Weber v. Life Insurance Co. of North America

836 F. Supp. 2d 427, 2011 WL 6812814, 2011 U.S. Dist. LEXIS 148810
CourtDistrict Court, W.D. Virginia
DecidedDecember 28, 2011
DocketCase No. 6:11-cv-00032
StatusPublished
Cited by1 cases

This text of 836 F. Supp. 2d 427 (Weber v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, W.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weber v. Life Insurance Co. of North America, 836 F. Supp. 2d 427, 2011 WL 6812814, 2011 U.S. Dist. LEXIS 148810 (W.D. Va. 2011).

Opinion

MEMORANDUM OPINION

NORMAN K. MOON, District Judge.

This action arises out of the decision by Defendant Life Insurance Company of North America (“Defendant” or “LINA”) to deny benefits claimed by Plaintiff Catherine Weber (“Plaintiff” or “Ms. Weber”) under two Accidental Death and Dismemberment (“AD & D”) policies of insurance issued by LINA and carried by her deceased husband, Carl Weber (“Mr. Weber”). Plaintiff originally filed her complaint in this matter in the Circuit Court for the City of Lynchburg on August 10, 2011. Subsequently, on August 29, 2011, Defendant removed the case to this Court on the basis of both federal question jurisdiction and diversity jurisdiction. Plaintiff concedes that this Court has subject matter jurisdiction over her case. On November 15, 2011, Plaintiff filed a motion for declaratory judgment pursuant to Federal Rule of Civil Procedure 57. In turn, Defendant filed a motion for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). For the reasons that follow, I will deny Plaintiffs motion and grant Defendant’s motion.

I. Background

The factual allegations of Ms. Weber’s complaint, which the court must accept as true, are as follows. Prior to his death, Mr. Weber was employed by AREVA NP, Inc. (“AREVA”) in Lynchburg, Virginia. On August 21, 2010, Mr. Weber was riding as a passenger in a light-sport aircraft1 registered to and piloted by John Milhous (“Mr. Milhous”), having taken off from a private airstrip for a pleasure flight. At approximately 6:49 P.M., the aircraft crashed in a pasture in Amherst County, killing both Mr. Weber and Mr. Milhous instantly. Mr. Weber, as an employee of AREVA, was a policyholder of two AD & D policies (“the Policies”) issued by LINA. Ms. Weber claims that together, the Policies provide $250,000 in accidental death benefits payable to her as the surviving beneficiary. One policy (the “Basic” policy) was made available to Mr. Weber by AREVA paying the premium for the AD & D benefit. It provided an AD & D benefit of $150,000. The other policy (the “Supplemental” policy) had the premiums paid by a payroll deduction from Mr. Weber’s salary. It provided an AD & D benefit of $100,000.

Following Mr. Weber’s demise, Ms. Weber filed the requisite claim form with AREVA, requesting benefits as the surviving beneficiary under the Policies. On September 24, 2010, LINA completed its investigation and denied Ms. Weber’s claim. Thereafter, Ms. Weber retained counsel to appeal LINA’s denial of benefits. After an administrative review in accordance with the Policies’ terms, LINA again denied Ms. Weber’s request for benefits on or about March 23, 2011.2 According to Ms. Weber, LINA’s denial of benefits is based on an exclusion contained in the “Common Exclusions” sections of both policies. Specifically, Common Exclusion 6(a) states that benefits under the policy will not be paid for any “Covered Injury” or “Covered Loss” which is caused by or results from:

[430]*4306. flight in, boarding or alighting from an Aircraft or any craft designed to fly above the Earth’s surface:
a. except as a passenger on a regularly scheduled commercial airline;

In her complaint, Ms. Weber alleges that the remaining terms in paragraph 6 of the Common Exclusions — that is, subparagraphs (b) through (g) — render that paragraph ambiguous. Further, Ms. Weber contends that this ambiguity should be resolved against LINA, the drafter of the Policies, and in favor of coverage rather than denial of benefits. Accordingly, in her complaint, Ms. Weber seeks an order pursuant to the Declaratory Judgment Act, 28 U.S.C. § 2201, declaring that the language in the Common Exclusions is ambiguous and that the internal conflicts it produces be construed in favor of coverage. In that vein, Ms. Weber also seeks an order requiring LINA to pay her the AD & D benefit under each of the Policies. Finally, Ms. Weber requests an award of costs and attorney’s fees., After filing an answer, LINA filed a motion for judgment on the pleadings in which it seeks an order granting judgment in its favor on the ground that coverage is unambiguously excluded under Common Exclusion 6 found in both of the Policies.

II. Motion for Judgment on the Pleadings Standard

A motion for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c) requires the Court to apply the same standard that is applied when ruling on a motion to dismiss pursuant to Rule 12(b)(6). Burbach Broad. Co. v. Elkins Radio Corp., 278 F.3d 401, 405-06 (4th Cir.2002); Edwards v. City of Goldsboro, 178 F.3d 231, 243 (4th Cir.1999). In considering a motion to dismiss under Rule 12(b)(6) or Rule 12(c), the Court must assume that the allegations in the non-moving party’s pleadings are true and construe all facts in the light most favorable to the non-moving party. Republican Party of N.C. v. Martin, 980 F.2d 943, 952 (4th Cir.1992). Legal conclusions in the guise of factual allegations, however, are not entitled to a presumption of truth. Ashcroft v. Iqbal, 556 U.S. 662, 129 S.Ct. 1937, 1950-51, 173 L.Ed.2d 868 (2009). Although a complaint “does not need detailed factual allegations, a plaintiffs obligation to provide the grounds of his entitle[ment] to relief requires more than labels and conclusions, and a formulaic recitation of a cause of action’s elements will not do.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (citations and quotations omitted). Thus, “[fjactual allegations must be enough to raise a right to relief above the speculative level.” Id.

In sum, a plaintiff must allege “enough facts to state a claim to relief that is plausible on its face.” Id. at 570, 127 S.Ct. 1955. Consequently, “only a complaint that states a plausible claim for relief survives a motion to dismiss.” Iqbal, 129 S.Ct. at 1950 (citing Twombly, 550 U.S. at 556, 127 S.Ct. 1955). If, after accepting all well-pleaded allegations in the plaintiffs favor, it appears that the plaintiff cannot prove any set of facts in support of his claim entitling him to relief, a motion to dismiss — or, in this case, a motion for judgment on the pleadings — should be granted. Edwards, 178 F.3d at 244.

III. Discussion

A. ERISA and the Applicable Standard of Review

Prior to oral argument in this matter, there was a dispute between the parties with respect to whether the Policies at issue qualify as employee welfare benefit plans and, as a result, whether they fall within the reach of the Employee Retirement Income Security Act of 1974

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Bluebook (online)
836 F. Supp. 2d 427, 2011 WL 6812814, 2011 U.S. Dist. LEXIS 148810, Counsel Stack Legal Research, https://law.counselstack.com/opinion/weber-v-life-insurance-co-of-north-america-vawd-2011.