Vann v. Central Benefits National Life Insurance Company
| Decision Date | 21 August 2007 |
| Docket Number | Civil Action No. 1:96cv155-D-A. |
| Parties | JOEL W. VANN, a minor, by and through his father and next friend, Fred Joe Vann, Jr., PLAINTIFF, v. CENTRAL BENEFITS NATIONAL LIFE INSURANCE COMPANY, DEFENDANT. |
| Court | United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Northern District of Mississippi |
Presently before the court in this ERISA action are the motions of the defendant for the entry of summary judgment on its behalf and of the plaintiff for the entry of summary judgment on his behalf. Finding that the defendant's motion is well taken and that the plaintiff's is not well taken, the court shall grant the defendant's motion and deny the motion of the plaintiff.
On or about October 14, 1995, the plaintiff Joel Vann was injured in an automobile accident in which he was operating a motor vehicle. As a result of that accident, Vann sustained personal injuries which required medical treatment. Consequently, the plaintiff incurred medical bills and expenses of approximately $12, 066.09.
Also as a result of that accident, the driver of another vehicle was killed. Authorities subsequently indicted the plaintiff on charges of negligently causing the death of another driver while operating a vehicle under the influence of intoxicating liquor. Miss. Code Ann. § 63-11-30(4). The indictment read in relevant part:
The Grand Jurors for the State of Mississippi . . . upon their oaths present: That Joel W. Vann . . . did willfully, unlawfully, feloniously and negligently operate a motor vehicle at a time when he, the said Joel W. Vann, had ten one-hundredths (.10%) weight volume of alcohol or more in his blood as shown by a chemical analysis; and while so operating a motor vehicle in a negligent manner, did negligently, unlawfully and feloniously cause the death of Scotty Plunk, a human being, by hitting the said vehicle Scotty Plunk was driving on the said Scotty Plunk's side of the road, in violation of Mississippi Code, Annotated, Section 63-11-30(4).
Administrative Record, p. 209. The plaintiff's blood alcohol level ("BAC") immediately following the accident, as reflected by a chemical test, was .269. The plaintiff plead guilty to the indictment and was subsequently sentenced in state court.
During the time period relevant to receiving his injuries, the plaintiff was a covered person under a group health insurance policy issued to the Southern Insurance Group by the defendant, Central Benefits National Life Insurance Company ("Central Benefits"), and governed by the provisions of the Employee Retirement Income Security Act of 1974 ("ERISA"). 29 U.S.C. §§ 1001, et seq. After submission of the plaintiff's claims for benefits and payment of medical expenses, Central Benefits ultimately denied coverage:
Central Benefits is denying coverage under your Group Policy for all charges related to injuries sustained by your son, Joel, in the motor vehicle accident of October 14, 1995. This denial is based upon the fact, as confirmed by medical records submitted to Central Benefits, that Joel was operating the vehicle under the influence of intoxicants and with a blood alcohol level in excess of .10%, in violation of Miss. Code Ann. Section 63-11-30, which constitutes illegal activity and/or a felony under the laws of the State of Mississippi.
Administrative Record, p. 231 (). As a result of this denial of coverage, the plaintiff instituted the present action before the undersigned. Both parties have filed motions for summary judgment with the court, and the court takes up those motions today.
Summary judgment shall be granted "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 burden rests upon the party seeking summary judgment to show to the district court that an absence of evidence exists in the non-moving party's case. Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S. Ct. 2548, 2553, 91 L. Ed. 2d 265 (1986); see Jackson v. Widnall, 99 F.3d 710, 713 (5th Cir. 1996); Hirras v. Nat'l R.R. Passenger Corp., 95 F.3d 396, 399 (5th Cir. 1996). Once such a showing is presented by the moving party, the burden shifts to the non-moving party to demonstrate, by specific facts, that a genuine issue of material fact exists. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249, 106 S. Ct. 2505, 2511, 91 L. Ed. 2d 202 (1986); Texas Manufactured Housing Ass'n, Inc. v. City of Nederland, 101 F.3d 1095, 1099 (5th Cir. 1996); Brothers v. Klevenhagen, 28 F.3d 452, 455 (5th Cir. 1994). Substantive law will determine what is considered material. Anderson, 477 U.S. at 248; see Nichols v. Loral Vought Sys. Corp., 81 F.3d 38, 40 (5th Cir. 1996). Anderson, 477 U.S. at 248; see City of Nederland, 101 F.3d at 1099; Gibson v. Rich, 44 F.3d 274, 277 (5th Cir. 1995). Further, "[w]here the record, taken as a whole, could not lead a rational trier of fact to find for the non-moving party, there is no genuine issue for trial." Anderson, 477 U.S. at 248; see City of Nederland, 101 F.3d at 1099. Finally, all facts are considered in favor of the non-moving party, including all reasonable inferences therefrom. See Anderson, 477 U.S. at 254; Banc One Capital Partners Corp. v. Kneipper, 67 F.3d 1187, 1198 (5th Cir. 1995); Taylor v. Gregg, 36 F.3d 453, 455 (5th Cir. 1994); Matagorda County v. Russell Law, 19 F.3d 215, 217 (5th Cir. 1994). However, this is so only when there is "an actual controversy, that is, when both parties have submitted evidence of contradictory facts." Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994); Guillory v. Domtar Industries Inc., 95 F.3d 1320, 1326 (5th Cir. 1996); Richter v. Merchants Fast Motor Lines, Inc., 83 F.3d 96, 97 (5th Cir. 1996). In the absence of proof, the court does not "assume that the nonmoving party could or would prove the necessary facts." Little, 37 F.3d at 1075 (emphasis omitted); see Lujan v. Nat'l Wildlife Fed'n, 497 U.S. 871, 888, 111 L. Ed. 695, 110 S. Ct. 3177 (1990).
This court must apply a de novo standard of review in actions brought by ERISA plan participants, such as the plaintiff, to challenge a denial of benefits unless the plan vests the plan administrator with discretionary authority to make eligibility determinations or construe the plan's terms. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 974 115, 109 S.Ct. 948, 956, 103 L.Ed.2d 80 (1989); Sunbeam-Oster Co., Inc. Group Benefits Plan v. Whitehurst, 102 F.3d 1368 (5th Cir. 1996); Bellaire General Hosp. v. Blue Cross Blue Shield of Michigan, 97 F.3d 822, 828 (5th Cir. 1996). In the case at bar, the defendant Central Benefits has directed the court to no provision of its plan which empowers a plan administrator with such discretion, and this court is not aware of any such provision. As such, the appropriate standard of review in this case is de novo.
The policy provision under which Central Benefits denied coverage to the plaintiff reads:
Your Health Care Coverage does not provide benefits for services, supplies or charges:
. . .
Incurred as a result of a Covered Person's voluntary involvement or participation in a felony or an illegal activity, including a riot or act of civil disobedience;
Administrative Record, p. 25 (Policy of Insurance, p. 3-18). The plaintiff's argument is two-fold. First, the plaintiff argues that he did not "voluntarily" involve himself or participate in the felonious activity to which he pled guilty. As such, he contends, his plea of guilty to the felony act proscribed in Miss. Code Ann. § 63-11-30(4) cannot be used as a basis for the application of this provision. Secondly, he argues that the undersigned should apply the interpretational doctrine of ejusdem generis to determine that the provision's phrase "illegal activity" does not encompass conduct constituting a misdemeanor, but rather only conduct equivalent to felonious acts. Therefore, he contends, he cannot be held to have violated the provision by "voluntarily" committing the misdemeanor act of driving a motor vehicle while intoxicated. See Miss. Code Ann. § 63-11-30(1). Should the court agree with these arguments, the plaintiff continues, there is no justification for using this provision to deny coverage under this ERISA plan.
In response to these arguments, and in support of its own motion for summary judgment, the defendant contends that since the plaintiff "voluntarily" participated in the acts which constituted the felony proscribed in Miss. Code Ann. § 63-11-30(4), his plea of guilty to violation of that statute constitutes justification for the application of this exclusionary provision. Further, the defendant contends that the plaintiff's ejusdem generis argument is non appropo in light of its argument regarding the plaintiff's felony conviction.
Under the rule of ejusdem generis, where general words follow a provision which definitely and specifically describes and enumerates matters, things, or persons of a particular class, the general words should be restricted in application to matters things, or persons of the same class, which are of the same kind as those that are particularly described and enumerated in the words that precede such general words, unless a contrary
intent is clearly expressed . . .
Northwestern National Insurance Co. v. Dade County, 461 F.2d 1158, 1164 (5th Cir. 1972).
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