McClelland v. Life Insurance Co. of North America

679 F.3d 755, 53 Employee Benefits Cas. (BNA) 2421, 2012 WL 1868782, 2012 U.S. App. LEXIS 10466
CourtCourt of Appeals for the Eighth Circuit
DecidedMay 24, 2012
Docket10-3353, 11-1300
StatusPublished
Cited by33 cases

This text of 679 F.3d 755 (McClelland v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McClelland v. Life Insurance Co. of North America, 679 F.3d 755, 53 Employee Benefits Cas. (BNA) 2421, 2012 WL 1868782, 2012 U.S. App. LEXIS 10466 (8th Cir. 2012).

Opinions

BEAM, Circuit Judge.

Life Insurance Company of North America (LINA) appeals the district court’s1 ruling that LINA abused its discretion in denying death benefits to Dawn McClelland based upon her husband Anthony’s life insurance policy. LINA also appeals the district court’s award of attorney fees. We affirm the district court’s decision on the award of benefits, but remand for further proceedings with regard to the attorney fee award.

I.BACKGROUND

Anthony worked as a machinist for Graco, and through Graco had insurance coverage for accidental death benefits. The plan was an Employee Retirement Income Security Act (“ERISA,” 29 U.S.C. § 1001 et seq.) qualified employee benefit plan. The plan provided for $250,000 of coverage for “Loss of Life,” and a covered accident was defined in the plan as:

A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or Covered Loss and meets all of the following conditions:
1. occurs while the Covered Person is insured under this Policy;
2. is not contributed to by disease, Sickness, mental or bodily infirmity;
3. is not otherwise excluded under the terms of this Policy.

On October 26, 2007, a Friday, Dawn got off work at 6:00 p.m. and went home. That evening she and Anthony ordered pizza, and Anthony consumed a few mixed drinks but Dawn did not think that he was intoxicated. The next morning, Saturday, October 27, Dawn got ready for work. Anthony showed her some family pictures on the internet, and told her he was going to ride his motorcycle because it was going to be a nice day. He also told her that he intended to do yard work with their son and tend to his garden that afternoon. The couple’s fifteen-year-old daughter reported that Anthony left on his motorcycle around 9:00 a.m. Anthony was headed toward a coworker’s house in a nearby suburb, and apparently stopped at a café and also spoke to a county sheriff to get directions on his way. Anthony stayed at the coworker’s house for about a half hour, did not have any alcohol, and the friend reported that Anthony did not seem intoxicated. Anthony next drove to his brother-in-law’s house in another nearby town. Anthony stayed there for about a half hour and, according to the brother-in-law, was in a good mood and did not seem any louder than normal. Anthony’s nephew reported that during the visit, Anthony did not smell of alcohol, was not slurring his [758]*758speech, and walked normally. Both the coworker and the brother-in-law felt that Anthony’s purpose in visiting was to show them the Harley Davidson motorcycle that he had purchased earlier in the year.

Shortly after leaving his brother-in-law’s house, Anthony was in a fatal traffic accident. Witnesses indicated that he seemed to be playing “follow the leader” with another motorcycle and possibly a Saturn vehicle by weaving in and out of traffic for approximately six miles. At the time of the accident, Anthony was not wearing a helmet, and witnesses estimated the speed of the weaving vehicles to be, at times, around 90 miles per hour. Witnesses noted that there was a curve in the road where the accident occurred, and that there was a “soft” or gravel shoulder at the curve. One of the eyewitnesses to the accident opined that Anthony simply “couldn’t make the curve.” The same witness noted that the driver of the Saturn also nearly lost control at the same curve. Toxicology reports indicated that Anthony’s blood alcohol content (“BAC”) was over .20.

Anthony had two prior driving under the influence (“DUI”) convictions, although the most recent DUI occurred ten years earlier in 1997. He was a motorcycle enthusiast and had even built his own motorcycle from parts. Anthony had been to the Sturgis, South Dakota, motorcycle rally earlier in 2007, and planned to return in a few years. Also, he and Dawn were planning a trip to Las Vegas in December 2007 to celebrate Dawn’s birthday.

When Dawn submitted a claim for accidental death benefits, LINA denied benefits, based upon its position that Anthony’s death was not a “covered accident” because it was foreseeable due to his intoxicated state at the time of the crash. Dawn appealed the denial, but LINA affirmed the denial of benefits. Dawn filed this ERISA action challenging the denial, and LINA removed the case to district court.

Following the parties’ cross-motions for summary judgment, the district court remanded the matter to the insurer for further proceedings, finding that LINA had employed an unreasonable definition of the term “accident” in denying coverage. The court ordered LINA to determine on remand whether Anthony’s death resulted from an “accident” as defined by Wickman v. Northwestern Nat’l Ins. Co., 908 F.2d 1077, 1088 (1st Cir.1990).2 Upon remand, both parties submitted expert reports, and Dawn submitted affidavits regarding Anthony’s behavior on the morning in question. Following consideration of these materials, and heavily relying upon the report of its expert, Dr. Berman, LINA again decided Anthony’s death was [759]*759not a covered accident. Dawn again appealed this determination to the district court. Upon cross-motions for summary judgment, the district court ruled in favor of Dawn, finding that LINA abused its discretion by applying an unreasonable interpretation of the term “accident” as defined by Wickman. The court found that LINA did not reasonably analyze Anthony’s subjective expectations on the morning of the accident. The district court also awarded attorney fees, in the amount of $134,088.50, and $26,384.11 in prejudgment interest. LINA appeals, arguing its decision to deny benefits was not an abuse of discretion, and that attorney fees were either unwarranted or excessive. The amount of the interest award was not appealed.

II. DISCUSSION

A. Standard of Review

We review the district court’s adjudication of this claim de novo, applying the same standard of review to the plan administrator’s decision as the district court. Manning v. Am. Republic Ins. Co., 604 F.3d 1030, 1038 (8th Cir.), cert. denied, — U.S. -, 131 S.Ct. 648, 178 L.Ed.2d 480 (2010). When an ERISAqualified employee benefit plan grants the plan administrator the discretion to determine whether a claimant is eligible for benefits, review of the administrator’s decision is for an abuse of discretion. Carrow v. Standard Ins. Co., 664 F.3d 1254, 1258 (8th Cir.2012). In reviewing LINA’s interpretation of its plan language, we generally examine the following factors: (1) whether the interpretation is consistent with the goals of the plan; (2) whether it renders any language in the plan meaningless or internally inconsistent; (3) whether it conflicts with the substantive or procedural requirements of ERISA; (4) whether LINA has interpreted the provisions at issue here consistently; and (5) whether the interpretation is contrary to the clear language of the plan. Finley v. Special Agents Mut. Benefit Ass’n,

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679 F.3d 755, 53 Employee Benefits Cas. (BNA) 2421, 2012 WL 1868782, 2012 U.S. App. LEXIS 10466, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcclelland-v-life-insurance-co-of-north-america-ca8-2012.