Lincoln National Life Insurance v. Evans

943 F. Supp. 564
CourtDistrict Court, D. Maryland
DecidedDecember 18, 1996
DocketCivil K-95-3239
StatusPublished
Cited by12 cases

This text of 943 F. Supp. 564 (Lincoln National Life Insurance v. Evans) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lincoln National Life Insurance v. Evans, 943 F. Supp. 564 (D. Md. 1996).

Opinion

FRANK A. KAUFMAN, Senior District Judge.

On November 24, 1993, Patricia Hawkins (“Ms. Hawkins”) set the bed in which her husband of ten years, Milton E. Hawkins, Jr. (“Mr. Hawkins”) was sleeping, on fire. 1 At the time of his death, Mr. Hawkins was insured by two accidental death and dismemberment insurance policies, one from The Lincoln National Life Insurance Company (“Lincoln National”) and the other from The Guardian Life Insurance Company of America (“Guardian”), who are plaintiffs in this action (the “Insurers”). Margaret Evans, as personal representative of the Estate for her son Milton E. Hawkins, Jr. (the “Estate”), asserted a claim for the proceeds under the Lincoln National and Guardian accidental death benefit policies. 2 The Insurers have refused to pay out these proceeds to the Estate or Ms. Hawkins, claiming that accidental death benefits under the respective group plans are not due, because Mr. Hawkins’ death “was not accidental and independent of all other causes within the meaning of the group plan[s].” Compl., ¶¶ 14, 15. In October 1995, the Insurers filed a Complaint for Declaratory Judgment to determine the rights and other duties of the parties under the group plans. Subsequently, the Insurers filed a Motion for Summary Judgment and the Estate filed a Cross-Motion for Summary Judgment. For the reasons set forth in this Opinion, this Court will deny the Cross-Motions for Summary Judgment, and inform counsel concerning further scheduling.

FACTS

The Hawkinses were married in February 1983. On November 24, 1993, Ms. Hawkins set fire to the bed in which her husband was sleeping, killing him. At the time of his death, Mr. Hawkins was insured by two accidental death and dismemberment insurance policies, one for $10,000 from Lincoln National and the other for $15,000 from Guardian. 3 Mr. Hawkins obtained both policies through his employer, D. Myers & Sons, Inc., pursuant to an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). 29 U.S.C. § 1001 et seq.

It is undisputed that Mr. and Ms. Hawkins had violent exchanges during their marriage. In fact, the Estate concedes that “there were occasional episodes of physical violence, maybe intense at times_” (Estate’s Opp. to Mot. of Insurers for Summ.J. at 40.) The last of these occasions took place on November 23,1993. On that day, Mr. Hawkins and his wife’s niece, Shannell Ricks (“Ricks”), argued and physically fought with each other until Ms. Hawkins intervened and escorted Ricks to a relative’s house. In her deposition, Ms. Hawkins testified that when she returned, Mr. Hawkins fought with her, followed her around the house, struck at least twenty-five blows to her face and upper arms, and threatened to kill her beforé he stopped and went to sleep.

*566 The Insurers allege that this type of abuse was commonplace in the Hawkins marriage. As stated above, the Estate does not deny that some violence occurred, but disputes “the amount, severity, regularity and term of any physical violence that occurred during the Hawkinses’ marriage.” (Estate’s Opp. to Mot. of Insurers for Summ.J. at 40). In support, of its contention, the Estate offers the sworn affidavits of relatives of Mr. Hawkins, who generally deny seeing evidence of bruises or other signs of physical injury as well as hearing anything from Ms. Hawkins about suffering any form of physical or mental abuse at the hands of Mr. Hawkins. According to the Estate, if a pattern of brutal abuse had existed, those individuals would have seen some evidence of it.

SUMMARY JUDGMENT

Summary judgment is appropriate where “there is no genuine issue of material fact and [where] the moving party is entitled to judgment as a matter of law.” Fed.R.Civ. Pro. 56(c); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256, 106 S.Ct. 2505, 2514, 91 L.Ed.2d 202 (1986); Barwick v. Celotex Corp., 736 F.2d 946, 958 (4th Cir.1984). The non-moving party is entitled to have “all reasonable inferences ... drawn in [its] favor.” Felty v. Graves-Humphreys Co., 818 F.2d 1126, 1129 (4th Cir.1987). The non-movants, however, “ ‘may not rest upon the mere allegations or denials of [their] pleadings’ but instead ‘must set forth specific facts showing that there is a genuine issue for trial.’” Felty, 818 F.2d at 1129 (citing Fed.R.Civ.Pro. 56(e)). “Genuine issues of material fact cannot be created through mere speculation.” Klebe v. Mitre Group Health Care Plan, 894 F.Supp. 898, 901 (D.Md.1995) (citing Beale v. Hardy, 769 F.2d 213, 214 (4th Cir.1985)).

DISCUSSION

The most logical source of information regarding potential liability is the language of the policies themselves. 4 Indeed, in an ERISA case, the language is particularly important for “[w]hile a court should be hesitant to depart from the written terms of a contract under any circumstances, it is particularly inappropriate in a case involving ERISA, which places great emphasis upon adherence to the written provisions in an employee benefit plan.” Coleman v. Nationwide Life Ins. Co., 969 F.2d 54, 56 (4th Cir.1992), cert. denied, 506 U.S. 1081, 113 5.Ct. 1051, 122 L.Ed.2d 359 (1993). Herein, the language of both policies is substantially similar. 5 The Lincoln National group coverage certificate provides benefits “for loss due to the Employee’s Accidental Death.... The loss must ... be due to an accident which occurs while the Employee is insured under this Benefit.” (Mem. of Law in Supp. of Insurers Mot. for Summ.J., Exhibit B). The Lincoln National certificate defines Accidental Death as the “loss of life which results directly from ... Bodily Injury.” 6 “Bodily Injury” is further defined in the certificate as “injury due directly to an accident, independent of all other causes.” Id. Likewise, Guardian’s certificate of coverage provides benefits “if you suffer a covered loss due to an accident that occurs while you’re insured.” Id. A covered loss is defined as “loss of life ... [which is] the direct result of an accident which occurs while you’re insured, independent of all other causes.” Id. Thus, for the Estate to recover under either policy, Mr. Hawkins’ death must have been due to an accident, independent of all other causes, which occurred while he was insured. The term “accident” is not further defined in either policy.

Burden of Proof

The Estate argues that it bears the burden of establishing a prima facie

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943 F. Supp. 564, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lincoln-national-life-insurance-v-evans-mdd-1996.