Spillers v. Webb

979 F. Supp. 494, 1997 U.S. Dist. LEXIS 19898, 1997 WL 594985
District Court, S.D. Texas·Decided August 1, 1997·No. Civil Action No. H-96-1107·Published·Cited by 1 cases

Opinion

ORDER

GILMORE, District Judge.

Before the Court is Defendant’s Motion for Summary Judgment. (Instrument No. 39). After review of the submitted papers and applicable law, the Court finds that Defendant’s motion should be GRANTED in part and DENIED in part.

I.

Plaintiff Devin Spillers brings this ERISA action against Defendant Linda Marie Webb, Administrator of Leasing Services, Inc. Occupational Injury Benefit Plan.

According to the parties’ undisputed submissions, Plaintiff began working for Leasing Services, Inc. (“LSI”) in March of 1992 as a modular furniture installer. On or about May 11,1992, Plaintiff reported to his supervisor that he had injured his back while lifting a furniture unit.

Following the May 11,1992 incident, Plaintiff filed for and began receiving benefits under the ERISA employee welfare benefit plan maintained by LSI, the Leasing Services, Inc. Occupational Injury Benefit Plan (the “Plan”). The Plan does not provide occupational disability benefits for an injury caused by, contributed to, or the result of a pre-existing medical condition. On June 15, 1992, Defendant Webb determined that Plaintiff was not eligible for Plan benefits because his injury was caused by, contribuí[496] ed to, or the result of a pre-existing medical condition.

Plaintiff filed a state court action on August 28, 1992 against LSI and two other corporations claiming entitlement to benefits under the Texas Workers’ Compensation Act. Plaintiff also pursued negligence claims against the corporations. Following trial in January of 1995, the state court ordered a take-nothing judgment against Plaintiff. Spillers v. Move Solutions, Inc., No. 92-38058 (113th Dist. Ct., Harris County, Tex. Mar. 1, 1995) (attached as Exhibit D1 to Defendant’s motion, Instrument No. 39). The Court entered Findings of Fact and Conclusions of Law stating that Plaintiff was not entitled to damages from LSI for the alleged May 11, 1992 injuries. Spillers v. Move Solutions, Inc., No. 92-38058 (113th Dist. Ct., Harris County, Tex. May 1, 1995) (attached as Exhibit D2 to Defendant’s motion, Instrument No. 39).

In January of 1995, Plaintiff requested that Defendant Webb reconsider the June 1992 decision to deny Plaintiff medical and occupational disability benefits. After review of the prior determination, Defendant decided not to reinstate Plan benefits.

Plaintiff originally filed this action in state court in February of 1996, and Defendant removed to this Court. Plaintiff seeks to recover Plan benefits and to clarify rights to future Plan benefits pursuant to 29 U.S.C. § 1132(a). (Second Amended Complaint, Instrument No. 31, at 4). Plaintiff also seeks statutory penalties for Defendant’s alleged failure to comply with requests for information regarding rights under the Plan. Finally, Plaintiff asserts claims for violations of the Texas Insurance Code and breach of fiduciary duty.

Defendant’s summary judgment motion addresses all of Plaintiffs claims.

II.

Summary judgment is appropriate if no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56. A fact is “material” if its resolution in favor of one party might affect the outcome of the suit under governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248,106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986). An issue is “genuine” if the evidence is sufficient for a reasonable jury to return a verdict for the nonmoving party. Anderson, 477 U.S. at 248,106 S.Ct. at 2510. If the evidence rebutting the motion for summary judgment is only colorable or not significantly probative, summary judgment should be granted. Anderson, All U.S. at 249-50, 106 S.Ct. at 2511; see Lewis v. Glendel Drilling Co., 898 F.2d 1083,1088 (5th Cir.1990).

Under Fed.R.Civ.P. 56(c), the moving party bears the initial burden of informing the district court of the basis for its belief that there is an absence of a genuine issue for trial, and for identifying those portions of the record that demonstrate such absence. Matsushita Elec. Ind. Co. v. Zenith Radio Corp., 475 U.S. 574, 584-88,106 S.Ct. 1348,1355-56, 89 L.Ed.2d 538 (1986); Leonard v. Dixie Well Serv. & Supply, Inc., 828 F.2d 291, 294 (5th Cir.1987).

Where the moving party has met its Rule 56(c) burden, the nonmovant “must do more than simply show that there is some metaphysical doubt as to the material facts ... [T]he nonmoving party must come forward with ‘specific facts showing that there is a genuine issue for trial. ’ ” Matsushita, 415 U.S. at 586, 106 S.Ct. at 1356 (quoting Fed. R.Civ.P. 56(e)) (emphasis in original); Celotex Corp. v. Catrett, All U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986); Leonard, 828 F.2d at 294. To sustain the burden, the nonmoving party must produce evidence admissible at trial. Anderson, All U.S. at 255-57, 106 S.Ct. at 2514; Thomas v. Price, 975 F.2d 231, 235 (5th Cir.1992) (“To avoid a summary judgment, the nonmoving party must adduce admissible evidence which creates a fact issue----”).

III.

Section 502(a)(1)(B) of ERISA provides a private cause.of action to recover benefits due under an employee benefit plan, either to enforce rights or to clarify rights to future benefits. 29 U.S.C. § 1132(a)(1)(B); ERISA Comprehensive Guide § 7.2, (Martin Wald & David E. Kenty eds., 1991). Private plain[497] tiffs also may recover statutory penalties under 29 U.S.C. § 1132(a)(1)(A).

A. Plaintiff’s ERISA claim for denial of benefits.

Defendant asserts entitlement to summary judgment on Plaintiffs ERISA claim for wrongful denial of benefits because (1) a person with a preexisting condition cannot receive benefits under the Plan, (2) Plaintiff is collaterally estopped on the issue of preexisting condition because of previous state court proceedings, and (3) Defendant’s decision to deny benefits was not arbitrary or capricious.

1. Standard of review.

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Spillers v. Webb, 979 F. Supp. 494, 1997 U.S. Dist. LEXIS 19898, 1997 WL 594985 (S.D. Tex. 1997).

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