Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Venditti v. Unum Life Insurance Co.

United States District Court, N.D. Iowa, Cedar Rapids Division

December 13, 2018

JODY VENDITTI, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA; KINDRED HEALTHCARE OPERATING INC. EMPLOYEE MEDICAL AND WELFARE BENEFITS PLAN, Defendants.

          REPORT AND RECOMMENDATION ON APPEAL OF ADMINISTRATIVE DECISION

          Mark A. Roberts, United States Magistrate Judge

         TABLE OF CONTENTS

         I. INTRODUCTION .......................................................................... 3

         II. JURISDICTION AND VENUE ......................................................... 3

         III. BACKGROUND ............................................................................ 3

         A. The Parties .......................................................................... 3

         B. The Plan ............................................................................. 4

         C. Factual Background ............................................................... 4

         D. Procedural Background .......................................................... 5

         IV. ANALYSIS .................................................................................. 7

         A. Whether Unum's interpretation and application of “contributed to” were reasonable.......................... 8

          i. Unum did not abuse its discretion when it interpreted “contributed to” ........................................................... 9

         a. Whether the Wickman test must be applied in this case ............................................................. 10

         b. Whether Unum's interpretation of “contributed to” was reasonable .......................................................... 10

         i. Discussion of the Finley Factors ....................... 12

         a. Factor 1, whether Unum's interpretation is consistent with the goals of the Plan ......... 12

         b. Factor 2, whether Unum's interpretation renders any language of the Plan meaningless or internally inconsistent ........................ 13

         c. Factor 3, whether Unum's interpretation conflicts with the substantive or procedural requirements of the ERISA statute ............ 14

         d. Factor 4, whether Unum has interpreted the words at issue consistently ...................... 15

         e. Factor 5, whether Unum's interpretation is contrary to the clear language of the Plan .......... 15

         ii. Conclusion on the Finley Factors ..................... 16

          ii. Whether Unum reasonably applied its interpretation of “contributed to” to the facts of this case and whether the fact-based determinations were supported by substantial evidence on the record ........... 17

         a. Whether Unum reasonably applied its interpretation of “contributed to” to the facts of the claim ............... 17

         b. Whether Unum's fact-based determinations were supported by substantial evidence on the record ......... 19

         B. Unum met its burden of proof ................................................. 22

         V. CONCLUSION ............................................................................ 23

         I. INTRODUCTION

         The matter now before me is Plaintiff Jody Venditti's appeal from Defendant Unum Life Insurance Company's (“Unum's”) administrative decision denying accidental death and dismemberment insurance benefits under an insurance policy issued pursuant to the Employee Retirement Income Security Act, 29 U.S.C. Sections 1001, et. seq. (“ERISA”). (Doc. 3.) The Honorable Linda R. Reade, United States District Court Judge, referred this matter to me for a Report and Recommendation.

         For the following reasons, I respectfully recommend that the Court affirm the administrative decision.

         II. JURISDICTION AND VENUE

         Under ERISA, this Court has jurisdiction to review Unum's denial of Plaintiff's claim. 29 U.S.C. § 1132(e)(1). Venue is appropriate in the Northern District of Iowa because the alleged breach occurred in the District. See 29 U.S.C. § 1132(e)(2) (Action may be brought, inter alia, in the district court where the breach took place).

         III. BACKGROUND

         A. The Parties.

         Plaintiff Jody Venditti was the sister of Jamie Schnede. (Docs. 18 at 3-4; 19 at 2.) Mr. Schnede was enrolled in life insurance and accidental death and dismemberment insurance policies through his employer Kindred Healthcare, and Venditti was designated as Mr. Schnede's beneficiary under both policies. (Docs. 3 ¶ 7; 18 at 4; 19 at 2.) Venditti is a resident of Lowden, Cedar County, Iowa. (Doc. 3 ¶ 1.)

         Unum Life Insurance Company of America is a life insurance company that did business in Linn County, Iowa at all times relevant to this litigation. (Id. ¶ 8.) Defendant Kindred Healthcare Operating, Inc. Employee Medical and Welfare Benefits Plan (“Kindred”) is an employee medical and welfare benefits plan that provides accidental death and dismemberment insurance to its participant employees. (Id. ¶¶ 3-4.) The plan administrator for Kindred is located in Louisville, Kentucky. (Id. ¶ 6.) Kindred is subject to the laws, provisions, and regulations of ERISA. (Id. ¶ 5.) Kindred's plan administrator delegated discretionary authority to Unum to make benefit determinations under the Plan. (Id. ¶ 9.) (Defendants will collectively be referred to as “Unum.”)

         B. The Plan.

         Jamie Schnede's accidental death and dismemberment insurance plan provided that his beneficiary would receive payment if his death was “the direct result of an accident, ” which the Plan defined as “accidental bodily injury.” (Doc. 17 at 183.) Under the Plan, accidental bodily injury means “bodily harm caused solely by external, violent and accidental means and not contributed to by any other cause.” (Id. at 194.) In relevant part, the Plan “does not cover any accidental losses caused by, contributed to by, or resulting from [the following]:

• the use of any prescription or non-prescription drug . . . or other chemical substance unless used according to the prescription or direction of your dependent's physician. This exclusion will not apply to you or your dependent if the chemical substance is ethanol.
...
• alcohol in combination with any drug, medication, or sedative [“the combination exclusion”].

(Id. at 187.) The Plan defines “intoxicated” as “your or your dependent's blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state where the accident occurred.” (Id. at 195.)

         C. Factual Background.

         The factual background of this case is largely undisputed. On June 24, 2017, at 10:27 p.m., Mr. Schnede was attempting to cross a six-lane highway in Tampa, Florida when he was struck by a car and died from his injuries. (Docs. 18 at 4; 19 at 2.) Mr. Schnede was attempting to cross the highway “near its intersection” with another road (Doc. 18 at 4) where “[t]here was no crosswalk and no traffic light.” (Doc. 19 at 2.) The driver of the vehicle was travelling at forty miles per hour and the posted speed limit was forty-five miles per hour. (Doc. 17 at 250.)

         An autopsy performed by the Hillsborough County Medical Examiner concluded that Mr. Schnede's cause of death was “Basilar Skull and Cervical Vertebral Fractures with Contusions of Brain and Traumatic Axonal Injury due to Blunt Impact to Head and Neck.” (Id. at 290.) The manner of death was “Accident (Pedestrian struck by automobile).” (Id.) The Medical Examiner's toxicology report revealed that at the time of his death, Mr. Schnede had a blood alcohol content (“BAC”) of 0.40 grams per deciliter (Id. at 299), which was five times more than the legal limit to lawfully drive or be in actual physical control of a vehicle. Fla. Stat. ยง 316.193(1)(b). The autopsy also showed that Mr. Schnede had tetrahydrocannabinol ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.