Cady v. Hartford Life & Accidental Ins. Co.

• Decision Date: 13 March 2013
• Docket Number: Case No. 3:10–CV–00276–EJL.
• Citation: 930 F.Supp.2d 1216
• Court: U.S. District Court — District of Idaho
• Parties: Nicole L. (Piper) CADY, Plaintiff, v. HARTFORD LIFE & ACCIDENTAL INSURANCE COMPANY, Defendant.

930 F.Supp.2d 1216

Nicole L. (Piper) CADY, Plaintiff,

v.HARTFORD LIFE & ACCIDENTAL INSURANCE COMPANY, Defendant.

Case No. 3:10–CV–00276–EJL.

United States District Court,

D. Idaho.

March 13, 2013.

Theodore O. Creason, Creason Moore & Dokken, Lewiston, ID, for Plaintiff.

Steven David Robinson, Karr Tuttle Campbell, Seattle, WA, for Defendant.

MEMORANDUM DECISION AND ORDER

EDWARD J. LODGE, District Judge.

Plaintiff Nicole Cady brings this action against Defendant Hartford Life and Accident Insurance Company claiming wrongful denial of accidental death benefits under 29 U.S.C. 1132(a)(1)(B). The parties have filed cross motions for summary judgment. The issues have been fully briefed and are ripe for the Court's consideration.

Having fully reviewed the record herein, the Court finds that the facts and legal arguments are adequately presented in the briefs and record. Accordingly, in the interest of avoiding further delay, and because the Court conclusively finds that the decisional process would not be significantly aided by oral argument, this motion shall be decided on the record before this Court without a hearing.

FACTUAL AND PROCEDURAL BACKGROUND

This is an Employment Retirement Income Security Act (“ERISA”) case. Hartford Life and Accident Insurance Company (“Hartford”) issued a group Accidental Death and Dismemberment insurance policy to Alliant Techsystems, Inc. (“ATK”), number ADD–S05459, for the benefit of eligible employees. (Dkt. 62, p. 2.) Decedent Matthew Marsh, an eligible ATK employee under the Hartford Policy, died on May 28, 2008. ( Id., p. 3.) Plaintiff Nicole Cady (“Cady”) is the former girlfriend of Mr. Marsh and was Mr. Marsh's named beneficiary under the Hartford Policy. (Dkt. 29–1, HCF 116.)

Cady completed a Beneficiary Statement and Claimant's Statement of Accidental Death on July 10, 2008, indicating that Mr. Marsh's death was due to an “overdose of prescription and non-prescription drugs.” ( Id., HCF 121.) ¹ On July 18, 2008, Cady mailed the Statement of Accidental Death and the Certificate of Death for Mr. Marsh to Hartford. ( Id., HCF 80.) The Certificate of Death listed Mr. Marsh's cause of death as an “overdose of prescription and non-prescription drugs.” ( Id., HCF 118.)

Hartford approved Cady's claim for life insurance benefits on August 12, 2008, and thereafter paid Cady $42,000, plus interest in the amount of $109.32. (Dkt. 62, p. 3.) In order to review Cady's claim for accidental death benefits in the amount of $140,000, Hartford stated it would need the Coroner's Report, the Toxicology Report and a prescription list from the pharmacies used by Mr. Marsh between January 2008 and May 2008. (Dkt. 29–1, HCF 58–59.) Hartford notified Cady that it had requested a vendor to obtain the Coroner's Report and Toxicology Report, but asked that Cady submit Mr. Marsh's prescription lists. ( Id.)

Hartford received the Toxicology Report on September 11, 2008 and the Coroner's Report on October 20, 2008. (Dkt. 70–9, p. 4.) The Toxicology Report indicated that Mr. Marsh's blood tested positive for Alprazolam (an anti-anxiety drug more commonly known as Xanax), Duloxetine (an anti-depressant known as Cymbalta), Olanzapine (an anti-psychotic with the trade name Zyprexa), Methadone, and Cannabinoids (THC). (Dkt. 70–4, HCF 136–38.) The Coroner's Report concluded that Mr. Marsh's death appeared to have been caused by an “accidental overdose.” (Dkt. 29–1, HCF 52–53.) The Coroner's Report suggested that Mr. Marsh's consumption of Xanax alone was four times the therapeutic range for Xanax. (Dkt. 70–6, HCF 144.) In the course of its review, Hartford also obtained copies of records from Dr. Michael Baldeck, Mr. Marsh's treating physician. (Dkt. 70–1, HCF 125–26.) Dr. Baldeck's records indicate that Mr. Marsh was being treated for anxiety and depression, and that Dr. Baldeck had prescribed Mr. Marsh Xanax, Cymbalta and Zyprexa. ( Id.) Dr. Baldeck's records do not show that Mr. Marsh had a prescription for Methadone or that he was being treated by any other medical professional. ( Id.)

Hartford did not receive Mr. Marsh's prescription list until January 10, 2011, over three years after Hartford initially requested the prescription list from Cady in August, 2008.² (Dkt. 70–9, p. 6.) Much of the factual history of this case involves the parties' dispute over their respective responsibility for obtaining, or, more accurately, failing to obtain, Mr. Marsh's prescription list from Walmart.³ Cady maintains that she was unable to initially acquire the prescription list because she was not a family member, that she made consistent and repeated attempts to procure the prescription list over several years, that she was ultimately forced to file a lawsuit in order to obtain the records from Walmart through use of the federal subpoena power, and that Hartford, by contrast, could have easily obtained the prescription list through its power under the Policy to conduct an investigation “without consent of the insured or the insured's family.” (Dkt. 66, pp. 5–6.) Hartford counters that it left unanswered messages for Cady stating it needed the pharmacy records for nearly a year, that it closed the file after notifying Cady on October 2, 2009 that it could not make a decision with respect to accidental death without the pharmacy records, that it did not receive notice from Cady that she was having difficulty obtaining the prescription list until January 13, 2009, that it re-opened the file to examine Cady's claim once it ultimately received the prescription list on January 10, 2011, and that Hartford, like Cady, did not have the power to compel production of pharmaceutical records without a subpoena.⁴ (Dkt. 70–9, pp. 4–6; Dkt. 75, p. 7.) Once it was ultimately obtained by Cady, Mr. Marsh's prescription list revealed that he did not have a prescription for Methadone with Walmart. (Dkt. 71–1, HCF 131.)

Once the prescription list was secured, Hartford completed its review, determined that the evidence did not establish a covered loss under the terms of the Policy, and denied Cady's claim. (Dkt. 70–4, HCF 136–38.) Hartford's May 6, 2011 denial letter (“Initial Denial”) explained that Mr. Marsh's death did not meet the definition of “Injury” required for purposes of accidental death coverage under the Policy. Specifically, the Policy defines “Injury” as:

... bodily injury resulting directly from accident and independently of all other causes which occurs while the Covered Person is covered under the policy. Loss resulting from: a) a sickness of disease, except a pus-forming infection which occurs through an accidental wound; or b) medical or surgical treatment of a sickness or disease; is not considered as resulting from injury.

( Id., HCF 136.)

Hartford concluded that, to the extent Mr. Marsh's fatal overdose resulted from taking Xanax, Cymbalta and Zyprexa, the medicines prescribed to treat his ongoing depression and anxiety, such loss was a result of “medical or surgical treatment of a sickness or disease,” and thus did not meet the definition of Injury required for covered losses under the Policy. ( Id., HCF 138.) In addition, Hartford explained that, to the extent Mr. Marsh's death was caused by Methadone, a drug for which he presumably had no prescription, Mr. Marsh's death was excluded from coverage under the Policy Exclusion providing:

The Policy does not cover any loss resulting from ... 6) Injury sustained while voluntarily taking drugs which federal law prohibits dispensing without prescription, including sedatives, narcotics, barbiturates, amphetamines, or hallucinogens, unless the drug is taken as prescribed or administered by a licensed physician.⁵

( Id., HCF 136–37.)

In its Initial Denial, Hartford encouraged Cady to submit any additional information she believed would support her claim, and suggested such information would include “documentation that confirms a prescription was written for Methadone, the medical records that establish the basis for the Methadone prescription, and any evidence ... that Mr. Marsh took Methadone as prescribed by a physician.” ( Id., HCF 138.) The Initial Denial also instructed Cady that she had a right to appeal the decision, and gave her directions on perfecting an appeal. ( Id.)

Cady appealed the Initial Denial on June 20, 2011. (Dkt. 70–5, HCF 140–42.) Cady's appeal letter contended that Hartford had failed to adequately investigate Mr. Marsh's death, had failed to meet its burden in establishing the non-prescription drug exclusion, had failed to provide a scientific or clinical judgment for its determination, and, through such failures, had deprived Cady of an opportunity to offer expert opinions regarding the evidence upon which Hartford relied. ( Id.) However, Cady did not submit any additional evidence or expert analysis with her appeal. Hartford thereafter referred Cady's claim to its Appeal Unit to conduct an independent review. (Dkt. 70–6, HCF 143–45.)

After independent review, Hartford re-affirmed its denial of Cady's claim. In its September 8, 2011 denial letter (“Final Denial”), Hartford again explained that Mr. Marsh's death was not a covered loss under the Policy, due to both the definition of “Injury” required for a covered loss and the non-prescription drug exclusion. ( Id.) The Final Denial further explained:

Please note that the Policy requires that a benefit will be paid if an accidental injury occurs. We do not interpret the word “accident” to include circumstances where it is reasonably foreseeable that death will occur. Accidents by nature are unforeseeable events. It is a well-known fact that if [sic] consuming four (4) times the therapeutic dose of Xanax and also ingesting Methadone can cause serious bodily injury or death. It is our opinion that Mr. Marsh should have reasonably foreseen that such actions would result in severe injury or death, even if death was not intended. The assumption of a known risk by the insured does not...