Michele Donaldson, Individually and as Special Administratrix of the Estate of Phillip Donaldson, Deceased
National Union Fire Insurance Company of Pittsburgh, PA Plaintiff- Appellant Defendant-Appellee
Submitted: January 13, 2017
from United States District Court for the Eastern District of
Arkansas - Batesville
COLLOTON, GRUENDER, and KELLY, Circuit Judges.
on his delivery route, Phillip Donaldson's truck was
struck by an oncoming vehicle that crossed the center
divider. Mr. Donaldson died on impact. His wife, Michele
Donaldson, filed a claim for accidental death and spousal
benefits under a Blanket Accident Insurance Policy (the
Policy) issued to Mr. Donaldson's employer, Schwan's
Shared Services, LLC (Schwan's), by National Union Fire
Insurance Company of Pittsburgh, Pennsylvania (National
Union). National Union denied the claim, concluding coverage
was excluded under the Policy. On a stipulated record, the
district court upheld National Union's denial of
benefits and dismissed the complaint. Ms. Donaldson appeals
that decision, and we affirm.
Donaldson's accident occurred on December 11, 2013. At
the time of the accident, he was driving a Schwan's truck
on his delivery route and was undisputedly within the scope
of his employment with Schwan's. Mr. Donaldson's
truck was struck by an oncoming vehicle that was operated by
a woman who was not employed by Schwan's. She was also
killed in the accident.
Donaldsons were insured under the Policy at the time of the
accident. The Policy is an employee-benefit plan governed by
the Employee Retirement Income Security Act (ERISA) that
provides insureds with "needed financial security in the
event of an accidental death or accidental injury"
"when traveling on business." As relevant, the
Policy provides coverage for injuries sustained as a result
of an accident that "occurs under the circumstances
described in a Hazard applicable to that person."
Mr. Donaldson's death, Ms. Donaldson filed a claim under
Hazard H-12, entitled "24-Hour Accident Protection While
On A Trip (Business Only)." National Union denied the
claim on the ground that coverage was excluded under Hazard
H-12 because at the time of his death, Mr. Donaldson
"was operating a conveyance he had been hired to
operate." Following the denial, Ms. Donaldson exhausted
her administrative remedies and then filed suit in state
court. The complaint seeks an accidental death benefit on
behalf of Mr. Donaldson's estate equal to ten times his
annual base earnings, or $286, 000, and a spousal benefit of
$50, 000. National Union removed the action to federal court.
The parties filed a stipulated record and briefing regarding
the denial of coverage. The district court found National
Union reasonably interpreted the Policy language and did not
abuse its discretion in denying coverage. The court dismissed
the compliant with prejudice, and Ms. Donaldson appealed.
parties agree that the abuse of discretion standard applies
to National Union's denial of benefits because the Policy
"grants the plan administrator . . . discretion to
interpret the plan and to determine eligibility for
benefits." Hampton v. Reliance Standard Life Ins.
Co., 769 F.3d 597, 600 (8th Cir. 2014). "Under this
standard of review, we must uphold [National Union]'s
decision so long as it is based on a reasonable
interpretation of the [Policy] and is supported by
substantial evidence." Id. Where, as here,
"a plan administrator holds the dual role of evaluating
and paying benefits claims, " this conflict of interest
should be considered "as a factor in determining whether
the plan administrator has abused its discretion."
Manning v. Am. Republic Ins. Co., 604 F.3d 1030,
1038 (8th Cir. 2010). Because the record in this case
contains no evidence about National Union's "claims
administration history or its efforts to ensure that claims
assessment is not affected by the conflict, " we only
"give the conflict some weight." Darvell v.
Life Ins. Co. of N. Am., 597 F.3d 929, 934 (8th Cir.
central issue on appeal is National Union's
interpretation of the language in Hazard H-12. To determine
if a plan administrator's interpretation of policy terms
is reasonable, the court examines:
 whether their interpretation is consistent with the goals
of the Plan,  whether their interpretation renders
anylanguage of the Plan meaningless or internally
inconsistent,  whether their interpretation conflicts with
the substantive or procedural requirements of the ERISA
statute,  whether they have interpreted the words at issue
consistently, and  whether their interpretation is
contrary to the clear language of the Plan.
King v. Hartford Life & Accident Ins. Co., 414
F.3d 994, 999 (8th Cir. 2005) (en banc) (quoting Finley
v. Special Agents Mut. Benefit Assoc., Inc., 957 F.2d
617, 621 (8th Cir. 1992)). Though these factors "inform
our analysis, " id., "[t]he dispositive
principle remains . . . that where plan fiduciaries have
offered a reasonable interpretation of disputed provisions,
courts may not replace [it] with an interpretation of their
own-and therefore cannot disturb as an abuse of discretion