Jones v. Regence Life & Health, Ins. Co.
| Decision Date | 30 November 2011 |
| Docket Number | Civ. Case No. 10-6415-AA |
| Parties | MARY ELIZABETH JONES, nka MARY ELIZABETH JONES DLOUHY, v. REGENCE LIFE AND HEALTH, INSURANCE COMPANY, |
| Court | U.S. District Court — District of Oregon |
James G. Nelson
Nelson & MacNeil, P.C.
Attorney for plaintiff
John C. Rothermich
Garvey Schubert Barer
Eleventh Floor
Attorneys for defendant
Defendant, Regence Life and Health Insurance Company (Regence), moves for summary judgment pursuant to Fed. R. Civ. P. 56 on plaintiff's claims for an accidental death "Seat Belt" benefit and for unpaid voluntary life insurance benefits. The Court heard oral argument on November 10, 2010. Based on the hearing, briefing, and evidence in the record, defendant's motion is granted and this case is dismissed.
Plaintiff, Mary Elizabeth Jones Dlouhy, is the named beneficiary for insurance policies covering the life of Eugene Luke. Mr. Luke's insurance was provided through his employer, Greenberry Tank & Iron Company (Greenberry). Greenberry's Group Life and Accidental Death and Dismemberment Insurance (the Group Policy) provides accident and life insurance. Key Decl. Supp. Summ. J., Ex. A. The accident insurance policy provides a $10,000 Seat Belt benefit. Id. at 33. Employees are eligible for this benefit if they are killed in an automobile accident and were "properly wearing a Seat Belt as verified on the police report..." Id. Moreover, Greenberry employees are eligible for two different types of life insurance. All employees are 9. The premiums for this coverage are paid by Greenberry. Id. An endorsement to the Group Policy also allows employees to purchase additional "Select Voluntary Life Insurance" coverage.Id. at 43-5. This voluntary coverage is exclusively paid for by the covered employee. Id. at 43. Employees who opt to purchase this coverage authorize a monthly premium deduction from their paychecks. Id. Mr. Luke purchased $300,000 of voluntary life insurance coverage beginning January 1, 2008. Mem. in Supp. of Def.'s Mot. for Summ. J., at 3,
On June 20, 2009, Mr. Luke signed a request to have certain voluntary insurance coverages, including his life insurance coverage, canceled effective August 1, 2009. Key Decl. Ex. B, at 2. This notice was presented to Greenberry. In compliance with Mr. Luke's request, the last coverage period for which Greenberry received payment for Mr. Luke's Select Voluntary Life insurance was July 2009, Strom Decl. Supp. Summ. J., at 2.
According to the terms of Greenberry's Group Policy, it is required to furnish Regence with "all data that [Regence] may require to administer the insurance under this Policy." Key Decl. Ex, A, at 7. This includes notice of all voluntary insurance terminations. Id. Mr. Luke's termination letter, however, was not sent to Regence until August 12, 2009. Key Decl. Ex. B, at 1. The letter was transmitted by email as a scanned attachment, and then printed and marked as received by Greenberry on August 20, 2009. Id. at 2. Regence sent a letter acknowledging receipt of plaintiff's request on August 21, 2009. Nelson Decl. in Resp. to Def.'s Mot. for Summ. J. Ex. 1. An official Regence change of coverage form was transmitted to Regence by Greenberry on December 1, 2009. Key Decl. Ex. C.
Mr. Luke was killed in a car accident on August 15, 2009. Strom Decl., at 3. Subsequently, Ms. Jones filed a claim with Regence for payments under Mr. Luke's voluntary life insurance policy and for the accidental death policy's Seat Belt benefit. On January 20, 2010, Regence sent a letter to Ms, Jones denying her claim for the accidental death policy's $10,000 Seat Belt benefit. Strom Decl. Ex. A. The letter notes that a copy of the Oregon Police Traffic Crash Report was received by Regence. Id. at 4. The letter states that "[t]his report notes that Mr. Luke was not using any type of restraint equipment at the time of the r concludes that "[b]ecause the police documentation does not verify that Mr. Luke was properly wearing a Seat Belt at the time of the accident, we must deny the Seat Belt Benefit proceeds for this claim." Id. Full payment for Mr, Luke's basic life and accidental death insurance policies were enclosed in the letter. Id. at 6. On January 25, 2010, Regence sent Ms. Jones' attorney its final decision denying her claim for $300,000 worth of additional voluntary life insurance coverage. Strom Decl. Ex. C. The letter states that:
Plaintiff filed suit on November 18, 2010, in Circuit Court of the State of Oregon for Linn County. On December 16, 2010, defendant removed this now moves for summary judgement.
Summary judgment is appropriate "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(c). The materiality of a fact is determined by the substantive law on the issue. T.W. Electrical Service, Inc. v. Pacific Electrical Contractors Assoc.. 809 F.2d 626, 630 (9th Cir. 1987). The authenticity of a dispute is determined by whether the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).
The moving party has the burden of establishing the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). If the moving party shows the absence of a genuine issue of material fact, the nonmoving party must go beyond the pleadings and identify facts which show a genuine issue for trial. Id. at 324, Special rules of construction apply to evaluating summary judgment motions: (1) all reasonable doubts as to the existence of genuine issues of material fact should be resolved against the moving party; and (2) all inferences to be drawn from the underlying facts must be viewed in the light most favorable to the nonmoving party. T.W. Electrical, 809 F.2d at 630.
The summary judgement standard can be modified if a claim is subject to the Employee Retirement Income Security Act (ERISA). ERISA gives the federal courts jurisdiction over claims involving benefit plans sponsored by an employer or an employee organization. See 29 U.S.C. § 1001.
Defendant argues that a police report verifying that the victim was properly wearing a seat belt is a condition precedent necessary to trigger payment of the Group Plan's Seatbelt Benefit. Defendant further argues that no such police report
Defendant is correct that the Seat Belt benefit is payable only if the police report verifies that the victim was properly wearing a seat belt at the time of death. The Oregon Police Traffic Crash Report that was completed after Mr. Luke's accident found that he was not wearing any safety restraints at the time of the crash. The finding that Mr, Luke was not eligible for theSeat Belt benefit is therefore supported by credible evidence in the record.
Plaintiff asks the Court to require defendant to produce a copy of the medical examiner's report to verify that Mr. Luke was not wearing a seat belt. Even if this report were to suggest that Mr. Luke was in fact wearing a seat belt, it would not effect this Court's judgement. According to the plain language of the Seat Belt benefit, the only question is whether the police report verifies that the victim was wearing a seat belt. There is no dispute that the police report in this case does not. Therefore, plaintiff's request is denied as moot and defendant's summary judgement motion with respect to the Seat Belt Benefit is granted.
This Court finds that an abuse of discretion standard applies to plaintiff's voluntary life insurance claim. The United States Supreme Court holds that plans governed by ERISA may grant an administrator discretionary authority to "... determine eligibility for benefits or to construe the plan's terms." Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 102 (1989). The usual test for summary judgment does not apply when an administrator has been granted this authority. Rather, the more deferential abuse of discretion standard applies. Bendixen v. Standard Ins. Co., 185 F.3d 939, 942-3 (9th Cir.1999}(overruled on other grounds in Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 966-69 (9th Cir. 2006)).
With few exceptions, ERISA coverage applies to all employee life insurance plans that are established or maintained by an employer. 29 U.S.C. § 1002(1). Federal regulations, however, have created a so-called "safe harbor" provision that designates certain benefit plans to which ERISA does not apply. 29 C.F.R. § 2510.3-1(j). Plans that fall under the safe harbor provision are not subject to the abuse of discretion standard.
An employee benefit plan must meet four requirements to fall within ERISA's safe harbor provision. Stuart v. UNUM Life Ins. Co. of Am., 217 F.3d 1145, 1153 (9th Cir. 2000). Federal...
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