Leavitt v. BASF Corp.

946 F. Supp. 488, 1996 U.S. Dist. LEXIS 17969, 1996 WL 693747
CourtDistrict Court, S.D. Texas
DecidedNovember 25, 1996
DocketCivil Action No. G-95-631
StatusPublished

This text of 946 F. Supp. 488 (Leavitt v. BASF Corp.) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Leavitt v. BASF Corp., 946 F. Supp. 488, 1996 U.S. Dist. LEXIS 17969, 1996 WL 693747 (S.D. Tex. 1996).

Opinion

ORDER

KENT, District Judge.

Plaintiff filed this action pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132(a)(1), after Defendants denied Plaintiff disability benefits under a voluntary group accident insurance plan. Now before the Court are Plaintiffs Motion for Partial Summary Judgment and Defendants’ Motion for Summary Judgment. For the reasons set forth below, Plaintiffs Motion is DENIED and Defendants’ Motion is GRANTED.

Plaintiff was an employee of BASF Corporation (“BASF”) from 1962 until 1991 and was enrolled in a voluntary group accident insurance plan maintained by BASF and provided by John Hancock Mutual Life Insurance Company (“John Hancock”). The plan provided benefits to insureds who became totally and permanently disabled as a result of an accident if the disability commenced within 365 days of the injury and continued for twelve consecutive months. In December 1987, Plaintiff was involved in a minor car accident while in the course of his employment when another vehicle side-swiped his vehicle on the BASF grounds. Plaintiff did not file a workers’ compensation claim regarding this accident, nor did he seek any medical attention as an immediate result of the accident.

In October 1991, Plaintiff retired from BASF, claiming he was permanently and totally disabled. In 1992, Plaintiff filed a claim with John Hancock for disability benefits under the voluntary group accident insurance plan claiming his disability was the result of the 1987 car accident. John Hancock initially was inclined to deny the claim because the policy required the total disability to arise within 365 days of the accident, whereas Plaintiff made his claim four years after the accident. This 365-day limitation, however, was not expressed in the employee brochure on benefits that Plaintiff was given. Rather, it was contained in the master policy between BASF and John Hancock. After being informed of this discrepancy, notified that it might constitute a violation of the Texas Deceptive Trade Practices Act, and sued1 by Plaintiff, John Hancock reversed its position and decided to consider Plaintiff’s claim even though the disability did not arise within 365 days of the accident. After reviewing all applicable documents and medical records, John Hancock denied Plaintiff’s claim for benefits on the grounds that his disability was not the result of the 1987 accident but rather was the result of a longstanding mus-culoskeletal disorder.

Plaintiff appealed this denial of benefits to BASF, the Plan Administrator. BASF had established a Voluntary Employee Beneficiary Association (“VEBA”) Committee to review and decide appeals of denied claims. Denise Childress, Manager of Benefits Regulatory Compliance and member of the VEBA Committee, obtained and reviewed the medical records that John Hancock had reviewed, in addition to records provided by Plaintiff. Additionally, Ms. Childress discussed Plaintiffs claim with Sharon Rogers, the Benefits Coordinator at the BASF plant where Plaintiff worked, who advised her that Plaintiff had made claims for medical benefits for back problems prior to the 1987 accident. As a result of her investigation and review of the records, Ms. Childress prepared a memorandum for the VEBA Committee, in which she listed documents for the Committee to review, outlined her findings, and recommended that Plaintiff’s claim be denied on the grounds that his disability was not the result of the 1987 accident. The VEBA Committee met in September 1995 to review [490]*490Plaintiffs appeal and denied his claim on the grounds that his disability was not the result of the car accident but rather was the result of a longstanding musculoskeletal disorder.

As a result of this denial, Plaintiff filed this suit pursuant to 29 U.S.C. § 1132(a)(1), which provides that a civil action may be brought by a participant or beneficiary of an employee benefit plan to recover benefits or enforce his rights under the terms of the plan. Plaintiff complains that BASF and the VEBA Committee unjustly denied his benefits and requests the Court to find him entitled to benefits under the voluntary group accident plan. Both parties moved for summary judgment on the issue of whether Plaintiff is entitled to recover disability benefits under the insurance plan.

Summary judgment is appropriate if no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). Issues of material fact are genuine only if they require resolution by a trier of fact. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986). In other words, the Court must accept the evidence of the nonmoving party and draw all justifiable inferences in favor of that party. Matsushita Elec. Indus. Co. v. Zenith Radio, 475 U.S. 574, 585-87, 106 S.Ct. 1348, 1355-56, 89 L.Ed.2d 538 (1986). Determining credibility, weighing evidence, and drawing reasonable inferences are left to the trier of fact. Anderson, 477 U.S. at 255, 106 S.Ct. at 2513.

The party moving for summary judgment bears the initial burden of “informing the district court of the basis for its motion, and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact.” Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2553, 91 L.Ed.2d 265 (1986); see also Fed.R.Civ.P. 56(c). The burden then shifts to the nonmoving party to establish the existence of a genuine issue for trial. Matsushita, 475 U.S. at 585-87, 106 S.Ct. at-1355-56; Wise v. E.I. DuPont De Nemours & Co., 58 F.3d 193, 195 (5th Cir.1995). To meet this burden, the nonmovant “must do more than simply show that there is some metaphysical doubt as to the material facts” by “com[ing] forward with ‘specific facts showing that there is a genuine issue for trial.’ ” Matsushita, 475 U.S. at 586-87, 106 S.Ct. at 1355-56 (quoting Fed.R.Civ.P. 56(e)). Summary judgment should be granted only if the evidence indicates that a reasonable fact-finder could not find in favor of the nonmoving party. Anderson, 477 U.S. at 248, 106 S.Ct. at 2510; see also Matsushita, 475 U.S. at 587, 106 S.Ct. at 1356.

The material facts in this case are not in dispute. What is in dispute, however, is whether the final outcome of this dispute, the denial of Plaintiffs claim, was proper and correct. In defending their denial of benefits, Defendants put forth two main arguments.

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946 F. Supp. 488, 1996 U.S. Dist. LEXIS 17969, 1996 WL 693747, Counsel Stack Legal Research, https://law.counselstack.com/opinion/leavitt-v-basf-corp-txsd-1996.