Dawson v. Jackson Nat'l Life Ins. Co.

• Court: U.S. District Court — Northern District of Alabama
• Writing for the Court: GRAY M. BORDEN, UNITED STATES MAGISTRATE JUDGE.
• Decision Date: 12 August 2021
• Docket Number: 2:19-cv-883-GMB
• Citation: Dawson v. Jackson Nat'l Life Ins. Co., 2:19-cv-883-GMB (N.D. Ala. Aug 12, 2021)
• Parties: JULIANA DAWSON, Plaintiff, v. JACKSON NATIONAL LIFE INSURANCE COMPANY, et al., Defendants.

JULIANA DAWSON, Plaintiff, v. JACKSON NATIONAL LIFE INSURANCE COMPANY, et al., Defendants.

No. 2:19-cv-883-GMB

United States District Court, N.D. Alabama, Southern Division

August 12, 2021

MEMORANDUM OPINION AND ORDER

GRAY M. BORDEN, UNITED STATES MAGISTRATE JUDGE.

Before the court is the Motion for Summary Judgment filed by Defendants Jackson National Life Insurance Company (“JNL”) and iptiQ Americas, Inc. (“iptiQ”). Doc. 32. Defendants seek summary judgment in their favor on Plaintiff Juliana Dawson's claims arising from JNL's refusal to pay a death benefit claim on her deceased husband's life insurance policy. The parties have consented to the jurisdiction of a United States Magistrate Judge pursuant to 28 U.S.C. § 636(c). Doc. 7. After careful consideration of the parties' submissions and the applicable law, and for the reasons to follow, the court concludes that the motion for summary judgment is due to be granted in part and denied in part.

I. STANDARD OF REVIEW

Summary judgment is appropriate “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). “Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute of material fact is genuine only if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id.

The moving party “always bears the initial responsibility of informing the district court of the basis for its motion and identifying those portions of the pleadings, depositions answers to interrogatories, and admissions on file, together with the affidavits, if any, which it believes demonstrate the absence of a genuine [dispute] of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986) (internal quotation marks omitted). In responding to a properly supported motion for summary judgment, the nonmoving party “must do more than simply show that there is some metaphysical doubt as to the material fact.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). Indeed, the nonmovant must “go beyond the pleadings” and submit admissible evidence demonstrating “specific facts showing that there is a genuine [dispute] for trial.” Celotex, 477 U.S. at 324 (internal quotation marks omitted). If the evidence is “merely colorable, or is not significantly probative, summary judgment may be granted.” Anderson, 477 U.S. at 249 (citations omitted).

When a district court considers a motion for summary judgment, it “must view all the evidence and all factual inferences reasonably drawn from the evidence in the light most favorable to the nonmoving party, and must resolve all reasonable doubts about the facts in favor of the nonmovant.” Rioux v. City of Atlanta, Ga., 520 F.3d 1269, 1274 (11th Cir. 2008) (citation and internal quotation marks omitted). The court's role is not to “weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.” Anderson, 477 U.S. at 249. “If a reasonable fact finder evaluating the evidence could draw more than one inference from the facts, and if that inference introduces a genuine issue of material fact, then the court should not grant summary judgment.” Allen v. Bd. of Pub. Ed. for Bibb County, 495 F.3d 1306, 1315 (11th Cir. 2007) (citation omitted). Importantly, if the nonmovant “fails to adduce evidence which would be sufficient . . . to support a jury finding for [the nonmovant], summary judgment may be granted.” Brooks v. Blue Cross & Blue Shield of Fla., Inc., 116 F.3d 1364, 1370 (11th Cir. 1997) (citation omitted).

II. FACTUAL BACKGROUND

In 1996, Midland Life Insurance Company issued a group term life insurance policy to a trust of participating financial institutions that allowed the banks' customers and their spouses to obtain certificates for individual life insurance. Colonial Bank was one of the participating financial institutions, and it offered the plan to its customers and their spouses. Doc. 33-1 at 38. Through various mergers and business arrangements, Defendant JNL became the owner of the policy in 2012 and Defendant iptiQ assumed responsibility for administering JNL's life insurance claims. Doc. 33-6 at 6; Doc. 42-5 at 3. iptiQ is a wholly owned subsidiary of Swiss Re. Doc. 33-6 at 6. NTTD served as the third-party administrator of Swiss Re's life insurance claims, including the one at issue here.^[1] Doc. 33-6 at 7. Employees of both iptiQ and NTTD were involved in the administration of the instant claim.

The policy language at issue states that a “Member's insurance under [the] Policy will terminate on the earliest of” three pertinent dates: (1) the “end of the last period for which premiums have been paid”; (2) the “next Premium Due Date following the date the Member attains age [70]”; and (3) the date the insured dies. Doc. 33-2 at 13. Neither the policy nor the individual certificates identify the time of day on the termination date that the coverage ends. Doc. 33-1 at 45; Doc. 33-2 at 13; Doc. 33-6 at 17.

A. Mr. Dawson's Life Insurance Policy

In 2000, Plaintiff Juliana Dawson was offered the opportunity to enroll in the Colonial Bank group term life insurance plan. Doc. 33-1 at 7 & 38. Both Mrs. Dawson and her husband, James Dawson, elected to enroll in the plan. Doc. 33-1 at 7, 38 & 41. On July 15, 2000, the Midland Life Insurance Company issued a life insurance policy to James Dawson with a death benefit of $100, 000 and Mrs.

Dawson as the beneficiary. Doc. 33-1 at 41 (reflecting $100, 000 policy value); Doc. 33-2 at 9-20 (specimen insurance policy); Doc. 33-3 at 1 (reflecting effective date of policy).^[2]

It is undisputed that Mr. Dawson paid his monthly premiums for the duration of the policy. Doc. 33-1 at 9-10; Doc. 33-6 at 11-12. In fact, JNL automatically debited the premium payments from Mrs. Dawson's checking account each month. Doc. 33-6 at 18. Although the premiums were due on the 15th day of each month (Doc. 33-6 at 16), bank records show that JNL drew the payments from Mrs. Dawson's account sometime between the 17th and the 20th of each month. Doc. 423 at 3-4. The final payment was drawn on August 17, 2018. Doc. 33-2 at 3.

Mr. Dawson turned 70 years old on September 3, 2018. Doc. 33-6 at 59. In accordance with the policy, JNL sent Mr. Dawson a letter stating that the policy would “expire on 09/15/2018 with no further benefits.” Doc. 33-3 at 1. The letter did not reference a conversion privilege to extend coverage. Doc. 33-3 at 1. According to JNL, the September 15, 2018 termination date was the “next premium due date following the date the Member attains age [70]” under the policy. Doc. 336 at 59. Mr. Dawson died at 7:55 p.m. on September 15, 2018. Doc. 33-3 at 2.

B. Mrs. Dawson's Claim

Following her husband's death, Mrs. Dawson could not locate a copy of his insurance policy. Doc. 42-3. On October 23, 2018, Mrs. Dawson notified JNL of her husband's death, requested a claim packet, and stated that she intended to make a claim on the policy. Doc. 33-6 at 21-22 & 64. The next day, Amanda TerMaat, a claims team leader employed by NTTD, sent an email to Denise Ratliff, an iptiQ Senior Claim Oversight Manager, and Renee McCarty, another iptiQ employee who administers claims for JNL, stating,

The policy expired on the anniversary date following the insured's 70th birthday. The insured died the same day that the policy expired. I wanted to verify that we would pay this benefit as the insured would be covered until 12 midnight on 09/15/2018.... Please review and advise.

Doc. 33-6 at 68-69. McCarty responded that they “would need to review the certified death certificate.” Doc. 33-6 at 68.

Mrs. Dawson submitted her formal written claim on January 19, 2019. Doc. 33-4 at 14-16.

C. The Denial of the Claim

Denise Ratliff made the decision to deny Mrs. Dawson's claim. Doc. 33-6 at 15. Ratliff testified that she believed the policy expired at 12:01 a.m. on September 15, 2018, before Mr. Dawson died. Doc. 33-6 at 15-17. According to Ratliff, Mr. Dawson's monthly premiums were due on the 15th day of each month, so the “next premium due date” after he turned 70 years old was September 15, 2018. Doc. 33 at 16-17. The policy stated that it would terminate “on” that date. Doc. 33-2 at 13. Ratliff interpreted this language to mean that coverage ended as soon as September 15, 2018 began. Doc. 33-6 at 16-17.

Ratliff did not consult with TerMaat regarding her decision. Doc. 33-6 at 19. She also did not consult any legal resources or speak with a member of the legal department in making her decision and interpreting the language of the insurance contract. Doc. 33-6 at 18-19 & 35. Ratliff did, however, review the claim file, policy language, submitted claim requirements, and the date of death. Doc. 33-6 at 18. She also discussed the claim with McCarty. Doc. 33-6 at 19.

After receiving Ratliff's decision, McCarty instructed NTTD to draft a denial letter for Mrs. Dawson. Doc. 33-6 at 67. The original draft of the letter stated, “According to our records, James attained age 70 on September 3, 2018 and the next premium due date was September 15, 2018; therefore the policy terminated September 15, 2018 and no benefit coverage is payable.”^[3] Doc. 42-4 at 7. McCarty received the draft letter and changed some of the language before mailing it to Mrs. Dawson. Doc. 42-2 at 6. At her deposition, McCarty could not remember the specific language she edited (Doc. 42-2 at 6), but the final denial letter inserts the phrase “as of” before the termination date. Doc. 42-4 at 2. The final denial letter reads as follows:

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