Opinion
NO. 4:00-CV-1805-A
July 26, 2001
MEMORANDUM OPINION and ORDER
Came on for consideration the motion of defendant, UNUM Life Insurance Company of America, for summary judgment. The court, having considered the motion, the response of plaintiff, Angelica Rodriguez, the record, the summary judgment evidence, and applicable authorities, finds that the motion should be granted.
I. Plaintiff's Claims
On October 27, 2000, plaintiff filed her original petition in the 153rd Judicial District Court of Tarrant County, Texas. The action was brought before this court by notice of removal filed by defendant.
Plaintiff seeks to recover benefits under an accidental death and dismemberment policy issued by defendant. Plaintiff's husband was killed in an automobile accident on or about January 15, 1998. Plaintiff alleges that defendant acted in bad faith in denying her claim for benefits.
II. Grounds of the Motion
Defendant asserts that all of plaintiff's state law claims are completely preempted, since its policy is governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001-1461 ("ERISA"). Defendant additionally contends that it did not abuse its discretion in denying plaintiff's claim.
III. Undisputed Facts
The summary judgment evidence establishes the following facts:
Defendant issued its group life insurance policy number 23805001 to the Select Group Insurance Trust. Effective October 1, 1997, Master Fibers, Inc., subscribed to coverage under the policy. The policy provides group life and accidental death and dismemberment insurance for covered employees. Plaintiff's husband was a covered employee under the policy. His employer paid the entire cost of the coverage. With respect to the accidental death and dismemberment coverage, the policy provides:
WHAT ACCIDENTAL LOSSES ARE NOT COVERED UNDER YOUR PLAN?
Your plan does not cover any accidental losses caused by, contributed to by, or resulting from:
. . . .
— an attempt to commit or commission of a crime under state or federal law.
Def.'s App. at 046.
On January 15, 1998, plaintiff's husband was killed in a two-car traffic accident in Fort Worth, Texas. The accident occurred at approximately 9:35 p.m. on a dry road. The decedent's blood alcohol content at the time of the accident was 0.17%. The police concluded that the decedent crossed the double center yellow line and collided with a second vehicle being driven by Czerny M. Teal ("Teal"). Teal was flown from the accident scene to John Peter Smith Hospital where he was treated for a fractured leg, a serious elbow injury, burns on his left arm, and a swollen face. Teal remained hospitalized for approximately three weeks.
On March 10, 1998, defendant received a claim for life and accidental death and dismemberment benefits. The claim form named plaintiff as the decedent's spouse and primary beneficiary under the policy. By letter dated March 12, 1998, defendant acknowledged receipt of plaintiff's claim for benefits under the policy. On March 30, 1998, defendant informed plaintiff that her claim for life insurance benefits had been approved, but that it was continuing to investigate her claim for accidental death benefits. On April 9, 1998, defendant received the autopsy report and postmortem toxicology analysis from the Tarrant County Medical Examiner. By letter dated April 20, 1998, defendant denied plaintiff's claim because the decedent's blood alcohol content was 0.17% at the time of the accident and his death. Defendant explained that the claim was excluded from coverage because the decedent's death resulted from or was contributed to by the commission of a crime.
On June 12, 1998, defendant received plaintiff's appeal of its determination to deny benefits. By letter dated August 20, 1998, defendant gave notice that its initial denial of plaintiff's claim was correct. Defendant cited to the decedent's blood alcohol level showing that he was driving while intoxicated, a crime under the laws of the State of Texas, and that he had committed the crime of intoxication assault under the Texas Penal Code.
IV. Applicable Summary Judgment Principles
A party is entitled to summary judgment on all or any part of a claim as to which there is no genuine issue of material fact and as to which the moving party is entitled to judgment as a matter of law. FED. R. CIV. P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986). The moving party has the initial burden of showing that there is no genuine issue of material fact. Anderson, 477 U.S. at 256. The movant may discharge this burden by pointing out the absence of evidence to support one or more essential elements of the non-moving party's claim "since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial."Celotex Corp. v. Catrett, 477 U.S. 317, 323-25 (1986). Once the moving party has carried its burden under Rule 56(c), the non-moving party must do more than merely show that there is some metaphysical doubt as to the material facts. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). The party opposing the motion may not rest on mere allegations or denials of pleading, but must set forth specific facts showing a genuine issue for trial.Anderson, 477 U.S. at 248, 256. To meet this burden, the nonmovant must "identify specific evidence in the record and articulate the `precise manner' in which that evidence support[s] [its] claim[s]."Forsyth v. Barr, 19 F.3d 1527, 1537 (5th Cir. 1994). An issue is material only if its resolution could affect the outcome of the action. Anderson, 477 U.S. at 248. Unsupported allegations, conclusory in nature, are insufficient to defeat a proper motion for summary judgment. Simmons v. Lyons, 746 F.2d 265, 269 (5th Cir. 1984).
The standard for granting a summary judgment is the same as the standard for a directed verdict. Celotex Corp., 477 U.S. at 323. If the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, there is no genuine issue for trial. Matsushita, 475 U.S. at 597.
V. Law Applied to the Facts
Plaintiff makes no response to defendant's contention that all of her state law claims are preempted by ERISA. Clearly, such is the case.See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 47-48 (1987); Hogan v. Kraft Foods, 969 F.2d 142, 144-45 (5th Cir. 1992).
As for the contention that defendant did not abuse its discretion in determining that the decedent's death was excluded from coverage, plaintiff cites no evidence whatsoever to raise a genuine issue of material fact. Plaintiff does not dispute that defendant's factual determinations in assessing her claim are subject to abuse of discretion review. Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 168 F.3d 211, 213 (5th Cir. 1999). The court must affirm the decision if it is supported by substantial evidence. Id. A decision is arbitrary, that is, not supported by substantial evidence, only if made without a rational connection between the known facts and the decision or between the found facts and the evidence. Id.
In fact, plaintiff's brief cites no legal authorities other than Rule 56(c) and one case, miscited, for the appropriate summary judgment standard. Pl.'s Br. at 4 n. 1.
Plaintiff contends that no review can be made, because the policy at issue lists Master Fibers, Inc., as the plan administrator and Master Fibers, Inc., did not make any findings. Plaintiff does not cite to summary judgment evidence to support the contention that the decedent's employer was required to make findings. The policy only provides: "If your claim for a benefit is denied, in whole or in part, you must receive a written explanation of the reason for the denial." Def.'s App. at 055. Further, under sections titled "WHAT IF YOUR CLAIM IS DENIED?" and "WHAT DO YOU DO TO APPEAL?" the policy says that defendant will respond.Id. at 056.
Here, the summary judgment evidence establishes that, at the time of his death, the decedent was intoxicated, having an alcohol concentration of more than 0.10%. TEX. PENAL CODE ANN. § 49.01(2)(B) (Vernon 1994). By driving while intoxicated, the decedent violated TEX. PENAL CODE ANN. § 49.04 (Vernon 1994). Moreover, by operating his vehicle while intoxicated and causing serious bodily injury to Teal, the decedent violated TEX. PENAL CODE ANN. § 49.07 (Vernon 1994).
Plaintiff has not come forward with any summary judgment evidence to raise a genuine fact issue as to any other cause unrelated to the decedent's drinking for the accident that led to his death. Defendant has established it is entitled to judgment as a matter of law. See Sisters of the Third Order of St. Francis v. SwedishAmerican Group Health Benefit Trust, 901 F.2d 1369, 1371 (7th Cir. 1990).
VI. ORDER
For the reasons discussed herein,
The court ORDERS that defendant's motion for summary judgment be, and is hereby, granted; that plaintiff take nothing on her claims against defendant; and that such claims be, and are hereby, dismissed with prejudice.
The court determines that there is no just reason for delay in, and hereby directs, entry of final judgment as to the dismissal of plaintiff's claims against defendant.
The court notes that defendant's counterclaim for attorneys' fees is still pending.