Masuda-Cleveland v. Life Insurance Company of America

CourtDistrict Court, D. Hawaii
DecidedNovember 30, 2020
Docket1:16-cv-00057
StatusUnknown

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

Bluebook
Masuda-Cleveland v. Life Insurance Company of America, (D. Haw. 2020).

Opinion

FILED IN THE UNITED STATES DISTRICT COURT DISTRICT OF HAWAII Nov 30, 2020, 7:53 UNITED STATES DISTRICT COURT DISTRICT OF HAWAII MARNIE MASUDA-CLEVELAND, CIV. NO. 16-00057 LEK-WRP Plaintiff, vs. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

ORDER GRANTING PLAINTIFF’S MOTION FOR JUDGMENT ON THE EXPANDED ERISA ADMINISTRATIVE RECORD Before the Court is Plaintiff Marnie Masuda- Cleveland’s (*Plaintiff"”) Motion for Judgment on the Expanded ERISA Administrative Record (“Motion”), filed on February 26, 2020. [Dkt. no. 120 (redacted).!] Defendant Life Insurance Company of North America (“Defendant” or “LINA”) filed its memorandum in opposition on March 20, 2020, and Plaintiff filed her reply on April 20, 2020. [Dkt. nos. 125, 129.] This matter came on for hearing on June 26, 2020. Plaintiff's Motion is hereby granted for the reasons set forth below.

1 An unredacted version of the memorandum in support of the Motion was filed under seal on February 27, 2020. [Dkt. no. 122.)

BACKGROUND This matter comes before the Court on remand from the Ninth Circuit. [Memorandum, filed 5/8/19 (dkt. no. 77).2] The parties are familiar with the factual and procedural history, and it will not be repeated here in full. Plaintiff’s husband,

Harlan Masuda (“Masuda”) was a participant in Hawaiian Electric Industries, Inc.’s Group Accident Plan (“the Plan”). [Plaintiff’s Concise Statement in Support of Motion for Judgment on the Expanded ERISA Administrative Record (“CSOF”), filed 2/26/20 (dkt. no. 121), at ¶ 1 (citing CSOF, Decl. of Jeffrey C. Metzger (“Metzger Decl.”),3 Exh. 1 (Group Accident Policy OK 820810 (“the Policy”)), Exh. 2 (letter from Paula Fukuoka dated April 15, 2014)).4] Masuda passed away following a single car

2 The Ninth Circuit’s Memorandum disposition is also available at 769 F. App’x 517 (9th Cir. 2019). 3 The CSOF and the Metzger Declaration were filed in redacted form. Unredacted versions were filed on February 27, 2020. [Dkt. nos. 123, 123-1.]

4 Defendant’s concise statement of facts in opposition to the Motion (“Defendant’s CSOF”), filed March 20, 2020, [dkt. no. 126,] fails to comply with Local Rule 56.1 of the Local Rules of Practice for the United States District Court for the District of Hawaii. Specifically, Defendant’s CSOF does not include “a separate document containing a single concise statement that admits or disputes each fact set forth in the movant’s concise statement.” See Local Rule LR56.1(e). Therefore, unless specifically controverted in Defendant’s CSOF, material facts set forth in Plaintiff’s CSOF are deemed admitted. See Local Rule LR56.1(g) (stating that “material facts set forth in the movant’s concise statement will be deemed (. . . continued) collision on February 11, 2014. [CSOF at ¶ 2; Def.’s CSOF at ¶ 3.] Lindsey Harle, M.D., Coroner’s Physician, performed the autopsy on Masuda. [CSOF at ¶ 4 (citing Metzger Decl., Exh. 6 (Maui County Police Department Request for Autopsy and Autopsy Report)); Def.’s CSOF at ¶¶ 6-7 (citation omitted).] She

concluded that the cause of death was “‘blunt force trauma to the face and neck’” and that the manner of death was accidental. [CSOF at ¶ 4 (quoting Metzger Decl., Exh. 6 (Autopsy Report)).] Dr. Harle also speculated that it was possible that an acute medical event, such as a heart attack or seizure, caused Masuda to lose consciousness and crash. [Metzger Decl., Exh. 6 at PageID #: 2903.5] Defendant denied Plaintiff’s claim for benefits, first taking the position that a medical event caused Masuda to crash. [CSOF at ¶ 5; Def.’s CSOF at ¶ 9.] In denying Plaintiff’s claim, Defendant relied on its in-house medical director Dr. R. Norton Hall who opined that,

[w]ith the history of bizarre, immediate events prior to the crash, the past medical history of prediabetes, [hypertension] and dyslipidemia and the autopsy findings of severe atherosclerotic

admitted unless controverted by a separate concise statement of the opposing party”).

5 Due to the presence of multiple page numbers on each of the Exhibits themselves, Plaintiff’s Exhibits will be cited to the page number assigned by the district court’s electronic case filing system. narrowing of the “widow maker” coronary artery it is concluded, with reasonable medical certainty, that Mr. Masuda had an acute medical event that was the etiology of his uncontrolled dash to his death.

See Metzger Decl., Exh. 7 ( letter, dated May 20, 2014, from Defendant denying Plaintiff’s claim (“Denial Letter”)) at PageID #: 2917 (second page of Staffing Documentation Form signed by R. Norton Hall, M.D., dated 5/19/14). Defendant concluded that “Harlan Masuda passed away on 2/11/2014 after sustaining blunt force injuries in a single vehicle crash. Information on file supports that Mr. Masuda suffered a medical event while driving which resulted in his crash.” [Id. at PageID #: 2912.] Therefore, Defendant denied payment of death benefits on the basis that “his death was not caused by an accident as mandated by the policy, but rather, a medical event which caused a motor vehicle crash.” [Id. at PageID #: 2913.] Plaintiff appealed the denial. In response to Plaintiff’s first appeal, Defendant upheld its denial of payment. Defendant reasoned that [a] medical event is the most likely explanation for Mr. Masuda hitting the lifeguard’s truck, not responding verbally when confronted by the lifeguard, revving his engine while his vehicle was against the barrier, and driving several hundred feet with no avoidance maneuvers. This is supported by the review by Dr. Hall that some form of medical event was likely to a reasonable degree of medical certainty and the pathology report concludes the insured had atherosclerotic cardiovascular disease and that some acute medical event, such as a myocardial infarction or seizure, likely occurred to cause the crash. Therefore, it would be reasonable to conclude under this policy language that there is no coverage for his death because an illness, disease or bodily infirmity directly caused the fatal accidental injury.

[Metzger Decl., Exh. 10 (appeal denial letter from Defendant, dated December 18, 2014 (“First Appeal Denial Letter”)) at PageID #: 2930.] Plaintiff appealed the denial again. In response to the second appeal, Defendant partly adopted the opinion of Dr. Scott Denton, a forensic pathologist hired by Defendant, who concluded that Masuda suffered a heart attack which caused both the crash and Masuda’s death, and that the cause of death was not, as Dr. Harle found, blunt force trauma to the face and neck. [CSOF at ¶ 15 (citing Metzger Decl., Exh. 18 (letter from Mike J., dated August 20, 2015 (“Second Appeal Denial Letter”)); Def.’s CSOF at ¶ 16 (citing same).] Based on Dr. Denton’s opinion that “the injuries to [Masuda’s] head and neck documented during the autopsy would be insufficient to cause sudden death in this witnessed manner,” Defendant decided that the evidence in the file supports that Mr. Masuda’s loss of ability to control his vehicle on 02/11/2014 and the subsequent crash was caused by a medical event due to his illness, disease or body infirmity, and was not caused by an accident, as required by the policy, and there is no coverage. [Metzger Decl., Exh. 18 (Second Appeal Denial) at PageID #: 3022-23.] Defendant also “concluded that Mr. Masuda’s sudden cardiac event, which was caused by his severe coronary artery atherosclerosis, significantly contributed to the crash as well as his death, and his loss is specifically excluded from

payment.” [Id. at PageID #: 3023.] On February 9, 2016, Plaintiff filed her complaint. [Dkt. no. 1.] On August 31, 2017, this Court issued its Order: (1) Granting Defendant’s Motion for Summary Judgment on Plaintiff Marnie Masuda-Cleveland’s Complaint Filed on February 9, 2016 [DOC. #1]; and (2) Denying Plaintiff’s Motion for Judgment on the Administrative Record (“8/31/17 Order”).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Black & Decker Disability Plan v. Nord
538 U.S. 822 (Supreme Court, 2003)
Don Ray Smith v. Cmta-Iam Pension Trust
746 F.2d 587 (Ninth Circuit, 1984)
Marjorie Booton v. Lockheed Medical Benefit Plan
110 F.3d 1461 (Ninth Circuit, 1997)
Abatie v. Alta Health & Life Ins. Co.
458 F.3d 955 (Ninth Circuit, 2006)
Jeanene Harlick v. Blue Shield of California
686 F.3d 699 (Ninth Circuit, 2012)
Nolan v. Heald College
551 F.3d 1148 (Ninth Circuit, 2009)
Bartholomew v. Unum Life Insurance Co. of America
588 F. Supp. 2d 1262 (W.D. Washington, 2008)
Lee v. Kaiser Foundation Health Plan Long Term Disability Plan
812 F. Supp. 2d 1027 (N.D. California, 2011)
Tommy Dowdy v. Metropolitan Life Ins. Co.
890 F.3d 802 (Ninth Circuit, 2018)
Gallupe v. Sedgwick Claims Mgmt. Servs. Inc.
358 F. Supp. 3d 1183 (W.D. Washington, 2019)
Day v. AT & T Disability Income Plan
698 F.3d 1091 (Ninth Circuit, 2012)
Rabbat v. Standard Insurance
894 F. Supp. 2d 1311 (D. Oregon, 2012)

Cite This Page — Counsel Stack

Bluebook (online)
Masuda-Cleveland v. Life Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/masuda-cleveland-v-life-insurance-company-of-america-hid-2020.