Wichita Firemen's Relief Ass'n v. Kan. City Life Ins. Co.

• Decision Date: 07 March 2016
• Docket Number: Case No. 11-1029-KGG
• Parties: WICHITA FIREMEN'S RELIEF ASSOCIATION, Plaintiff, v. KANSAS CITY LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — District of Kansas

WICHITA FIREMEN'S RELIEF ASSOCIATION, Plaintiff, v. KANSAS CITY LIFE INSURANCE COMPANY, Defendant.

Case No. 11-1029-KGG

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS

March 7, 2016

POST-REMAND MEMORANDUM & ORDER

The Court issues this Memorandum & Order following remand from the Tenth Circuit Court of Appeals (Doc. 414). The Circuit Court reversed this Court's order granting summary judgment to the Defendant and remanded the matter for trial. This action requires the re-examination of issues raised by the parties in their previous motions for summary judgment and other motions which were not addressed by this Court because of the previous ruling. The purpose of this Order is to clarify the status of various issues - and address those that remain - after remand.

Several motions were denied as moot as a result of the Court's grant of summary judgment to Defendant (Doc. 401), including Plaintiff's request to make an addition to the "administrative record" (Doc. 216).¹ Other motions were denied as a matter of law because of the grant of summary judgment for Defendant. (See Doc. 401, at 35, referencing Doc. 204 (Plaintiff's "Motion for Protective Order and a Determination as a Matter of Law . . .) and Doc. 342 (Plaintiff's Motion for Summary Judgment).) The Court therefore did not address the merits of these motions. As such, the Court will herein discuss issues contained in the following motions of the parties:

1. Plaintiff's "Motion for Protective Order and a Determination as a Matter of Law Pursuant to Fed.R.Civ.P. 56 that Plaintiff is Entitled to a De Novo Review of Defendant's Decision to Deny Coverage - on the Administrative Record - and Quashing and Staying Defendant's Discovery of Post-Administrative Appeal Matters" (Doc. 204);

2. Plaintiff's "First Motion for an Addition to the Administrative Record" (Doc. 216);

3. Defendant's Motion for Summary Judgment (Doc. 341) and supporting Memorandum (Doc. 349); and

4. Plaintiff's Motion for Summary Judgment (Doc. 342) and supporting Memorandum (Doc. 347).

For the reasons following, each of these motions is DENIED.

BACKGROUND

Plaintiff's claim is for payment of an Accidental Death and Dismemberment insurance benefit arising out of the death of Wichita firefighter Captain Urban Eck. Defendant denied the claim for AD&D benefits relating to Decedent on February 26, 2010. Accidental injury is the primary coverage predicate of the policy at issue. The denial letter, from Senior Claims Examiner Kelly Wenninghoff, stated that Decedent's "death was not caused directly and independently of all causes from accidental injury as the insured's underlying heart condition, as well as circumstances surrounding the surgery, contributed to his death and therefore, the applicable exclusions of the policy apply." (Doc. 347-17, sealed, at 2.) The letter continues that "benefits are payable if the loss results directly and independently of all other causes from accidental bodily injuries." (Id.) The letter then includes reference to exclusion (5), "bodily or mental illness or disease of any kind or medical or surgical treatment of the illness or disease." (Id.)

On April 26, 2010, Plaintiff appealed Defendant's denial of benefits under the AD&D Rider. On June 10, 2010, the appeal was denied by letter from Matthew O'Connor, Defendant's Assistant General Counsel for Investments, on the same grounds as the initial request - that the benefit was precluded by policy exclusions which applied to pre-existing medical conditions and medicalnegligence - while again referencing exclusion (5). (Doc. 347-17, sealed, at 3-4.) The written denial of Plaintiff's appeal also states that Decedent's "death did not result directly and independently from accidental bodily injury." (Id., at 3.)

The case returns to this Court following remand from the Tenth Circuit after Plaintiff's appeal of this Court's grant of summary judgment for Defendant on the issue of coverage. (See Docs. 401, 414.) In granting summary judgment, this Court held there was no "accident," and thus no coverage. (See Doc. 401.) According to the Tenth Circuit's mandate, summary judgment was improper because "on this record, genuine issues of material fact exist as to whether the rupture of chordal structures within Mr. Eck's heart, brought upon by extreme exertion in fighting a fire, constituted 'accidental bodily injury.'" (Doc. 414, at 11.)

The more specific background of this case has been summarized numerous times, most recently in the Order and Judgment issued by the Tenth Circuit. (Doc. 414, at 2-6.) Rather than restate the case background yet again, the Court will instead incorporate by reference the Tenth Circuit's factual summary. (Id.)

Following remand from the Tenth Circuit, this Court ordered counsel for the parties to participate in a telephone conference to discuss the status of the case. (Doc. 415, text entry.) As a result of the teleconference, the Court filed its "FirstSupplement to the Pretrial Order" (Doc. 417), setting a procedure and providing instructions for the parties to file memoranda of law supplementing their prior briefing both in support of and in opposition to the prior motions for summary judgment. (Id.) The parties were told that the memorandum may address

(1) the effect of the appellate ruling on issues raised in the prior motions and rulings made thereon, including which summary judgment issues are proper for the court's reconsideration in light of the appellate court proceeding; and (2) any new law on summary judgment issues previously raised and/or ruled upon which has issued since the previous summary judgment ruling (and whether such new law should be considered).

(Id., at 1-2.)

Plaintiff submitted its "Memorandum Regarding 'Law of the Case'" (Doc. 419) and Defendant submitted its "Post-Appeal Supplemental Summary Judgment Memorandum" (Doc. 430). Having reviewed these memoranda, in addition to the correlating response and reply briefs, as well as the underlying motions, the Court's analysis turns to the issues contained in the motions enumerated above.

A. Plaintiff's "Motion for Protective Order and a Determination as a Matter of Law . . ." (Doc. 204).

Plaintiff brought this motion seeking

summary judgment on the issues of the scope of review and the limitations on the record to be reviewed, based on the procedural law of ERISA, 29 U.S.C. §1132, and Fed. R. Civ. P. 56. It also seeks a protective order barring allfurther discovery that is not specifically ordered by the Court, consistent with ERISA discovery restrictions, and an Order limiting the discovery that can be used to supplement the administrative record to the depositions of KCL employees and agents, along with the documents produced by KCL from its files.

(Doc. 214, at 1.) In its Order granting summary judgment for Defendant, this Court held that "[t]here is no rationale for importing broad principals of ERISA into a insurance policy that lacks the plan structure requiring those rules, and Plaintiff has provided no legal authority requiring such." (Doc. 401, at 35.)

Plaintiff has presented the Court with no new evidence or argument upon which the Court would choose to overturn it's prior ruling on ERISA issues. The Court hereby incorporates by reference the entirety of its analysis of the ERISA issues from the prior dispositive motion Order. (See Doc. 401, at 24-35.) Plaintiff's motion (Doc. 204) is DENIED.

B. Plaintiff's "First Motion for an Addition to the Administrative Record" (Doc. 216).

In this motion, Plaintiff requests an Order from the Court adding a particular document to the ERISA administrative record. (See Doc. 217, 217-1.) Again, ERISA does not apply to, and will not be imported into, the insurance contract at issue. See supra. As such, there is no reason for the Court to allow an addition tothe ERISA "administrative record."² Plaintiff's motion (Doc. 216) is DENIED.

C. Defendant is Not Prohibited from Urging as a Defense the Failure of the Primary Coverage Provision.

This ruling from the Court's original opinion (Doc. 401, pages 21-35) stands unmolested by the Circuit Court ruling and nothing in the parties' supplemental memoranda sways the Court to change course. Thus, this portion of the Court's previous ruling is incorporated herein. The corresponding portion of Plaintiff's Motion for Summary Judgment arguing that Defendant should be precluded from relying on any basis for denial other than the disease exclusion (Doc. 347, sealed, Section II, at 37-44) is DENIED.

D. The Cross-Motions for Summary Judgment on the Application of the Primary Coverage Provision - Whether Death Resulted from an "Accident" or an "Accidental Bodily Injury" (Defendant's Motion Doc. 341 with supporting memorandum Doc. 349, sealed; Plaintiff's Motion Doc. 342 with supporting memorandum Doc. 347, sealed, at Sections III and IV).

Defendant's Motion for Summary Judgment posed two issues. The first of these issues was "[w]hether an 'accident' or 'accidental bodily injury' could not and did not occur within the meaning of an accidental death and dismemberment insurance policy where the decedent allegedly injured his heart while performinghis normal duties as a firefighter." (Doc. 349, sealed, at 50.) It is on this issue that the Tenth Circuit Court of Appeals reversed and remanded this Court's grant of summary judgment for Defendant, finding that "genuine issues of material fact exists as to whether the rupture of chordal structures within [Decedent's] heart, brought upon by extreme exertion in fighting a fire, constituted 'accidental bodily injury.'" (See Doc. 414, at 11.) The Circuit Court ruling that the coverage issue turns on an issue of fact disposes of both parties motions for summary judgment on this issue. This issue will, therefore, be decided at trial.

An additional argument made by Plaintiff in prior briefing in support of its motion for summary judgment and in opposition to Defendant's, was that evidence of the incident during surgery in which the...