims seeking benefits under an employer-sponsored plan, and courts may develop federal common law to interpret plan terms where ERISA and the plan do not define them.
- “Accidental” death in an ERISA AD&D policy is assessed through a two-step inquiry:
  - If the insured’s actual (subjective) expectation can be determined, death is not accidental if the insured intended or expected serious injury or death.
  - If subjective expectation cannot be determined or is unreasonable, the fact-finder asks whether a reasonable person with the insured’s actual background and characteristics would have viewed serious injury or death as highly likely or substantially certain from the insured’s intentional conduct.
- Even without a definitive finding of suicidal intent, deliberate conduct that makes serious harm substantially certain is outside ordinary accidental-death coverage.

## Conclusion

The First Circuit held ERISA governed the claim and, under a federal common-law subjective–objective standard, denied AD&D benefits because a reasonable person in the insured’s position would have viewed death or serious injury as highly likely to result from intentionally placing himself outside a high bridge guardrail.


Wickman v. Nw. Nat’l Ins. Co., 908 F.2d 1077 (1st Cir. 1990)