McNinch v. The Guardian Life Insurance Company of America

CourtDistrict Court, N.D. Illinois
DecidedFebruary 14, 2022
Docket1:19-cv-02305
StatusUnknown

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

Bluebook
McNinch v. The Guardian Life Insurance Company of America, (N.D. Ill. 2022).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION

TERANCE MCNINCH and PEGGY MCNINCH,

Plaintiffs, Case No. 19-cv-2305

v. Judge Mary M. Rowland

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA,

Defendant.

MEMORANDUM OPINION AND ORDER This case arises from the tragic death of Jason McNinch, a former Chicago resident and employee at the Museum of Contemporary Art. After his death due to the toxic combination of cocaine and fentanyl in 2017, his parents, Plaintiffs Terance and Peggy McNinch, attempted to obtain accidental death benefits pursuant to Jason’s employee welfare benefit plan under which Jason named them co- beneficiaries. After Defendant, The Guardian Life Insurance Company of America, denied benefits and a subsequent appeal, Plaintiffs brought suit in this Court pursuant to the Employee Retirement Income Security Act of 1974 (ERISA) seeking de novo review of Defendant’s coverage denial. The parties have cross-moved for judgment under Federal Rule of Civil Procedure 52(a). For the reasons explained herein, this Court grants Defendant’s motion [76], denies Plaintiffs’ motion [74], and directs the Clerk to enter judgment in Defendant’s favor. I. Standard of Review A. ERISA ERISA authorizes participants of employee benefit plans to sue to recover benefits due under the terms of those plans. Fontaine v. Metro. Life Ins. Co., 800 F.3d

883, 886 (7th Cir. 2015) (citing 29 U.S.C. § 1132(a)(1)(B)). Courts review a denial of benefits challenge under ERISA de novo “unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989); see also Dorris v. Unum Life Ins. Co. of Am., 949 F.3d 297, 303 (7th Cir. 2020); Black v. Long Term Disability Ins., 582 F.3d 738, 743 (7th Cir. 2009). This Court has already determined that the de novo standard applies in this case. [25].

Under the de novo standard, district courts do not actually “review[ ] anything.” Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640, 643 (7th Cir. 2007). Rather, this Court must make an “independent decision” about an employee’s entitlement to benefits and come to an “independent decision” on both the legal and factual issues presented. Id. In other words, “what happened before the plan administrator is irrelevant in a de novo review case.” Dorris, 949 F.3d at 304; see also

Marantz v. Permanente Med. Grp., Inc. Long Term Disability Plan, 687 F.3d 320, 328 (7th Cir. 2012) (noting that any “procedural foibles” the insurer “may have made are irrelevant on appeal”). B. Rule 52 The parties have cross-moved for judgment on the papers and without a hearing pursuant to Federal Rule of Civil Procedure 52(a). This procedure “is essentially a trial on the papers, and is well-suited to ERISA cases in which the court reviews a closed record.” Fontaine, 800 F.3d at 885–86 (internal citation omitted). Because the court serves as the trier of fact under Rule 52(a), the court must “find

the facts specially and state its conclusions of law separately.” Fed. R. Civ. P. 52(a)(1); see Arpin v. United States, 521 F.3d 769, 776 (7th Cir. 2008) (“When a federal judge is the trier of fact, he, unlike a jury, is required to explain the grounds of his decision.”). In other words, this Court must “explain the grounds” of its decision and provide a “reasoned, articulate adjudication.” Alice F. v. Health Care Serv. Corp., 367 F. Supp. 3d 817, 822 (N.D. Ill. 2019) (quoting Arpin v. United States, 521 F.3d 769,

776 (7th Cir. 2008)). II. Findings of Fact The following findings of fact come from the parties’ proposed findings of fact and conclusions of law [75] [77], their responses to the opposing party’s findings of fact and conclusions of law [78] [80], and the joint appendix [71]. A. Jason McNinch and the Plan Jason McNinch was born on May 31, 1973 and died in October 2017. [71-3] at 23. Plaintiffs Terance McNinch and Peggy McNinch are Jason’s parents. Id.

From October 1, 2012 until his death in October 2017, Jason worked as an information technology audiovisual (IT AV) manager at the Chicago Museum of Contemporary Art in Chicago, where he kept a normal schedule of forty hours per week, Monday through Friday. Id. at 26; [77] ¶ 14. As a Museum employee, Jason participated in the Museum’s employee welfare benefit plan—the Museum of Contemporary Art Class 0001 AD&D, Optional Life, Dental, LTD, Life, STD, Vision, Voluntary AD&D (the Plan). [77] ¶¶ 14, 15. Defendant Guardian insured the Plan via Group Policy No. G-00483436; Guardian also served as the Plan’s Claim Fiduciary. Id. ¶ 16.

The Plan provided basic term life insurance coverage to Jason in the amount of $50,000, which Defendant paid to Plaintiffs in February 2018. Id. ¶ 17. The Plan also provided basic accidental death and dismemberment insurance coverage (AD&D) for specifically defined covered losses, including death. Id. ¶ 18. Specifically, the Plan states: We’ll pay the benefits described below if you suffer an irreversible covered loss due to an accident that occurs while you are insured. The loss must be a direct result of the accident, independent of disease or bodily infirmity. And, it must occur within 365 days of the date of the accident.

[71-1] at 63. The maximum benefit for AD&D coverage amounted to $50,000. [77] ¶ 19. Certain exclusions apply to the accidental death coverage; relevant here, the Plan lays out a voluntary use exclusion as follows: We won’t pay for any loss caused . . .

by your voluntary use of a controlled substance, unless: (1) it was prescribed for you by a doctor; and (2) it was used as prescribed. A controlled substance is anything called a controlled substance in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as amended from time to time.

[71-1] at 65. Jason named his parents, the Plaintiffs, as co-beneficiaries of his accidental death benefits. [77] ¶ 22. B. Jason’s Death In the week leading up to his death, Jason took a scheduled vacation, from October 25 to October 30, 2017. [75] ¶ 3; [77] ¶ 1. According to the Medical Examiner case report (M.E. report), on October 31, 2017, at 4:56 p.m., a Chicago police officers conducted a wellness check at Jason’s home in Chicago after a co-worker called 9-1-1 because Jason had not shown up to

work. [71-4] at 139. Once the officers entered Jason’s home, they found him unresponsive on a bed. Id. Jason was pronounced dead after EMS arrived on the scene. Id. The M.E. report states that “it is unknown when” Jason “was last known to be alive.” Id. The report also notes that Jason’s body was “decomposed,” that there “was no trauma or foul play” and “no illicit drugs or paraphernalia on the scene.” Id.

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Bluebook (online)
McNinch v. The Guardian Life Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcninch-v-the-guardian-life-insurance-company-of-america-ilnd-2022.