Fulkerson v. Unum Life Insurance Company of America

CourtDistrict Court, N.D. Ohio
DecidedMarch 31, 2021
Docket1:19-cv-01180
StatusUnknown

This text of Fulkerson v. Unum Life Insurance Company of America (Fulkerson v. Unum Life Insurance Company of America) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fulkerson v. Unum Life Insurance Company of America, (N.D. Ohio 2021).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO EASTERN DIVISION

JUDY FULKERSON, ) CASE NO. 1:19-cv-01180 ) Plaintiff, ) ) v. ) MAGISTRATE JUDGE DAVID A. RUIZ ) UNUM LIFE INS. CO. of AMERICA, ) ) MEMORANDUM OPINION AND ORDER Defendant. ) )

I. Procedural History On May 22, 2019, Plaintiff Judy Fulkerson (“Plaintiff”) filed a complaint against Defendant Unum Life Insurance Company of America (hereafter “Defendant” or “Unum”). (R. 1). After receiving leave from the court, Plaintiff filed an Amended Complaint on August 26, 2019. (R. 14). Plaintiff’s claim arises under the Employee Retirement Income Security Act of 1974 (“ERISA”) and 29 U.S.C. § 1132(e)(1) and 28 U.S.C. § 1391(b). (R. 14, PageID# 89). Specifically, Plaintiff alleges that her son, Daniel Tymoc, had life insurance coverage issued by Unum that also included accidental death and dismemberment (“AD&D”) coverage. Id. at PageID# 88. On or about July 7, 2017, Mr. Tymoc sustained fatal injuries while driving an automobile. Id. at PageID# 89. It is alleged that Plaintiff’s claim for AD&D benefits under the policy was wrongfully denied by Unum both initially as well as after a number of appeals. Id. at Pa geID# 92-95. The parties have consented to the jurisdiction of the undersigned Magistrate Judge. (R. 9). After briefing by the parties, the court determined that the “de novo” standard of review applies in this case. (R. 24). Now pending before the court are the parties’ respective motions for judgment on the administrative record. (R. 27 & 28). Each party has filed their respective opposition brief (R. 30 & 31), and this matter is ripe for the court’s consideration. II. Brief Statement of Facts1 Mr. Tymoc was employed by Pyrotek, Inc. (“Pyrotek”). (R. 18, Administrative Record “AR” at 18). Unum acknowledges that because Pyrotek, “offered the Policy as part of an employee welfare benefit plan, there is no dispute that the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001–1461, applies on these facts.” (R. 28, PageID# 1106). Mr. Tymoc sustained fatal injuries while operating an automobile on US-422, a two lane highway. According to witnesses, Mr. Tymoc was traveling at 80 to 100 miles per hour (“mph”);

he attempted to change lanes to the right when the gap between two vehicles began to close; his vehicle veered off to the right of the road and proceeded to roll down an embankment leading to his death. (R. 18, Administrative Record (“AR”) 478, 480-482). Following the fatal single-car accident, the medical examiner’s postmortem toxicology report reflected findings for both alcohol and Delta-9-THC (the psychoactive ingredient in marijuana) in Mr. Tymoc’s system. (AR 215, 229, 478).2

1 The court includes only a basic recitation of the facts, as they are generally not in dispute and sufficiently set forth in the parties’ briefs. 2 Postmortem analysis reflected a vitreous humor blood alcohol level of 0.149 (+/- 0.0009g/dL), which defendant’s medical expert, Brent Morgan, M.D., concluded could be artificially high due III. Law and Analysis A. Standard of Review In reviewing a denial of benefits under ERISA, “[t]he court is to conduct its review ‘based solely upon the administrative record.’” Cooper v. Life Ins. Co. of N. Am., 486 F.3d 157, 171 (6th Cir. 2007) (quoting Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 618-19 (6th Cir. 1998)). The court has already determined that the de novo standard of review applies. (R. 24). As this court previously observed, “[t]he general principles of contract law dictate that we interpret the Plan’s provisions according to their plain meaning, in an ordinary and popular sense,” and this approach applies to the interpretation of ERISA contract provisions. Perez v. Aetna Life Ins. Co., 150 F.3d 550, 556 (6th Cir. 1998); see also Morgan v. SKF USA, Inc., 385 F.3d 989, 992 (6th Cir. 2004) (“In interpreting a plan, the administrator must adhere to the plain meaning of its language as it would be construed by an ordinary person.”) (citing Shelby County Health Care Corp. v. S. Council of Indus. Workers Health and Welfare Trust Fund, 203 F.3d 926, 934 (6th

Cir. 2000)); Walker v. Metro. Life Ins. Co., Case No. 96-CV-60248, 1997 U.S. Dist. LEXIS 23187, at *12 (E.D. Mich. Apr. 3, 1997) (“an insured should not have to consult a long line of case law or law review articles and treatises to determine the coverage he or she is purchasing under an insurance policy. Policy language should be given its plain meaning, unless a technical meaning is clearly provided in the insurance policy.”) (citations omitted).3

to the postmortem analysis and cause of death; and the doctor concluded he could not determine the blood alcohol concentration was at or above 0.08g/dL at the time of the crash, but it could correspond to a level of 0.067. (AR 654-55). Mr. Tymoc also had a femoral blood sample that reflected THC level of 2.8 (+/-0.4ng/mL). (AR 215, 229, 478). 3 “The summary plan description … shall be written in a manner calculated to be understood by the average plan participant, and shall be sufficiently accurate and comprehensive to reasonably “When applying a de novo standard in the ERISA context, the role of the court reviewing a denial of benefits is to determine whether the administrator ... made a correct decision. The administrator’s decision is accorded no deference or presumption of correctness.” Hoover v. Provident Life & Acc. Ins. Co., 290 F.3d 801, 808-809 (6th Cir. 2002) (internal quotations omitted). The de novo standard applies to both factual and legal determinations by a plan administrator. Rowan v. Unum Life Ins. Co. of Am., 119 F.3d 433, 435 (6th Cir. 1997). B. Parties’ Respective Positions Defendant asserts that its Administrative Decision denying AD&D benefits should be upheld for two reasons: (1) Mr. Tymoc’s death was not accidental because it was not caused solely by accidental means; and (2) even if accidental, AD&D benefits were unavailable based on the policy’s crime exclusion. (R. 28). Plaintiff challenges both of these findings. To prevail, Plaintiff must show that both of these findings are incorrect. Conversely, because Defendant asserts two separate grounds for denying benefits, Defendant need only successfully defend one of its grounds to uphold the denial of AD&D benefits.

C. Whether Mr. Tymoc’s Death Was Accidental Defendant asserts that Mr. Tymoc’s death was not an “accidental bodily injury,” as required for a covered loss, because it did not result from “accidental means” and was “contributed to” by other causes. (R. 31, PageID# 1158, citing AR 259). Defendant, however, acknowledges that the term “accidental” is not defined in the policy. (R. 31, PageID# 1159).

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Bluebook (online)
Fulkerson v. Unum Life Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fulkerson-v-unum-life-insurance-company-of-america-ohnd-2021.