United States District Court, S.D. Alabama, Southern Division
V. S. GRANADE SENIOR UNITED STATES DISTRICT JUDGE.
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”). (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.
FACTUAL AND PROCEDURAL BACKGROUND
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).
“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).
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).
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).
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,
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.
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
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).
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.
ERISA plan administrator has discretionary authority to
interpret a plan, a court applies the six-step
Williams 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.” ...