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.

Hutson v. Reliance Standard Life Insurance Co.

United States District Court, W.D. Michigan, Southern Division

November 29, 2017

LAUREN L. HUTSON, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

          OPINION

          GORDON J. QUIST UNITED STATES DISTRICT JUDGE

         Plaintiff, Lauren L. Hutson, seeks accidental death benefits under a group accident policy issued by Defendant, Reliance Standard Life Insurance Company. After Reliance denied Hutson's claim based on a policy exclusion for any loss “to which sickness, disease, or myocardial infarction, including medical or surgical treatment thereof, is a contributing factor, ” Hutson sued Reliance under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., seeking review of Reliance's decision.

         The parties have filed cross-motions for judgment on the administrative record. See Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998). For the following reasons, the Court will grant Reliance's motion, deny Hutson's motion, and affirm Reliance's decision denying benefits.

         I. Standard Of Review

         The parties agree that the Court must review Reliance's denial of benefits de novo. (ECF No. 7 at PageID.372-73; ECF No. 8 at PageID.398.) The de novo standard applies to a plan administrator's factual and legal determinations. Rowan v. Unum Life Ins. Co. of Am., 119 F.3d 433, 435 (6th Cir. 1997). “In the ERISA context, the role of the reviewing federal court is to determine whether the administrator or fiduciary made a correct decision, applying a de novo standard.” Perry v. Simplicity Eng'g, 900 F.2d 963, 966 (6th Cir.1990). “This review is limited to the administrative record and the court is obligated to determine whether the administrator properly interpreted the plan and if the insured was entitled to benefits under the plan.” Kaye v. Unum Group/Provident Life & Accident, No. 09-14873, 2012 WL 124845, at *5 (E.D. Mich. Jan.17, 2012) (citing Perry, 900 F.2d at 967). “The administrator's decision is accorded no deference or presumption of correctness.” Hoover v. Provident Life & Accident Ins. Co., 290 F.3d 801, 809 (6th Cir. 2002) (citing Perry, 900 F.2d at 966). “When conducting a de novo review, the district court must take a ‘fresh look' at the administrative record but may not consider new evidence or look beyond the record that was before the plan administrator.” Wilkins, 150 F.3d at 616 (citations omitted).

         II. Background

         A. The Decedent and the Policy

sAs of August 28, 2014, Robert Krugman was employed by Gast Manufacturing, a subsidiary of IDEX Corporation, and was eligible for coverage under Reliance group accidental death and dismemberment policy VAR 205667 (Policy) issued to IDEX. (ECF No. 6-4 at PageID.138.) The Policy excludes coverage for losses arising under various circumstances, including “any loss . . . to which sickness, disease, or myocardial infarction, including medical or surgical treatment thereof, is a contributing factor.” (ECF No. 6 at PageID.67.) The Policy is an “employee welfare benefit plan” within the meaning of § 3(1) of ERISA, 29 U.S.C. § 1002(1). Krugman elected coverage under the Policy and named his mother, Helen Krugman, his primary beneficiary and his sister, Lauren Hutson, his secondary beneficiary. (ECF No. 6-4 at pageID.107.)

         B. The Accident

         On August 28, 2014, at approximately 10:28 a.m., Krugman and his mother were traveling eastbound on Red Arrow Highway in Hartford Township, Michigan, in Krugman's orange Honda Fit when they collided head-on with a vehicle traveling in the westbound lane. (ECF No. 6-4 at PageID.152-53.) Peter Sinclair was driving the westbound vehicle, a red Ford Escape. (Id. at PageID.155, 157.) At the time of the accident, the weather was partly cloudy and the pavement was dry. (Id. at PageID.154.)

         Both vehicles came to rest in the westbound half of the road, generally facing west. Krugman's orange Honda Fit was within the lane toward the center of the road with its left rear tire slightly over the double yellow line, and Sinclair's red Ford Escape was situated several feet to the east of the orange Honda Fit on the shoulder, entirely north of the fog line. (Id. at PageID.154-55; ECF No. 6-5 at PageID.202.) Krugman's mother was pronounced dead at the scene. Krugman was found unconscious, “but breathing, ” and was transported to Lakeland Hospital, where he died a short time later. Sinclair was also taken to Lakeland Hospital, where he was treated and later released. (ECF No. 6-4 at PageID.135, 155, 157.)

         It is undisputed that one of the two vehicles crossed the center line into the opposite lane of travel, and there was no evidence that either driver was impaired. (Id. at PageID.121, 169.) Hutson argues that Sinclair's red Escape crossed the center line into Krugman's lane. She relies primarily upon a witness statement from Takela Broyles, who lived on the south side of Red Arrow Highway. The morning of the accident, Broyles told Michigan State Police Trooper Nathan McClain that she saw the accident from her kitchen window. Broyles “stated that the orange vehicle was eastbound and the red vehicle was westbound on Red Arrow H[ighway] when she saw the red vehicle cross the center line into the lane of the orange vehicle. She said it appeared the driver of the red vehicle lost control.” (Id. at PageID.156.) Broyles observed the accident from a distance of approximately 70-80 feet. (Id. at PageID.157.) Hutson also notes that Trooper McClain spoke with another witness, Cynthia Roethel, who did not see the accident but said she heard a horn followed by a crash. (Id.) Trooper McClain returned to Broyles after speaking with Roethel and asked Broyles if she heard a horn. Broyles said that the driver of the orange vehicle blew his horn apparently to get the attention of the red vehicle that crossed the center line. (Id. at PageID.156.) Hutson finally notes that, while in the back of the ambulance, Sinclair said that he did not blow his horn. (Id. at PageID.158.) Thus, Hutson argues, Broyles's statement and Sinclair's denial that he blew his horn show that Sinclair's red Escape was the vehicle that crossed the center line. (ECF No. 8 at PageID.388-89.)

         Hutson's version is implausible. The overwhelming weight of the evidence shows that Krugman's vehicle crossed the center line:

• Trooper McClain also spoke with Sinclair at the scene. Sinclair said that as he was traveling westbound, “the eastbound orange vehicle drove left of center into his lane.” Sinclair also said that “he moved over to the right shoulder before being struck.” (Id. at PageID.158.) Notwithstanding Broyles's statement, Trooper McClain wrote in his narrative that Krugman's vehicle (Vehicle#1) “appeared to have ...

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.