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Morris v. Southern Intermodal Xpress

United States District Court, S.D. Alabama, Southern Division

September 14, 2017

DAVID MORRIS, Plaintiff,
v.
SOUTHERN INTERMODAL XPRESS; ASSURANT EMPLOYEE BENEFITS; UNION SECURITY INSURANCE COMPANY, Defendants.

          ORDER

          CALLIE V. S. GRANADE SENIOR UNITED STATES DISTRICT JUDGE.

         This matter is before the Court on a motion for judgment on the record and brief in support filed by Defendant Union Security Insurance Company (“Union Security”).[1] (Doc. 43; Doc. 44). Plaintiff David Morris (“Mr. Morris”) filed a response in opposition. (Doc. 46). Upon de novo review of the administrative record in this matter, the Court cannot say that Union Security's claim-denial is wrong because Mr. Morris's dependent life insurance coverage for Gwendolyn Morris (“Ms. Morris”) ended when their divorce was finalized, which occurred approximately two months prior to her death. Additionally, Union Security's claim-denial was reasonable for the same reason and made without a conflict of interest. Given this and as fully explained below, the Court grants Union Security's motion.

         I. FACTUAL AND PROCEDURAL BACKGROUND[2]

         Mr. Morris and Ms. Morris married January 11, 2003. (Doc. 44-2, p. 2). Mr. Morris began working for Southern Intermodal Xpress (“SIX”) April 4, 2011. (Doc. 44-6, p. 3). As part of Mr. Morris's employment benefits, SIX offered an employee group life insurance policy (“the Policy”), which Union Security issued and administered. See (Doc. 44-1, pp. 1-44). The Policy provided each employee with the opportunity to purchase life insurance for “covered dependents.” The Policy defined a “covered dependent” as an “eligible dependent” insured by Mr. Morris under the Policy. (Doc. 44-1, p. 6). Under the Policy, an “eligible dependent” included (1) Mr. Morris's “lawful spouse” and (2) Mr. Morris's “unmarried children from live birth but less than age 19, or less than 25 if a full-time student.” (Doc. 44-1, p. 18).

         A “covered dependent's” policy coverage ends when any of five events occur: (1) the Policy ends; (2) the Policy is “changed to end dependent insurance;” (3) “the dependent is no longer eligible;” (4) an employee's “insurance for the same coverage under the policy ends;” or (5) “a required contribution for dependent insurance” goes unpaid. (Doc. 44-1, p 19). Union Security reserved “sole discretionary authority to determine eligibility for participation or benefits and to interpret the terms of” the Policy. (Doc. 44-1, p. 39).

         At some point after he began work with SIX, Mr. Morris took out dependent life insurance coverage for Ms. Morris under the Policy. Mr. Morris and Ms. Morris separated sometime thereafter, and an Alabama court entered a judgment of divorce dissolving their marriage on September 24, 2015. (Doc. 44-3, p. 2); see also (Doc. 44-4, p. 2) (certificate of divorce). On November 21, 2015, Ms. Morris passed away from natural causes. (Doc. 44-5, p. 2).

         Following Ms. Morris's death, Mr. Morris filed a claim against the Policy for his dependent life insurance coverage of Ms. Morris. (Doc. 44-6, p. 2). Union Security, by way Assurant Employee Benefits, a trade name under which Union Security does business, denied Mr. Morris's claim because, among other reasons, Ms. Morris “was not an eligible dependent when her death occurred ….” (Doc. 44-7, p. 3). Mr. Morris appealed this determination per the Policy's appeals process. The appeal was also denied because, among other reasons, Ms. Morris's “coverage ended when she and Mr. Morris were divorced, ” which preceded her death. (Doc. 44-8, p. 4).

         Following denial of his appeal, Mr. Morris brought the present suit pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461. See (Doc. 1). As previously explained by the magistrate judge, Mr. Morris's Complaint does not specify what provision of ERISA he travels under. (Doc. 28, p. 4). But Mr. Morris does assert in the Complaint that “the acts complained of in this suit concern … failure to pay … the beneficiary proceeds pursuant to an ERISA policy” and that he “seek[s] death benefits as the named beneficiary for the life insurance policy invoked pursuant to the ERISA policy attached hereto.” (Doc. 1, pp. 2-3).

         SIX moved, pursuant to Federal Rule of Civil Procedure 12(b)(6), to be dismissed from this action. (Doc. 5). In deciding SIX's motion, the magistrate judge interpreted the Complaint as asserting a claim pursuant to 29 U.S.C. § 1132(a)(1)(B): “recover benefits due to [Mr. Morris] under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan ….” (Doc. 28, p. 4) (citing Jones v. Am. Gen. Life & Acc. Ins. Co., 370 F.3d 1065, 1069 (11th Cir. 2004) (“Section 502(a)(1)(B) empowers ERISA participants and beneficiaries to bring a civil action in order to recover benefits, enforce rights to benefits, or clarify rights to future benefits due under the terms of an ERISA-governed welfare plan. 29 U.S.C. § 1132(a)(1)(B)….”)) The magistrate judge recommended Mr. Morris's claim against SIX be dismissed but that Mr. Morris also be allowed an opportunity to amend his complaint as it pertained to SIX. (Doc. 28, p. 15). In reasoning that an opportunity to amend should be provided, the magistrate judge pointed to Mr. Morris's pro se status and explained, “The undersigned is not convinced it is outside the realm of possibility that [Mr.] Morris could state a valid § 132(a)(1)(B) ERISA claim against SIX, and at present there is no indication that [Mr.] Morris would not wish to do so.” (Doc. 28, p. 15). The undersigned adopted the magistrate judge's recommendations and allowed Mr. Morris until May 15, 2017, to file any amendment as to his claim against SIX. (Doc. 37). May 15, 2017, came and went without amendment by Mr. Morris.

         Now, Union Security moves for judgment on the record. Union Security contends judgment is proper because Ms. Morris was ineligible for coverage at the time of her death. (Doc. 44, p. 2). The entirety of Mr. Morris's substantive response to Union Security's motion is as follows: “The motion filed by Defendants does not address the civil action complaint of David Morris.” (Doc. 46, p. 1). The parties having stated their positions, this matter is ripe for consideration.

         II. ANALYSIS

         “ERISA permits a person denied benefits under an employee benefit plan to challenge that denial in federal court.” Lamb v. Hartford Life and Acc. Ins. Co., 862 F.Supp.2d 1342, 1349 (M.D. Ga. 2012) (citing 29 U.S.C. § 1132(a)(1)(B)). But the “standard of review [in the ERISA context] does not neatly fit under either Rule 52 or Rule 56 [of the Federal Rules of Civil Procedure], but it is a specially fashioned rule designed to carry out Congress's intent under ERISA.” Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 618 (6th Cir. 1998). ERISA claims-denial cases place the district court as more of “an appellate tribunal than as a trial court.” See Curran v. Kemper Nat. Servs., Inc., 2005 WL 894840, at *7 (11th Cir. 2005) (quoting Leahy v. Raytheon Co., 315 F.3d 11, 17-18 (1st Cir. 2002)). The court “does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary.” Id.; see also Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350, 1354 (11th Cir. 2011) (review of a plan administrator's denial of benefits is limited to consideration of the material available to the administrator at the time it made its decision). Thus, there “may indeed be unresolved factual issues evident in the administrative record, but unless the administrator's decision was wrong, or arbitrary and capricious, these issues will not preclude summary judgment as they normally would.” Pinto v. Aetna Life Ins. Co., 2011 WL 536443, at *8 (M.D. Fla. Feb. 15, 2011).

         Under ERISA, motions under Rule 52 or under Rule 56 “are nothing more than vehicles for teeing up ERISA cases for decision on the administrative record.” See Stephanie C. v. Blue Cross Blue Shield of Mass. HMO Blue, Inc., 813 F.3d 420, 425 n.2 (1st Cir. 2016); see also Al-Abbas v. Metro. Life Ins. Co., 52 F.Supp.3d 288, 294-96 (D. Mass. 2014) (on review of denial of ERISA benefits, where defendant moved for judgment on administrative record and plaintiff cross-moved for summary judgment, court considered record in light of parties' briefing to determine whether administrator's decision was reasonable). Therefore, notwithstanding the specific vehicle chosen, the standard of review-which requires the Court to review the administrative record-remains the same. With this in mind, the Court addresses the proper standard of review under which Mr. Morris's claim is to be analyzed.

         When an ERISA plan administrator has discretionary authority to interpret a plan, a court applies the six-step Williams[3] framework. Carr v. John Hancock LifeIns. Co. (USA), __F. App'x__, 2017 WL 2963446, at *6 (11th Cir. 2017) (citing Blankenship, 644 F.3d at 1354 & n.4). Here, the Plan imparts Union Security with “sole discretionary authority to determine eligibility for participation or benefits and to interpret the terms of the policy.” ...


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