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Fields v. Ashford

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

May 2, 2018

ANGELA J. FIELDS, Plaintiff,
v.
PIERRE OCTAVIUS ASHFORD, et al., Defendants.

          ORDER GRANTING LIFE INSURANCE COMPANY OF NORTH AMERICA'S MOTION FOR SUMMARY JUDGMENT (ECF #32)

          MATTHEW F. LEITMAN UNITED STATES DISTRICT JUDGE.

         This action arises of an automobile accident between Plaintiff Angela Fields (“Fields”) and Defendant Pierre Octavius Ashford. In her Complaint, Fields asserts one claim (Count V) against Defendant Cigna Life and Health Insurance Company (“Cigna”) for failing to pay benefits under her long-term disability policy (the “Policy”) after she suffered injuries in the automobile accident with Ashford. (See Compl. at ¶¶ 37-44, ECF #1 at Pg. ID 19-20.[1])

         Cigna did not file an Answer to the Complaint. Instead, Life Insurance Company of North America (“LINA”) filed an Answer addressing the claim in Count V. (See LINA Ans., ECF #5.) LINA explained that it was filing the Answer because it issued the long-term disability policy in question and Cigna did not. (See Id. at Pg. ID 38.)

         LINA has now filed a motion for summary judgment on its own behalf and on behalf of Cigna. (See Mot. for Summ. J., ECF #32.) LINA argues that it is entitled to summary judgment on two independent bases: (1) there is no case or controversy because it has paid all benefits to which Fields is entitled and (2) Fields' claim is deficient because she failed to exhaust her administrative remedies under the Policy before filing suit. (See id.) For the reasons stated below, the Court GRANTS LINA's motion for summary judgment because Fields did not exhaust her administrative remedies under the Policy before filing suit.

         I

         On May 25, 2016, a vehicle driven by Ashford and a vehicle driven by Fields were involved in an automobile accident. (See Compl. at ¶¶ 11-12, ECF #1 at Pg. ID 11.) Fields allegedly sustained injuries as a result of the collision. (See Id. at ¶15, Pg. ID 12.)

         At the time of the accident, Fields had long term disability insurance coverage through LINA. (See Policy, ECF #36 at Pg. ID 278-309.) After the Policy's required 90-day waiting period, LINA began paying Fields long-term disability benefits under the Policy. (See Decl. of Lisa Mekkelsen (“Mekkelsen Decl.”) at ¶4, ECF #32-1 at Pg. ID 255.) LINA never made a formal decision to finally deny any claim for benefits by Fields, and Fields never filed any administrative appeal of any decision affecting her right to benefits. (See Id. at ¶6, Pg. ID 256.)

         While LINA never denied a claim for benefits by Fields, it did withhold certain amounts from some of her benefits payments. (See ECF #36 at Pg. ID 335.) It did so based upon its erroneous belief that it was entitled to deduct from Fields' benefit amounts paid by other insurers. (See id.; Resp. to Mot for Summ. J., ECF #36 at Pg. ID 271.) LINA ultimately rectified its error by making an $8, 000 payment to Fields after she filed this action. (See ECF #36 at Pg. ID 334-35.) Fields does not appear to argue that LINA is currently delinquent in the payment of any benefits owing under the Policy. However, Fields does contend that LINA owes her interest for the period during which it wrongly withheld the $8, 000 in benefits. (See Resp. to Mot. for Summ. J., ECF #36 at Pg. ID 272.)

         II

         A movant is entitled to summary judgment when it “shows that there is no genuine dispute as to any material fact . . . .” SEC v. Sierra Brokerage Servs., Inc., 712 F.3d 321, 326-27 (6th Cir. 2013) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251-52 (1986)) (quotations omitted). When reviewing the record, “the court must view the evidence in the light most favorable to the non-moving party and draw all reasonable inferences in its favor.” Id. “The mere existence of a scintilla of evidence in support of the [non-moving party's] position will be insufficient; there must be evidence on which the jury could reasonably find for [that party].” Anderson, 477 U.S. at 252. Summary judgment is not appropriate when “the evidence presents a sufficient disagreement to require submission to a jury.” Id. at 251-52. Indeed, “[c]redibility determinations, the weighing of the evidence and the drafting of legitimate inferences from the facts are jury functions, not those of a judge . . . .” Id. at 255.

         III

         A

         LINA first argues that there is no case or controversy with respect to Fields' claim in Count V because Fields “has already received-and is continuing to receive-all of the relief she is seeking” in that count. (Mot. for Summ. J., ECF #32 at Pg. ID 252.) The Court disagrees. As noted above, Fields is seeking interest on the erroneously withheld benefits. The remaining claim for interest is thus a live issue that satisfies the constitutional requirement of a case or controversy. See, e.g., Templin v. Indep. Blue Cross, 487 Fed.Appx. 6, 11 (3d Cir. 2012) (‚ÄúDismissal of the claims as moot without considering the plaintiffs' entitlement to interest was error. Voluntary payment of ...


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