Byerly v. Standard Ins. Co.
| Decision Date | 25 March 2020 |
| Docket Number | Civil Action No. 4:18-CV-00592 |
| Parties | SONYA E. BYERLY, INDEPENDENT EXECUTOR OF THE ESTATE OF GREGORY G. BYERLY, DECEASED Plaintiff, v. STANDARD INSURANCE COMPANY Defendants. |
| Court | U.S. District Court — Eastern District of Texas |
MEMORANDUM OPINION AND ORDER
Pending before the Court is Plaintiff's Motion for Partial Summary Judgment with Supporting Memorandum (Dkt. #37) and Defendant's Motion for Summary Judgment or, Alternatively, for Judgment under Rule 52 (Dkt. #38). Having considered the motions and the relevant pleadings, the Court finds that Plaintiff's Motion for Partial Summary Judgment with Supporting Memorandum (Dkt. #37) is DENIED and Defendant's Motion for Summary Judgment or, Alternatively, for Judgment under Rule 52 (Dkt. #38) is GRANTED.
This is an action for insurance benefits under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001, et seq. Plaintiff Gregory G. Byerly ("Byerly") filed this action on August 18, 2018 alleging that Defendant Standard Insurance Company ("Standard Insurance") refused to provide benefits which Standard Insurance was contractually obligated to pay (Dkt. #1; Dkt. #14; Dkt. #37; Dkt. #38). Byerly is accordingly seeking to recover the accidental death and dismemberment ("AD&D") benefits, pursuant to 29 U.S.C. § 1132(a)(1)(B), that he claims he was due under his group life insurance policy: Policy No. 648852-A (the "Group Policy").1 Byerly is also requesting pre-judgment interest or disgorgement of profits earned—pursuant to § 1132(a)(3)—and attorneys' fees and costs—pursuant to § 1132(g). The facts leading to the present action are as follows.
In December of 2016, Byerly, a Texas resident and citizen, was employed by Fidelity National Information Services, Inc. ("FIS") (Dkt. #14; Dkt. #37; Dkt. #38). FIS is a Delaware limited liability company with its principal place of business in Jacksonville, Florida, that, among other things, sells computer software to financial institutions (Dkt. #38). Byerly was employed as a manager at FIS (Dkt. #14; Dkt. #37; Dkt. #38). As part of his compensation package, Byerly was insured under the Group Policy that Standard Insurance issued to FIS (Dkt. #14; Dkt. #37; Dkt. #38). Because the Group Policy was non-contributory, FIS paid all premiums to Standard Insurance (Dkt. #51). The Group Policy included accidental death and dismemberment coverage (Dkt. #14; Dkt. #37; Dkt. #38). Although AD&D benefits were included in the Group Policy, Byerly alleges that he elected to purchase additional AD&D coverage and thus personally paid additional premiums directly to Standard Insurance (Dkt. #51).2
On December 28, 2016, Byerly was allegedly involved in an accident which resulted in him sustaining an injury to his left foot; specifically, Byerly injured the second toe of his left foot (Dkt. #38, Exhibit 1 at pp. 821-33). Following this injury, Byerly developed a bone infection in his left foot (Dkt. #38, Exhibit 1 at p. 800). The infection eventually spread to his leg (Dkt. #38, Exhibit 1 at p. 188). As a result of said bone infection, Byerly was forced to undergo a below the knee amputation ("BKA") (Dkt. #38, Exhibit 1 at p. 188). Byerly subsequently made a claim (the "Claim") for AD&D benefits under the Group Policy (Dkt. #38, Exhibit 1 at pp. 821-35).
On June 26, 2018, Standard Insurance received Byerly's AD&D claim (Dkt. #38, Exhibit 1 at pp. 821-35). Upon receipt of the Claim, Standard Insurance began its investigation (Dkt. #38, Exhibit 1 at p. 817). First, Standard Insurance began by collecting Byerly's medical records and looking to Byerly's Claim. Accompanying Byerly's Claim was a letter from a cardiologist, Tony M. Das, M.D., FACC ("Dr. Das"), which described the alleged accident and its aftermath. The letter stated:
Gregory Byerly is 67-year-old gentlemen with significant history of coronary artery disease, chronic kidney disease, and type 1 diabetes mellitus. In December 2016, he sustained an open wound to his left foot in a household accident. This occurred when he hit his foot against a piece of furniture. He was treated initially by a podiatrist and wound care doctor and referred for further treatment. This wound quickly became necrotic and ultimately as result he developed osteomyelitis, which spread to the lower leg. In spite of multiple vascular procedures to hopefully avoid and at least minimize amputation, it was necessary for him to undergo a below-the knee amputation on 04/03/17. This was performed by Dr. Matthew Pompeo.
(Dkt. #38, Exhibit 1 at pp. 821-33). Byerly additionally listed his treating physicians (Dkt. #38, Exhibit 1 at pp. 834-35). As a result of Byerly's disclosures, Standard Insurance pursued medical records from the listed treating physicians. The records revealed a history of medical ailments. More specifically, Byerly's medical records detailed an extensive history of diabetes, peripheral neuropathy, and peripheral arterial disease ("PAD") (Dkt. #38, Exhibit 1 at pp. 158-59). The records also revealed that Byerly had been undergoing dialysis since approximately 2015 due to poor renal function (Dkt. #38, Exhibit 1 at pp. 158-59). Further, the records revealed that, in 2015, Byerly was diagnosed with moderate to severe distal polyneuropathy in his lower extremities (Dkt. #38, Exhibit 1 at pp. 747-48). Byerly's medical records also outlined, in greater detail than Dr. Das' summary, the treatment that Byerly sought relating to the December 28 injury. The line of events following Byerly's December 28 injury are as follows.
As Byerly's medical records indicate, Byerly first visited Dr. Douglas A. Fullington ("Dr. Fullington"), on December 31, 2016 (Dkt. #38, Exhibit 1 at pp. 701-02). Byerly complained of a three-day-old wound on the second toe of his left foot and stated that "that he stubbed his toe on the bedframe in his room" (Dkt. #38, Exhibit 1 at p. 701). Dr. Fullington, after examining Byerly, noted that Byerly had "diabetes with peripheral neuropathy and no feeling in his toes" (Dkt. #38, Exhibit 1 at p. 701). Dr. Fullington then diagnosed Byerly with a toe wound with secondary cellulitis and uncontrolled Type 1 diabetes mellitus with peripheral neuropathy (Dkt. #38, Exhibit 1 at p. 703). Notably, Dr. Fullingon stated that there "[did] not appear to be a deeper infection" of the wound (Dkt. #38, Exhibit 1 at p. 703). "Accordingly, Dr. Fullington instructed Byerly to treat the wound with antibiotics, discussed the risk of a worsening infection, and referred Byerly to a podiatrist for further care" (Dkt. #38) (citing Dkt. #38, Exhibit 1 at pp. 703-704).
On February 2, 2017, Byerly underwent magnetic resonance imaging ("MRI") of his left foot per standard protocol without contrast to evaluate for osteomyelitis (Dkt. #38, Exhibit 1 at p. 801). The MRI revealed "[s]econd digit distal soft tissue loss with adjacent osteomyelitis of the distal phalanx and early osteomyelitis of the middle phalanx" (Dkt. #38, Exhibit 1 at p. 801). Byerly then visited a podiatrist, Steven Miller, DPM ("Dr. Miller") on March 7, 2017 (Dkt. #38, Exhibit 1 at p. 799). Byerly's chief complaint to Dr. Miller was that he was suffering from continuing pain, swelling, and tenderness in the second toe of his left foot (Dkt. #38, Exhibit 1 at p. 799). Upon examination, Dr. Miller observed that Byerly's toe had "wet gangrene," a foul odor, and "ha[d] begun auto-amputation and ha[d] a demarcation line" (Dkt. #38, Exhibit 1 at p. 800). Dr. Miller additionally noted that the "bioburden [was] extreme and the infection seem[ed] to be spreading" (Dkt. #38, Exhibit 1 at p. 800). The toe was accordingly excised at the proximal interphalangeal joint two days later (Dkt. #38, Exhibit 1 at pp. 797-98). Byerly was then placed in a post-operative shoe, weight bearing as tolerated, and instructed to return to the clinic for a follow-up with Dr. Miller one-week post-operation (Dkt. #38, Exhibit 1 at p. 798).
On March 15, 2017, at Byerly's follow-up appointment, Dr. Miller indicated that Byerly's formal diagnoses was "Gangrene of toe 2nd LEFT" (Dkt. #38, Exhibit 1 at p. 795). Dr. Miller also noted that the toe was "[p]rogressing as expected" (Dkt. #38, Exhibit 1 at p. 796). On March 28, 2017, at his next follow-up appointment with Dr. Miller, Byerly was diagnosed with a "[d]iabetic ulcer of foot associated with diabetes mellitus due to underlying condition, with necrosis of bone" (Dkt. #38, Exhibit 1 at pp. 793-794). This time, Dr. Miller noted that the toe exhibited "very slow improvement" (Dkt. #38, Exhibit 1 at p. 794). Accordingly, Byerly underwent a second MRI, without contrast, due to his renal function, which revealed a worsening infection and a "large irregular abscess containing gas centered around the second metatarsal extending proximally" (Dkt. #38, Exhibit 1 at p. 792). The MRI also gave the impression of "extensive osteomyelitis of the second and third metatarsal and third proximal phalanx" (Dkt. #38, Exhibit 1 at p. 792).
On April 3, 2017, after it was discovered that the infection spread from Byerly's foot to his leg, Dr. Matthew Q. Pompeo ("Dr. Pompeo") performed a left-leg below-the-knee amputation (Dkt. #38, Exhibit 1 at p. 188). Dr. Pompeo's notes described Byerly's recent medical history leading to the BKA as follows:
Patient was recently admitted with a nonhealing left heel decubitus related to his neuropathy and peripheral arterial disease. He ended up having to have a left below-the-knee amputation done at Walnut Hill Medical Center on April 3, 2017.
(Dkt. #38, Exhibit 1 at p. 188). On April 25, 2017, at Byerly's post-BKA follow-up appointment, Dr. Pompeo documented that Byerly was "seen today for complications of diabetic neuropathy" (Dkt. #38, Exhibit 1 at p. 188). Dr. Pompeo also noted that his impression was that Byerly's "[d]iabetic neuropathy put[] him at a high risk for limb loss, especially combined with his peripheral arterial disease" (Dkt. #38, Exhibit...
To continue reading
Request your trial