Calderon v. Hartford Life & Accident Ins. Co.

372 F. Supp. 3d 1259
CourtDistrict Court, D. New Mexico
DecidedFebruary 12, 2019
DocketCase No: 18-CV-331-F
StatusPublished

This text of 372 F. Supp. 3d 1259 (Calderon v. Hartford Life & Accident Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, D. New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Calderon v. Hartford Life & Accident Ins. Co., 372 F. Supp. 3d 1259 (D.N.M. 2019).

Opinion

NANCY D. FREUDENTHAL, UNITED STATES DISTRICT JUDGE

This matter is before the Court on Plaintiff Bethany Calderon's Motion for Summary Judgment. The Court has considered the parties' briefs and oral arguments and is fully informed in the premises. The Court FINDS AND ORDERS as follows.

BACKGROUND

The instant suit stems from a 2016 motorcycle accident in Albuquerque, New Mexico. On August 31, 2016, Mr. Calderon was driving northbound on San Mateo Boulevard, approaching the intersection of San Mateo Lane. (Doc. 22-1 at 47).1 At the *1263same time, another driver, Timothy Wade, was traveling on San Mateo Lane. (Id. ). When Mr. Wade reached the intersection of San Mateo Lane and San Mateo Boulevard, he began making a left-hand turn onto San Mateo Boulevard. (Id. ). As Mr. Wade came to the intersection, he stopped at a stop sign and then proceeded to enter the intersection, believing it was clear. (Doc. 22-1 at 16). Unfortunately, this was not the case. Mr. Wade failed to yield the right of way to Mr. Calderon, causing a collision. (Id. ). Calderon died from the injuries he sustained during the crash. (Id. ).

As an employee of Sennheiser New Mexico, LLC, Calderon enjoyed an insurance plan governed by the Employee Retirement Income Security Act ("ERISA"), which included an accidental death and dismemberment provision. (Doc. 17-1 at 299). Hartford issued the plan, and Calderon's wife, Ms. Calderon, was a beneficiary under that plan. (Id. ) In September 2016, following her husband's death, Ms. Calderon submitted a claim for accidental death benefits under her husband's plan. (Id. at 299-302). On October 10, 2016, Hartford informed Ms. Calderon it had received her claim. (Id. at 22). Six months later, on April 5, 2017, Hartford denied coverage. (Id. at 17-20). In doing so, Hartford noted Mr. Calderon was intoxicated at the time of the collision. (Id. at 18-19). Indeed, Hartford cited a toxicology report that revealed Calderon had a blood-alcohol content of .2 percent at the time of the accident. (Id. at 18). Additionally, Hartford referenced a police report compiled after the crash. (Id. ). Citing a quotation from one of the responding officers in a supplementary offense report compiled several months after the crash, Hartford noted that "Mr. Calderon's level of intoxication likely would have affected his ability to reasonably respond and react to the vehicle pulling in front of him which may have reduced the severity of the collision." (Id. ).

Given Mr. Calderon's intoxication, Hartford concluded two policy provisions excluded coverage. (Id. at 17-18). First, Hartford noted the policy defined covered injuries as those "resulting directly from an accident" and "independently of all other causes." (Id. at 17). Second, Hartford cited to a provision that barred recovery for "any loss caused or contributed to by" an "injury sustained while intoxicated." (Id. at 18). According to Hartford, since Mr. Calderon was intoxicated, his injury did not occur "independently of all other causes." (Id. at 18-19). Likewise, Hartford determined the second provision also barred recovery, as his intoxication likely "caused or contributed to" his injury (Id. ).

At the time of denial, Hartford informed Ms. Calderon she had 60 days to submit any additional information she thought might be relevant to Hartford's consideration of her benefits claim. (Id. at 19). Hartford also indicated ERISA provides policy beneficiaries a right of appeal and a "full and fair review." (Id. ). If Ms. Calderon wanted to appeal, she also had to pursue this remedy within 60 days. (Id. ). Finally, Hartford informed Ms. Calderon that she could seek review in federal district court upon exhaustion of her administrative remedies. (Id. ).

On June 8, 2017, in response to Hartford's denial, Ms. Calderon sent the Hartford Claims Appeals Unit a document captioned "Appeal for Full and Fair Review of Decision to Deny Accidental Death and Disability Benefits." (Doc 22-1 at 1). Though Ms. Calderon captioned the document as an "appeal," Hartford seemed to view the document in a different manner. On June 14, 2017, Hartford informed Ms. Calderon it had received the materials she *1264sent on June 8 and that it would treat those documents as a supplementation to Ms. Calderon's original claim for benefits. (Doc. 17-1 at 16). Hartford stated it would forward the document to its claims office for consideration and informed Ms. Calderon she would have a right to appeal if Hartford denied her claim again. (Id. at 15). On October 10, 2017, Hartford sent another denial letter, citing the same policy provisions it relied upon in its initial denial. (Id. at 13).

On April 9, 2018, Ms. Calderon filed suit in this Court under 29 U.S.C. § 1132(a).2 (Doc. 1). This statutory section allows beneficiaries to bring civil actions to recover benefits, enforce rights under a plan, or to clarify rights and benefits under a plan. 29 U.S.C. § 1132(a) (2018). Later, Ms. Calderon moved for summary judgment. (Doc. 18). As part of her motion, she also requested attorney's fees and prejudgment interest. (Doc. 18).

At the beginning of her motion, Ms. Calderon asserts the Court should utilize a de novo standard of review because Hartford failed to comply with procedural deadlines set forth in the policy when responding to her claim for benefits. (Id. at 12-14). On the merits, Ms. Calderon contends summary judgment is proper because Hartford failed to point to evidence demonstrating any causal link between Mr. Calderon's crash and the collision. (Id. at 19-24). Accordingly, Ms. Calderon claims Hartford wrongfully denied coverage under the two provisions cited in its letter of denial.3 (Id. ). Finally, Ms. Calderon argues she is entitled to attorney's fees and prejudgment interest under ERISA because the Court should deem her the prevailing party in this matter (Id. at 18).

As to the standard of review, Hartford advocates for a more deferential arbitrary and capricious standard, because the policy gave Hartford discretion to make benefits determinations. (Doc. 21 at 15-20). On the merits, Hartford claims it presented some evidence of causation. (Id. at 16). As Hartford notes, a responding police officer stated in a supplementary offense report that Calderon's "level of intoxication likely *1265would have affected his ability to reasonably respond and react to the vehicle pulling in front of him which may have reduced the severity of the collision." (Id. ). Moreover, even in the absence of evidence demonstrating causation, Hartford contends denial of Ms. Calderon's claim would have still been proper based on the plain language of the policy. (Id. at 18-20).

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Bluebook (online)
372 F. Supp. 3d 1259, Counsel Stack Legal Research, https://law.counselstack.com/opinion/calderon-v-hartford-life-accident-ins-co-nmd-2019.