Tran v. United of Omaha Life Insurance

780 F. Supp. 2d 965, 2011 U.S. Dist. LEXIS 10032, 2011 WL 335587
CourtDistrict Court, D. Nebraska
DecidedJanuary 31, 2011
Docket4:10CV3128
StatusPublished
Cited by2 cases

This text of 780 F. Supp. 2d 965 (Tran v. United of Omaha Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Nebraska primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tran v. United of Omaha Life Insurance, 780 F. Supp. 2d 965, 2011 U.S. Dist. LEXIS 10032, 2011 WL 335587 (D. Neb. 2011).

Opinion

*967 MEMORANDUM AND ORDER

RICHARD G. KOPF, District Judge.

The plaintiff, Dung Tran (“Tran”), is a beneficiary under a group life and accidental death and dismemberment insurance policy that the defendant, United of Omaha Life Insurance Company (“United of Omaha”), issued to Lester Electrical of Nebraska, Inc. (“Lester Electrical”). Tran’s nephew, Huy Nguyen (“Nguyen”), was insured under the policy as an employee of Lester Electrical, and he named Tran as his sole beneficiary. Nguyen was killed when he drove his car around a lowered cross-arm at a railroad crossing in Lincoln, Nebraska, and was struck by a train. United of Omaha paid Tran the life insurance benefits under the policy but denied coverage for accidental death benefits. The denial was based on a determination that Nguyen was driving while intoxicated and under the influence of controlled drugs.

Tran appealed the claim denial in accordance with the procedure specified in the policy, but when that was unsuccessful he brought suit against United of Omaha in the County Court of Lancaster County, Nebraska. The action was removed to this court on the basis of federal question jurisdiction. There is no dispute that the group insurance policy was an employee benefit plan governed by the Employee Retirement Income and Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., and therefore the action effectively is brought under 29 U.S.C. § 1132(a)(l)(B)(providing that “[a] civil action may be brought ... by a participant or beneficiary ... to recover benefits due to him under the terms of his plan[.]”).

The matter is submitted to the court on cross-motions for summary judgment based solely on evidence contained in the administrative record that was developed by United of Omaha (filing 15, hereinafter designated as “AR”). 1 Although lacking an index and not authenticated, the administrative record appears to include a copy of the insurance policy (AR at 1-69), written correspondence (AR at 70-76, 78, 80-87, 89-91, 93, 110), notes (AR at 88, 92, 111), Tran’s claim for benefits (AR at 94-97), Nguyen’s application for insurance (AR at 98-99), a motor vehicle accident report (AR at 100-101), an autopsy report with attached forensic toxicology report (AR at 102-108), a death certificate (AR at 109), and internal emails (AR 77, 79, 112-114).

The evidence indicates that Lester Electrical is the plan administrator, but that United of Omaha has discretionary authority to construe the terms of the insurance policy and to determine eligibility for benefits. Thus, the summary plan description states:

By purchasing this Policy, the policyholder [Lester Electrical] grants us [United of Omaha] the discretion and the final authority to construe and interpret the Policy. This means that we have the authority to decide all questions of eligibility and all questions regarding the amount and payment of any Policy benefits within the terms of the policy as interpreted by us...: Our interpretation of the Policy as to the amount of benefits and eligibility shall be binding and conclusive on all persons.

(AR at 67.)

The parties are in agreement that the foregoing provision requires the court to apply a deferential abuse-of-discretion standard in reviewing United of Omaha’s decision to deny Tran’s claim for *968 accidental death benefits. See McKeehan v. Cigna Life Ins. Co., 344 F.3d 789, 792 (8th Cir.2003) (“In reviewing the denial of ERISA benefits, the reviewing court applies a deferential abuse-of-discretion standard if the plan ‘gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.’ ”) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)); Parkman v. Prudential Ins. Co. of America, 439 F.3d 767, 772 (8th Cir.2006) (“A plan gives the administrator or fiduciary discretionary authority if it contains explicit discretion-granting language.”). Under this standard, the court may only reverse a decision to deny ERISA benefits if the decision is “arbitrary and capricious.” Jackson v. Prudential Ins. Co. of America, 530 F.3d 696, 701 (8th Cir.2008). When a plan administrator or fiduciary “offers a reasonable explanation for its decision, supported by substantial evidence, it should not be disturbed.” Id. (quoting Ratliff v. Jefferson Pilot Fin. Ins. Co., 489 F.3d 343, 348 (8th Cir.2007)). “Substantial evidence ‘means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’ ” Ratliff, 489 F.3d at 346 (quoting McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 924 (8th Cir.2004)). The discretionary decision of a plan administrator or fiduciary “is not unreasonable merely because a ‘different, reasonable interpretation could have been made.’ ” Id. at 348 (quoting Parkman, 439 F.3d at 773). However, when an insurer both evaluates claims for ERISA benefits and pays granted claims, a conflict of interest exists which may be relevant in determining whether the insurer abused its discretion in denying a claim. See Jones v. Unum Provident Corp., 596 F.3d 433, 438 (8th Cir.2010); Chronister v. Unum Life Ins. Co. of America, 563 F.3d 773, 775 (8th Cir.2009); Metropolitan Life Ins. Co. v. Glenn, 554 U.S. 105, 112-15, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008).

According to the motor vehicle accident report prepared by the investigating officer from the Lincoln Police Department, the car-train collision occurred at 5:56 a.m. on November 11, 2009. Witnesses stated that Nguyen drove his car around another vehicle which was stopped at the railroad crossing and then proceeded into the crossing at between five to ten miles per hour. The cross-arms and flashing red warning lights at the crossing were activated and working, and the approaching Amtrak train was blowing its whistle. Nguyen was pronounced dead at the scene. (AR at 100-01.)

An autopsy performed at the Douglas County Morgue 2

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Cite This Page — Counsel Stack

Bluebook (online)
780 F. Supp. 2d 965, 2011 U.S. Dist. LEXIS 10032, 2011 WL 335587, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tran-v-united-of-omaha-life-insurance-ned-2011.