United States District Court, D. Colorado
ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY
JUDGMENT AND DENYING PLAINTIFF’S MOTION FOR SUMMARY
CHRISTINE M. ARGUELLO UNITED STATES DISTRICT JUDGE.
matter is before the Court on Defendant Liberty Life
Assurance Company of Boston’s Motion for Summary
Judgment or, in the Alternative, Motion for Judgment on the
Record (Doc. # 57) and Plaintiff’s Motion for Summary
Judgment Pursuant to Fed.R.Civ.P. 56 (Doc. # 59). Both
motions have been fully briefed. (Doc. ## 61, 62, 65, 73,
76.) Based on the following reasons, the Court grants
Defendant’s Motion and denies Plaintiff’s Motion.
life insurance dispute arises out of a motorcycle collision
that resulted in the death of Plaintiff Wanika Howell’s
son, Joel McClain (“Decedent”). On December 13,
2015, Decedent was operating a motorcycle headed eastbound on
Sunrise Highway in Merrick, New York. (Doc. # 24-1 at 45.) As
Decedent approached the intersection of Sunrise Highway and
Hewlett Avenue, a Lexus SUV traveling westbound on Sunrise
Highway began to make a left turn onto Hewlett Avenue.
Decedent collided with the SUV at a right angle and sustained
fatal injuries as a result.
described Decedent traveling at a high rate of speed
immediately before the collision. See, e.g.,
(id. at 63). Additionally, Decedent did not have a
valid license to operate a motorcycle, and the registration
plate displayed on the motorcycle had been issued for a
different vehicle. After investigating the incident,
Detective Gary T. Ferrucci concluded, inter alia,
that “[o]peration of this vehicle by [Decedent] [was]
neither reasonable nor prudent . . . .” (Id.
at 48.) Detective Ferrucci later stated that Decedent would
have been charged with reckless driving if he had survived
the collision. (Id. at 6.)
time of the collision, Decedent was insured as
Plaintiff’s dependent under a Group Life Insurance
Policy (“the Policy”), which Plaintiff had
purchased from Defendant through her employer’s
Employee Retirement Income Security Act (“ERISA”)
welfare plan. See 29 U.S.C. § 1001, et
seq. Defendant was the claims administrator, and
pursuant to the terms of the Policy, Defendant had “the
authority, in its sole discretion, to construe the terms of
[the Policy] and to determine benefit eligibility . . .
.” (Doc. # 24 at 51.)
Policy offered both life and accidental death and
dismemberment (“AD&D”) benefits. Plaintiff
filed claims for both types of benefits, and Defendant paid
Plaintiff’s life insurance claim in full. (Doc. # 24-1
at 132.) However, Defendant denied Plaintiff’s claim
for AD&D benefits.
Policy provides AD&D benefits when a covered dependent
“suffers a loss solely as the result of an accidental
injury that occurs while covered, ” but various
exclusions may preclude coverage if they apply to a claim.
(Doc. # 24 at 31.) Relevant here, the Policy indicates that
“[n]o benefits are payable for any loss that is
contributed to or caused by . . . committing or attempting to
commit a felony or misdemeanor . . . .” (Id.
at 46.) After conducting an investigation, Defendant
determined that the felony/misdemeanor exclusion applied to
Plaintiff’s claim because Decedent was driving
recklessly at the time of the collision, which is a
misdemeanor under New York law.
subsequently appealed the denial of AD&D benefits.
However, on September 5, 2017, Defendant informed Plaintiff
that it had considered Plaintiff’s appeal and
determined that the denial would be maintained. (Id.
at 12.) Defendant also informed Plaintiff of her right to
file a civil action challenging the adverse benefit
determination under section 502(a) of ERISA. (Id. at
15.) This lawsuit followed.
STANDARD OF REVIEW
both parties move for summary judgment in an ERISA case,
“summary judgment is merely a vehicle for deciding the
case; the factual determination of eligibility for benefits
is decided solely on the administrative record, and the
non-moving party is not entitled to the usual inferences in
its favor.” LaAsmar v. Phelps Dodge Corp. Life,
Accidental Death & Dismemberment and Dependent Life Ins.
Plan, 605 F.3d 789, 796 (10th Cir. 2010) (internal
quotation marks and citation omitted). As a preliminary
matter, however, the Court must determine the appropriate
standard to be applied to Defendant’s decision to deny
as here, a “benefit plan gives the administrator or
fiduciary discretionary authority to determine eligibility
for benefits or to construe the terms of the plan, ”
the decision is subject to an arbitrary and capricious
standard of review. Dardick v. Unum Life Ins. Co. of
Am., 739 Fed.Appx. 481, 485 (10th Cir. 2018) (quoting
DeGrado v. Jefferson Pilot Fin. Ins. Co., 451 F.3d
1161, 1167 (10th Cir. 2006)).
the arbitrary and capricious standard, the
administrator’s decision need not be the only logical
one or the best one; the decision will be upheld so long as
it is “grounded on any reasonable basis.”
Kimber v. Thiokol Corp., 196 F.3d 1092, 1098 (10th
Cir. 1999). Thus, reviewing courts “need only assure
that the administrator’s decision falls somewhere on a
continuum of reasonableness-even if on the low end.”
Nance v. Sun Life Assurance Co. of Canada, 294 F.3d
1263, 1269 (10th Cir. 2002). To determine if a decision falls
somewhere on a continuum of reasonableness, courts look for
“‘substantial evidence’ in the record to
support the administrator’s conclusion, meaning
‘more than a scintilla’ of evidence ‘that a
reasonable mind could accept as sufficient to support a
conclusion.’” Eugene S. v. Horizon Blue Cross
Blue Shield of N.J., 663 F.3d 1124, 1134 (10th Cir.
2011) (citation omitted).
“[i]n cases such as this one, where the same entity
serves as the administrator and payor, an inherent, dual-role
conflict of interest exists.” Loughray v.
Hartford Grp. Life Ins. Co., 366 Fed.Appx. 913, 923
(10th Cir. 2010) (citing Metro. Life Ins. Co. v.
Glenn, 554 U.S. 105, 108 (2008)). Nevertheless,
“[t]he existence of a dual-role conflict does
not alter the standard of review, but [courts] weigh
the conflict as one of many case-specific factors in
determining whether the administrator's decision was an
abuse of discretion.” Id. (emphasis added)
(citing Glenn, 554 U.S. at 115–16; Holcomb
v. Unum Life Ins. Co. of Am., 578 F.3d 1187, 1192 (10th