O'Neal v. Life Insurance Co. of North America

10 F. Supp. 3d 1132, 58 Employee Benefits Cas. (BNA) 1825, 2014 U.S. Dist. LEXIS 43936, 2014 WL 1309115
CourtDistrict Court, D. Montana
DecidedMarch 29, 2014
DocketNo. CV 12-80-H-CCL
StatusPublished
Cited by5 cases

This text of 10 F. Supp. 3d 1132 (O'Neal v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, D. Montana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
O'Neal v. Life Insurance Co. of North America, 10 F. Supp. 3d 1132, 58 Employee Benefits Cas. (BNA) 1825, 2014 U.S. Dist. LEXIS 43936, 2014 WL 1309115 (D. Mont. 2014).

Opinion

CHARLES C. LOVELL, Senior District Judge.

This action is brought pursuant to § 502(a) of the Employers Retirement and Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), which is a “comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans.” See Shaw v. Delta Air Lines, 463 U.S. 85, 90-91, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983). Plaintiffs Amended Complaint seeks review of Defendant’s denial of an $83,000.00 accidental death insurance benefit. Before the Court are cross-motions for summary judgment. The parties having stipulated [1135]*1135that the case shall be decided by “de novo review by the Court on cross-motions for summary judgment based on the administrative record” (see Doc. 12, ¶ 2), the Court finds that the matter is suitable for determination without a hearing.

Background.

Plaintiff Julia E. O’Neal (“O’Neal”) is the beneficiary of an accident insurance policy made available to her son through the Helmerich & Payne, Inc. (“H & P”) employee benefit plan. Defendant Life Insurance Company of North America (“LINA”) issued the group accident insurance policy to H & P. Plaintiff O’Neal is the mother of Reece E. Cape (“Cape”), who was employed by H & P at the time of his death in an automobile crash. After her claim was denied by the LINA, O’Neal appealed administratively and has therefore exhausted her administrative remedies. The group policy issued by LINA does not grant LINA discretion to construe plan provisions or interpret plan terms. The parties therefore have agreed that a de novo standard of review applies in this action.

Legal Standards.

Summary Judgment.

The moving party must inform the court of the basis for the motion for summary judgment. Celotex Corp. v. Catrett, 477 U.S. 317, 823, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Summary judgment should be granted if the moving party demonstrates that “there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” Rule 56(C), Fed.R.Civ.P. Once this initial burden is met, the opposing party must “go beyond the pleadings” and “set forth specific facts showing that there is a genuine issue for trial.” Celotex Corp., 477 U.S. at 322, 106 S.Ct. at 2552 (internal quotes omitted). “If a party fails to properly support an assertion of facts or fails to properly address another party’s assertion of fact as required by Rule 56(c), the court may ... consider the fact undisputed for purposes of the motion.... ” Rule 56(e)(2). “[A] party cannot manufacture a genuine issue of material fact merely by making assertions in its legal memoranda.” S.A. Empresa De Viacao Aerea Rio Grandense (Varig Airlines) v. Walter Kidde & Co., 690 F.2d 1235, 1238 (9th Cir.1982).

“On summary judgment, the proper task is not to weigh conflicting evidence, but rather to ask whether the non-moving party has produced sufficient evidence to permit the fact finder to hold in his favor.” Ingram v. Martin Marietta Long Term Disability Income Plan for Salaried Employees of Transferred GE Operations, 244 F.3d 1109, 1114 (9th Cir.2001). Because there is no right to jury trial in ERISA cases, a bench trial, confined to the administrative record, before a district judge who has already ruled on summary judgment would be “little more than a formality.” Id. at 1114. At a bench trial, the district court can admit additional evidence if “circumstances clearly establish that [it] is necessary to conduct an adequate de novo review of the benefit decision.” Id. (quoting Mongeluzo, 46 F.3d at 944). In this case, however, neither party gives any indication of having any additional evidence to offer. Indeed, both parties seek summary judgment on the existing administrative record and assert there are no genuine issues of material fact.

Review of denial of ERISA benefits.

It is undisputed that the de novo standard of review applies because H & P’s ERISA-government employee benefit plan does not give the administrator “discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” See Firestone Tire & Rubber [1136]*1136Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Under de novo review, “[t]he court simply proceeds to. evaluate whether the plan administrator correctly or incorrectly denied benefits.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir.2006). The court must weigh the evidence to determine what is most persuasive. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir.1999). The Court applies federal common law to interpret an insurance policy under ERISA. Id. at 110, 109 S.Ct. 948; Shaw v. Delta Air Lines, Inc., 463 U.S. 85, 98, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983) (federal common law of ERISA preempts state law for purposes of plan interpretation). Under the federal common law, terms of insurance policies are to be interpreted “in an ordinary and popular sense as would a person of average intelligence and experience.” Babikian v. Paul Revere Life Ins. Co., 63 F.3d 837, 840 (9th Cir.1995) (internal quotations omitted). Terms that are not defined by the plan (and other ambiguities) are to be construed against the drafter of the plan. See Patterson v. Hughes Aircraft Co., 11 F.3d 948, 950 (9th Cir.1993). A term is ambiguous if it can reasonably be interpreted to have more than one meaning and the proper interpretation is not demonstrated by the contract itself. Bjomstad v. Senior American Life Ins. Co., 599 F.Supp.2d 1165, 1170 (D.Ariz.2009) (citing J.D. Land Co. v. Killian, 158 Ariz. 210, 762 P.2d 124, 126 (1988)).

The claimant seeking to clarify a right to benefits under the terms of the plan carries the burden of proof, and she must establish her entitlement by a preponderance' of the evidence. See Muniz v. Amec Const. Management, Inc., 623 F.3d 1290, 1294 .(9th Cir.2010) (citing Horton v. Reliance Standard Life Ins. Co.,

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10 F. Supp. 3d 1132, 58 Employee Benefits Cas. (BNA) 1825, 2014 U.S. Dist. LEXIS 43936, 2014 WL 1309115, Counsel Stack Legal Research, https://law.counselstack.com/opinion/oneal-v-life-insurance-co-of-north-america-mtd-2014.