McGillivray v. Life Ins. Co. of North America

• Decision Date: 29 September 2007
• Docket Number: C.A. No. 05-11826-MLW.
• Citation: 519 F.Supp.2d 157
• Parties: Ines McGILLIVRAY, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.
• Court: U.S. District Court — District of Massachusetts

519 F.Supp.2d 157

Ines McGILLIVRAY, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

C.A. No. 05-11826-MLW.

United States District Court, D. Massachusetts.

September 29, 2007.

Paul R. Chomko, Alford & Bertrand, LLC, Watertown, MA, for Plaintiff.

David B. Crevier, Katherine R. Parsons, Crevier & Ryan LLP, Springfield, MA, for Defendant.

MEMORANDUM AND ORDER

MARK L. WOLF, District Judge.

The court has received the attached August 23, 2007, Magistrate Judge's Report and Recommendation on the cross-motions for judgement on the record filed by plaintiff Ines McGillivray and defendant Life Insurance Company of North America. The matters as to which the plaintiff objected have been reviewed de novo. See 28 U.S.C. § 636(b)(1)(B) & (C); Delgado v. Bowen, 782 F.2d 79, 82 (7th Cir.1986). Each of the plaintiffs objections were previously raised in her initial briefing, and the Magistrate Judge addressed each of her contentions. The court finds the Magistrate Judge's Report and Recommendation to be thorough, thoughtful, and persuasive.

Accordingly, it is hereby ORDERED that:

1. The attached Report and Recommendation (Docket No. 26) is ADOPTED and INCORPORATED pursuant to 28 U.S.C. § 626(b)(1)(C).

2. The plaintiff's Motion for Judgment on the Record (Docket No. 17) is DENIED.

3. The defendant's Motion for Judgment on the Record (Docket No. 19) is ALLOWED.

REPORT AND RECOMMENDATION ON PLAINTIFF'S MOTION FOR JUDGMENT ON THE RECORD (# 17) AND DEFENDANT'S MOTION FOR JUDGMENT ON THE RECORD FOR JUDICIAL REVIEW (#19)

COLLINGS, United States Magistrate Judge.

I. INTRODUCTION

On September 7, 2005, after exhausting her administrative remedies, plaintiff Ines McGillivray (hereinafter "McGillivray") filed a complaint pursuant to the Employee Retirement Income and Security Act (hereinafter "ERISA"), 29 U.S.C. §§ 1001 et seq., seeking to recover accidental death and dismemberment benefits under a Group Accident Policy issued by defendant Life Insurance Company of North America (hereinafter "the Company"). Specifically, McGillivray seeks a judgment declaring that the death of her husband is covered, and not excluded, under the terms of the applicable policy. On January 13, 2006, the Company filed its answer to the complaint, contending that McGillivray is owed no benefits or payments under the terms and conditions of the policy.¹

On September 28, 2006, the parties filed an Agreed Upon And Complete Record For Judicial Review. (# 14) Approximately three months later, on or about December 15, 2006, McGillivray filed Plaintiffs Motion For Judgment On The Record and Brief In Support Of Plaintiffs Motion For Judgment On The Record. (# 17) Thereafter, on or about January 31, 2007, the Company filed Defendant's Motion For Judgment On The Record For Judicial Review (# 19) together with a memorandum both in support of its motion and in opposition to the plaintiffs motion. (# 20) The Company also submitted a Statement Of Undisputed Material Facts In Support Of Its Motion For Judgment On The Record For Judicial Review. (# 21)

At this juncture the record is complete and the cross-motions for judgment are poised for resolution.

II. THE FACTS

On January 15, 2004, Paul McGillivray died as a result of a head-on automobile accident when his car crossed the center line of Lake Street in Peabody, Massachusetts and collided with a box truck. (Agreed Upon And Complete Record For Judicial Review # 14 at 61) Mr. McGillivray was thrown from his car and later pronounced dead at Lynn Union Hospital from "multiple injuries due to blunt trauma." (# 14 at 52) Approximately thirteen hours before the crash, Mr. McGillivray had been arrested for drunk driving and had his license revoked. (# 14 at 67) The results of a post-accident toxicology report reflect that the decedent's blood alcohol level was 0.242, that being well above the legal limit for the Commonwealth of Massachusetts sachusetts. He also tested positive for the presence of benzodiazepine. (# 14 at 89)

The plaintiff, Paul McGillivray's wife, through her employer, was entitled to coverage under Group Accident Policy No. OK 826557 (hereinafter "the Policy") which was underwritten by the Company. (# 14 at 1-23) The Policy included coverage for the accidental death of an insured, or the spouse of an insured, in the amount of $100,000. (# 14 at 10) On or about February 7, 2004, McGillivray completed a claim form for group term accidental death benefits which was then certified and filed by her employer on her behalf on or about .February 26, 2004. (# 14 at 24-25) About three months later on May 12, 2004, the Company issued a denial of the plaintiff's claim for accidental death benefits with regard to her husband's death. (# 14 at 91) The denial was justified by the Company on the grounds that "Mr. McGillivray died as a result of his own voluntary actions, namely driving a motor vehicle while intoxicated" and, consequently, "that his death was not accidental but the foreseeable consequence of his actions." (# 14 at 93)

Within two weeks of the time that the denial of benefits issued, the plaintiff appealed the Company's decision. (# 14 at 95-101) After reviewing the additional information provided by McGillivray, on November 17, 2004, the defendant denied the plaintiffs appeal, reiterating that "Mr. McGillivray's death was not accidental in nature, as his death resulted from drinking and driving, which was the foreseeable result of his self inflicted, voluntary actions." (# 14 at 126-128) The plaintiff then filed the instant ERISA action on September 7, 2005 seeking to recover accidental death benefits under the Policy.

III. STANDARD OF REVIEW TO BE APPLIED IN THIS CASE

In a typical

ERISA benefit denial case, trial is usually not an option: in a very real sense, the district court sits more as an appellate tribunal than as a trial court. It does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.

Leahy v. Raytheon Co., 315 F.3d 11, 17-18 (1 Cir., 2002) (citations omitted). In Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the Supreme Court stated that, when a denial of benefits is challenged under ERISA, 29 U.S.C. § 1132(a)(1)(B), the standard of review depends largely upon whether "the benefit plan expressly gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the plan's terms." Id. at 115, 109 S.Ct. 948. If the plan does give such discretion to the administrator or fiduciary, "Firestone and its progeny mandate a deferential `arbitrary and capricious' standard of judicial review." Recupero v. New England Tel. & Tel. Co., 118 F.3d 820, 827 (1 Cir., 1997) (quoting Firestone, 489 U.S. at 115, 109 S.Ct. 948);) see also Wright v. R.R. Donnelley & Sons Co. Group Benefits Plan, 402 F.3d 67, 74 (1 Cir., 2005) (where the plan confers such authority upon the fiduciary, the decision is upheld "unless it is `arbitrary, capricious, or an abuse of discretion' ") (quoting Doyle v. Paul Revere Life Ins. Co., 144 F.3d 181, 183 (1 Cir., 1998)).² The First Circuit "has interpreted the Firestone rule `to mean that a benefits plan must clearly grant discretionary authority to the administrator before decisions will be accorded the deferential, arbitrary and capricious, standard of review.'" Guarino v. Metropolitan Life Ins. Co., 915 F.Supp. 435, 443 (D.Mass., 1995) (quoting Rodriguez-Abreu v. Chase Manhattan Bank, N.A., 986 F.2d 580, 583 (1 Cir., 1993)).

Under the arbitrary and capricious standard, the decision of the plan administrator will be upheld even where contrary evidence might suggest a different result, so long as the decision "is plausible in light of the record as a whole, ... or, put another way, whether the decision is supported by substantial evidence in the record." Leahy, 315 F.3d at 17 (citing Doyle, 144 F.3d at 184). "Substantial evidence ... means evidence reasonably sufficient to support a conclusion. Sufficiency, of course, does not disappear merely by reason of contradictory evidence." Doyle, 144 F.3d at 184 (citations omitted); see also Vlass v. Raytheon Employees Disability Trust, 244 F.3d 27, 30 (1 Cir., 2001) ("[T]he existence of contradictory evidence does not, in itself, make the administrator's decision arbitrary."). A court must not substitute its judgment for that of the fiduciary or administrator if the fiduciary's or administrator's interpretation of the plan was "reasonable." Terry v. Bayer Corp., 145 F.3d 28, 40 (1 Cir., 1998)(citing Dewitt v. Penn-Del Directory Corp., 106 F.3d 514, 520 (3 Cir., 1997)).

When considering what standard of review is appropriate, it is first necessary to determine whether the provisions of the employee benefit plan under which recovery is sought reflect a clear grant of discretionary authority to decide eligibility for benefits. Id. at 37 (citations omitted). In the case at hand, the Policy provides that:

For plans subject to the Employee Retirement Income Security Act (ERISA), the Plan Administrator of the Employer's employee welfare benefit plan (the Plan) has appointed the Insurance Company [the Company] as the Plan fiduciary under federal law for the review of claims for benefits provided by this Policy and for deciding appeals of denied claims. In this role the Insurance Company shall have the authority, in its discretion, to interpret the terms of the Plan documents, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact. All decisions made by the Insurance Company in this capacity shall be final and binding on Participants and Beneficiaries of The Plan to the full extent permitted by law.

Agreed Upon And Complete Record For Judicial Review # 14 at 4 (emphasis added).

The language of this provision plainly states that the Company is the plan...