Moore v. Metropolitan Life Insurance Co. et al

Filing 83

OPINION. Signed by Honorable Judge Myron H. Thompson on 6/10/13. (scn, )

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE
MIDDLE DISTRICT OF ALABAMA, NORTHERN DIVISION

JANIE MOORE,

)
)
)
)
)
)
)
)
)
)

Plaintiff,
v.
METROPOLITAN LIFE
INSURANCE CO.; et al.,
Defendants.

CIVIL ACTION NO.
2:11cv170-MHT
(WO)

OPINION
Plaintiff

Janie

Moore

filed

this

action

against

defendants Metropolitan Life Insurance Company; Southern
Company Services, Inc.; and Group Life Insurance Plan,
Dependent Life Benefits for Southern Company Services,
Inc., and Associated or Affiliated Companies, claiming a
violation of the Employee Retirement Income Security Act
of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq. and seeking
to recover benefits pursuant to 29 U.S.C. § 1132(a)(1).
Jurisdiction over Ms. Moore’s federal claim is proper
under 28 U.S.C. § 1331 (federal question).

This case is

currently before the court on a review of the insurance

company’s denial of benefits to Ms. Moore.

For the

reasons that follow, the court holds that Ms. Moore is
entitled to benefits.

I.
Ms.

Moore

worked

for

Alabama

Power

division of defendant Southern Company.
she

participated

insurance plan.

in

a

Company,

a

As an employee,

dependent-life-benefits-group-

Metropolitan Life serves as both the

plan’s administrator of claims as well as the payor of
benefits.
The plan documents state that a claimant must submit
proof satisfactory to Metropolitan Life to get a benefit
under the plan.

The plan defines “spouse” as “your

lawful

and

spouse,”

the

plan

administrator

has

“discretionary authority to interpret the terms of the
plan and to determine eligibility for and entitlement to
plan benefits in accordance with the terms of the Plan.”
Claims File - Part Two (Doc. No. 57-4) at 38.

2

The plan

states

that

any

interpretation

made

under

its

discretionary authority shall have effect unless it was
arbitrary and capricious.

Id.

In 2003, Ms. Moore enrolled in the plan to secure
$ 50,000 in dependent-life-insurance coverage for her
common-law husband, Mr. Moore.
Moore died of lung cancer.

In September of 2009, Mr.
After his death, Alabama

Power submitted a claim for Ms. Moore to Metropolitan
Life certifying that she had enrolled and had certifiable
coverage and that Mr. Moore was her spouse.

Claims File

- Part One (Doc. No. 57-1) at 2-5.
As part of the claims process, Ms. Moore completed a
common-law marriage questionnaire for Metropolitan Life.
Id. at 14-23.

On the questionnaire, she listed the

address of the couple’s shared rented residence, date the
marriage

began

(1985),

cohabitation (Wisconsin).

and

the

location

of

first

She also provided the names

and contact information of three people who would affirm
that they knew the Moores as husband and wife (of whom

3

two had known the Moores for 23 years).

She indicated

that both she and Mr. Moore had listed “single” as their
marital status on the last federal income-tax return.
She provided the names and personal information of the
three

children

together.

the

She

couple

left

three

had

conceived

questions

and

raised

blank:

those

requesting information for joint checking, savings, and
investment accounts.
Ms. Moore also voluntarily attached three documents
to the questionnaire: an insurance policy from 2004 where
Mr. Moore listed her as his spouse, a birth certificate
for one of their children showing both Mr. and Ms. Moore
as

the

funeral.

parents,

and

a

program

from

the

decedent’s

After Ms. Moore sent all of this information to

Metropolitan Life, she received a letter denying her
claim.
In November 2009, Metropolitan Life notified Ms.
Moore that, based on the documentation in her file, her
claim was denied.

Id. at 27-28.

4

The initial denial

letter states that “documentation within the claim file
acknowledges that yourself [sic] and Mr. Moore were
Common-Law spouses.”

Id. at 27.

The insurance company

explained that, because the Moores’ cohabitation began
in

Wisconsin--a

State

that

does

not

recognize

the

validity of common-law marriage--it was denying the
claim.
Ms. Moore appealed the decision in December 2009.
Id. at 29.

In her appeal letter, she stated that,

although the Moores’ cohabitation began in Wisconsin,
they had been residing together permanently in Alabama
since 1995 and thus did have a common-law marriage under
Alabama law. Later that month, Metropolitan Life upheld
its adverse-claim determination reiterating its earlier
claim that: “Wisconsin, the state in which your commonlaw marriage was established does not recognize the
validity of common-law marriage.

Therefore, based on

the record before MetLife, we denied your claim on
November 25, 2009.” Id. at 34-35. The insurance company

5

then addressed Ms. Moore’s statement that it had applied
the wrong State’s laws, writing: “Although Alabama does
recognize common-law marriage, you have not provided our
office with any documentation to substantiate that a
common-law marriage existed.

Therefore, based on the

record before MetLife, we uphold our denial of your
claim.” Claims File - Part Two (Doc. No. 57-1) at 35
(emphasis added).
In August 2010, Ms. Moore again wrote Metropolitan
Life requesting reconsideration of its denial.

Claims

File - Part Two (Doc. No. 57-2) at 4-5.

She reasserted

that

applied

Alabama–-not

Wisconsin–-law

and

supplemented the items already submitted by laying out
that the Moores had lived together as husband and wife
for more that two decades.

She reasserted that the

couple had resided together permanently in Alabama since
1995, holding themselves out as married to those who
knew them (she took his surname) and raised three
children together (who all took the Moore name as well).

6

Without repudiating its earlier denial of benefits
based on Wisconsin law, Metropolitan Life wrote to Ms.
Moore requiring documents that it claimed could possibly
substantiate a common-law marriage. Id. at 14.

The

insurance company required submission of at least two of
the following three items: (1) documentation of a joint
lease or deed; (2) documentation showing joint bank
accounts, credit cards, or other investments; (3) a copy
of federal-tax returns showing joint filing.
In December 2010, Ms. Moore notified Metropolitan
Life that, absent a repudiation of its decision based on
Wisconsin law or a final ruling on the appeal, she would
not submit any more information. Id. at 26-27.

The

insurance company responded that same month with a
letter stating that she had exhausted her administrative
remedies under the Plan and that it would consider no
further appeals. Id. at 31.

7

After litigation began in this case, Metropolitan
Life conceded that Alabama law governs the couple’s
relationship.

Id. at 33-34.

II.
Ms. Moore challenges Metropolitan Life’s denial of
her claim for spousal-death benefits.

She argues that

she had a valid common-law marriage under Alabama law
and that the insurance company erred in denying her
spousal-death benefits.

Metropolitan Life claims that

Ms. Moore failed to submit satisfactory proof of a
common-law marriage.

The insurance company argues that

its decision was correct, reasonable, and not affected
by a conflict of interest.

A. ERISA Standard of Review
This court must determine whether a reasonable basis
existed for the ERISA plan administrator’s benefits
decision.

8

The court uses a modified version of the test
articulated in Williams v. Bell South Telecomm., Inc.,
373 F.3d 1132, 1137-38 (11th Cir. 2004).
reviewing an ERISA-plan benefit denial must:
“(1) Apply the de novo standard to
determine
whether
the
claim
administrator’s
benefits-denial
decision is ‘wrong’ (i.e. the court
disagrees with the administrator’s
decision); if it is not, end judicial
inquiry and affirm the decision.
“(2) If the administrator’s decision
in fact is ‘de novo wrong,’ then
determine whether he was vested with
discretion in reviewing claims; if not
end the judicial inquiry and reverse
the decision.
“(3) If the administrator’s decision
is ‘de novo wrong’ and he was vested
with discretion in reviewing claims,
then determine whether ‘reasonable’
grounds supported it (hence, review
his
decision
under
the
more
deferential arbitrary and capricious
standard).
“(4) If no reasonable grounds exist,
then end the inquiry and reverse the
administrator’s
decision;
if
reasonable grounds do exist, then
determine if he operated under a
conflict of interest.
9

A court

“(5) If there is no conflict, then end
the inquiry and affirm the decision.
“(6) If there is a conflict of
interest, the conflict should merely
be a factor for the court to take into
account when determining whether an
administrator’s decision was arbitrary
and capricious.”
Blankenship v. Metropolitan Life Ins. Co., 644 F.3d
1350, 1355 (11th Cir. 2011); see also Capone v. Aetna
Life Ins. Co., 592 F.3d 1189, 1195-96 (11th Cir. 2010)
(“[T]he Williams methodology remains intact except for
the sixth step.”).
In

other

words,

a

denial

of

plan

benefits

is

reviewed de novo unless the plan states otherwise.
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115
(1989). Where the plan provides discretionary authority
to the administrator, an abuse-of-discretion standard is
appropriate.

Id. at 111; see also Metro. Life Ins. Co.

v. Glenn, 554 U.S. 105, 111 (2008). Review of the
administrator’s
consideration

denial
of

the

of

benefits

material

10

is

limited

available

to

to
the

administrator at the time it made its decision.

See

Jett v. Blue Cross & Blue Shield of Ala., 890 F.2d 1137,
1140 (11th Cir. 1989).

B.

Discussion

This

court

first

examines

whether

the

plan

administrator’s benefits-denial decision is “wrong.”
Blankenship, 644 F.3d at 1355.

Although Metropolitan

Life based its preliminary denials on Wisconsin law,
Moore argues--and the insurance company now concedes-that Alabama law applies to the determination of whether
the Moores had a valid common-law marriage. As such,
this

court

looks

to

Alabama

substantive

law

in

determining whether the Moores had a common-law marriage
under Alabama law.
Alabama has recognized common-law marriage since
Campbell’s Adm’r v. Gullatt, 43 Ala. 57, 59

1869.
(1869).
must

A party seeking to prove a common-law marriage

establish

her

claim

11

by

clear

and

convincing

evidence.

Lofton v. Estate of Weaver, 611 So. 2d 335,

336 (Ala. 1992).

In Alabama, recognition of common-law

marriage requires proof of “(1) capacity; (2) present,
mutual

agreement

relationship

to

to

relationships;

permanently

the

and

(3)

enter

exclusion
public

the

of

marriage

all

recognition

other
of

the

relationship as a marriage and public assumption of
marital duties and cohabitation.” Boswell v. Boswell,
487 So. 2d 479, 480 (Ala. 1986).
Whether

the

essential

elements

of

marriage exist is a question of fact.

a

common-law
Stringer v.

Stringer, 689 So. 2d 194, 195 (Ala. Civ. App. 1997)
(citing Johnson v. Johnson, 120 So. 2d 739, 740 (Ala.
1960)).

Whether the parties had the intent, or the

mutual assent, to enter the marriage is also a question
of fact.

Id. at 195.

“Each case must be determined on

its

particular

facts,

own

having

regard

to

situations of the parties and their status in life.

the
A

pertinent inquiry is to determine the attitude of the

12

parties with respect to marriage and the common law
relationship.” Etheridge v. Yeager, 465 So. 2d 378, 380
(Ala. 1985) (quoting Goodman v. McMillan, 61 So. 2d 55,
59 (Ala. 1952)).
With these standards in mind, this court turns to
the first element: capacity.

Alabama courts have held

that parties do not have the capacity to marry if they
are

of

unsound

underage.

mind,

are

already

married,

or

are

See, e.g., Beck v. Beck, 246 So. 2d 420, 425

(Ala. 1971) (unsound mind); Steele v. Steele, 522 So. 2d
269, 270 (Ala. 1988) (already married); Adams v. Boan,
559 So. 2d 1084, 1086-87 (Ala. 1990) (underage).

There

is nothing in the record to indicate that either Mr. or
Ms. Moore lacked capacity.
The second element is a present, mutual agreement to
enter

permanently

the

marriage

relationship

exclusion of all other relationships.
2d at 480.

to

the

Boswell, 487 So.

No particular words of consent, nor proof of

words of consent, are required.

13

See Beck, 246 So. 2d at

425.

An

agreement

may

be

inferred

from

the

circumstances. See Moore v. Heineke, 24 So. 374, 378-79
(Ala. 1898), overruled on other grounds by Alexander v.
Gibson, 57 So. 760 (Ala. 1912).

If the couple consents

and rears children together and others recognize them
through their declarations and conduct as being married,
a trier of fact may infer that a marriage exists.

Id;

see also Sloss-Sheffield Steel & Iron Co. v. Watford, 17
So. 2d 166 (Ala. 1944).
The same behavior that evinces agreement to marry
may also satisfy the third element: public recognition
of the relationship as a marriage and public assumption
of marital duties and cohabitation. Crosson v. Crosson,
668 So. 2d 868, 870 (Ala. Civ. App. 1997).

To prove

this third prong, Alabama courts have looked to many
factors.

See, e.g., Cross v. Rudder, 380 So. 2d 766,

773 (Ala. 1979) (man’s reliance on advice of lawyer that
he had common-law marriage with the mother of his
children

was

an

indication

14

man

considered

himself

married); Adams v. Boan, 559 So. 2d 1084, 1086 (Ala.
1990)

(sharing

of

household

expenses);

Copeland

v.

Richardson, 551, So. 2d 353, 355 (Ala. 1989) (maintained
joint accounts); Crosson, 668 So. 2d at 871 (referred to
or introduced each other as spouse, filed joint-tax
returns); Aaberg v. Aaberg, 512 So. 2d 1375, 1377 (Ala.
1987) (used the same surname); Downs v. Newman, 500 So.
2d 1062, 1063 (Ala. 1986) (parties’ own designations of
themselves on documents); Mills v. Bose, 435 So. 2d 1264
(Ala. 1983) (reared children together).

But the most

crucial part of establishing this third element is that
others in the public recognize them as husband and wife.
See, e.g., Vinson v. Vinson, 69 So. 2d 431, 432, (Ala.
1953) (finding “no proof that [the parties’] neighbors
or friends knew of them as husband and wife”); John B.
Crawley, Is the Honeymoon over for Common-Law Marriage:
A

Consideration

of

the

Continued

Viability

of

the

Common-Law Marriage Doctrine, 29 Cumb. L. Rev. 399, 40910 (1999).

15

As to the present case, Metropolitan Life argues
that

Ms.

Moore

failed

to

provide

sufficient

documentation to substantiate that a common-law marriage
existed.
The

This court disagrees.
court

has

analyzed

the

evidence

in

the

administrative record that Metropolitan Life possessed
regarding Ms. Moore’s claim from the time she filed for
dependent-benefits

coverage

to

the

time

the

administrative remedies were exhausted. The information
Ms. Moore submitted to Metropolitan Life states that she
and Mr. Moore cohabitated for over 24 years, the last 14
of which were in Alabama.

The Moores reared children

together. They held themselves out as husband and wife;
she took his name.

They also listed each other as

spouse on some, but not all, documents.

Furthermore,

Ms. Moore provided the names of three individuals who
would testify that they knew the couple as husband and
wife.

16

The standards for common-law marriage in Alabama,
weighed with the documentation Ms. Moore provided to
Metropolitan Life, lead this court to conclude that the
two

had

sufficient

capacity,

agreement,

and

public

recognition to establish a common-law marriage.

The

insurance company is quick to point out that there were
inconsistencies in the way the Moores characterized
their marital status and argues that this undermines Ms.
Moore’s claim to benefits. However, these instances are
actually telling.

Ms. Moore did not see herself as

“married,” but rather as “common-law married.” When she
was presented with a choice between married or single,
she listed single.

When given the option to choose

“other,” she always chose “other” and wrote out to the
side, “common-law married.”

While this case would be

even more clear-cut if Ms. Moore had consistently listed
“married,” “once a couple is married by common-law,
subsequent representations of a single status do not
invalidate the marriage by common law anymore than such

17

representations

would

invalidate

a

marriage

by

ceremony.” See Matter of Estate of Stodola, 519 N.W. 2d
97, 100 (Iowa Ct. App. 1994) (citing In re Estate of
Fisher, 176 N.W. 2d 801 (Iowa 1970)).

In addition, to

fault Ms. Moore, who is not learned in legal niceties,
for drawing a distinction between common-law married and
just married is not only to exalt form over substance,
it suggests an unsavory relish in the use of the petty
against her.
Because Metropolitan Life’s decision was de novo
“wrong” under the first step of the modified Williams
test,

the

insurance

next

step

company

was

is

to

determine

vested

with

whether

discretion

the
in

reviewing claims.
The parties dispute whether Metropolitan Life had
discretionary authority to construe the plan’s terms.
Ms. Moore argues that the plan did not expressly grant
the insurance company discretionary authority to make
eligibility determinations or construe the plan’s terms.

18

Her argument misses the mark.
states

that

the

plan

The plan explicitly

administrator

“shall

have

discretionary authority to interpret the terms of the
Plan and to determine eligibility for and entitlement to
Plan benefits in accordance with the terms of the Plan.”
Benefit Plan - Part Two (Doc. No. 57-4) at 38.
Furthermore, the Eleventh Circuit Court of Appeals
has held that language requiring submission of proof
“satisfactory to” an administrator confers discretionary
authority on the administrator.

See, e.g., Tippitt v.

Reliance Standard Life Ins. Co., 457 F.3d 1227, 1233-34
(11th Cir. 2006) (holding that language requiring the
claimant

to

“submit

satisfactory

proof”

to

an

administrator conferred discretionary authority on the
administrator).

Metropolitan Life’s plan documents

state that, when filing a claim for benefits, Ms. Moore
must submit “proof” “satisfactory to” the insurance
company.

Benefit Plan - Part Two (Doc. No. 57-4) at 7,

31.

19

Thus, under the plan, Metropolitan Life did have
discretion to “interpret the terms of the Plan and to
determine

eligibility

for

and

entitlement

to

Plan

benefits in accordance with the terms of the Plan.” Id.
at 38.

Because the administrator’s decision is “de novo

wrong” and it was vested with discretion in reviewing
claims, this court moves on to step three to determine
whether

“reasonable”

Life’s decision.

grounds

supported

Metropolitan

In other words: Was the insurance

company’s decision arbitrary and capricious?
The

parties

dispute

two

issues

surrounding

the

reasonableness of Metropolitan Life’s decision: which
decision is reviewable and whether sufficient evidence
had been submitted for a proper determination.
Metropolitan Life’s first reason for denying Ms.
Moore’s claim was that her marriage was invalid because
her

and

Mr.

Moore’s

cohabitation

began

in

1985

in

Wisconsin, a State that does not recognize common-law
marriage.

Even after Ms. Moore notified the insurance

20

company that the couple had resided in Alabama since
1995 and Alabama law applied, the insurance company
upheld its initial denial based on Wisconsin law.

Ms.

Moore argues that it is inexcusable that Metropolitan
Life, having been made aware of its error in choice of
law, would continue to insist on an untenable position.
It is the ultimate “decision” that a court must affirm
or reverse, but a full and fair review includes “a
review that takes into account all documents, records,
and other information submitted by the claimant relating
to the claim, without regard to whether such information
was submitted or considered in the initial benefit
determination.”
Consideration

of

29

C.F.R.

the

full

§

2560.503-1(h)(2)(iv).

administrative

record

is

essential because the insurance company’s final decision
is the result of multiple frivolous denials and the
creation
erroneous

of

a

record

assertion

distorted
that

by

Wisconsin

its
law

admittedly
applied.

Metropolitan Life’s repeated references to Wisconsin

21

law–-even after it was aware that Ms. Moore claimed
Alabama

law

applied–-raise

concerns

about

willingness to review fairly Ms. Moore’s file.

its
This

court, therefore, cannot look at the insurance company’s
final decision in a vacuum.
Metropolitan Life’s second argument is that Ms.
Moore failed to satisfy the “public recognition” prong
of the Alabama common-law-marriage test.

After her

second appeal, the insurance company notified her that,
pursuant to the insurance company’s own policies and
procedures, she must provide two of three specific
documents to substantiate her marriage.

While a joint

lease or deed, joint bank accounts, credit cards or
other investments, or a jointly filed federal-tax return
may

be

considered

as

circumstantial

evidence

of

a

common-law marriage, they are not a sine qua non under
Alabama law for any marriage.

In other words, Alabama

law does not restrict proof to two of the three and only
two of the three.

22

The

court

finds

this

particular

list

documents troubling for several reasons.

of

three

First, the

items required in this list were already requested in
the common-law questionnaire that Ms. Moore completed.
Furthermore,

these

documents

that

Metropolitan

Life

deemed necessary for Ms. Moore to produce represent only
seven questions on a 26-question survey and are not
identified as requisite, or even of increased import.
Second, Ms. Moore had already responded that she rented
her home.
lease

if

The questionnaire asked for a copy of the
it

showed

joint

leasehold.

Ms.

Moore’s

omission of a copy of the lease points to the fact that
it likely did not show joint leasehold and thus would
not have satisfied Metropolitan Life, even if provided.
Next, there were only three questions on the entire
questionnaire

that

Ms.

Moore

left

blank:

those

requesting information for joint checking, savings, and
investment

accounts–-the

precise

information

Metropolitan Life determined to be required.

23

Last, the

third

option

for

proving

a

common-law

marriage

to

Metropolitan Life was marital status on the last federal
income-tax

return–-an

answer

Ms.

Moore

had

already

provided.

The insurance company, in requiring two out

of

of

three

these

categories

to

be

submitted

and

satisfied, demanded financial entanglement of spouses
that

is

not

even

required

for

ceremonially

married

couples. Furthermore, the insurance company’s responses
to Ms. Moore show that it ignored evidence that was
already in hand.
While Metropolitan Life may require proof of a
common-law marriage to avoid fraudulent claims, it may
not use its discretionary authority to require evidence
to establish that the claimant is “legally” entitled to
recover damages when Alabama law itself does not require
that same evidence to prove legality.
The Supreme Court of Alabama has examined heightened
corroborative-evidence
contracts.

requirements

in

insurance

In Walker v. GuideOne Specialty Mut. Ins.

24

Co., the Alabama Supreme Court examined an insurance
company’s denial of benefits under an uninsured-motorist
statute.
that,

834 So. 2d 769 (Ala. 2002).

where

the

insurance

company’s

The court held
corroborative-

evidence requirement contractually raised the burden of
proof higher than it was under Alabama law, it was void
and unenforceable because to hold otherwise would permit
the insurance company to alter Alabama law.

Id. at 773.

The court also stated that, if the insured was “legally
entitled”

under

“establish

an

Alabama

law,

evidentiary

the

hurdle

insurer
of

could

not

corroborative

evidence to bar legally entitled [individuals] from
recovery ... in its policy.” Id.

The Supreme Court of

Alabama recognized that, while the insurance company had
a valid desire to protect against fraud, neither the
court nor the insurance company could impose a heightened
requirement

that

the

legislature

did

not

deem

the

situation to warrant the requirement. Id. at 774. While
the uninsured-motorist provision in Walker was in a

25

statute and common-law marriage in Alabama is by its very
definition created by the judiciary, this court sees no
basis for creating a new common-law-marriage requirement
under Alabama law.

The effect is the same.

Neither this court, nor Metropolitan Life can read
into Alabama law a common-law-marriage requirement that
simply is not there. The insurance company may interpret
the terms of its plan, but it may not rewrite the laws
of Alabama. The terms of Ms. Moore’s plan stated “lawful
spouse.” Under Alabama law, Mr. Moore was Ms. Moore’s
lawful spouse.

The insurance company’s decision to

restrict the documents that may establish a common-law
marriage in Alabama is unreasonable.
Because Metropolitan Life’s basis for denial was
arbitrary and capricious, this court need not reach the
issue of whether the insurance company operated under a
conflict of interest.

As such, the insurance company’s

decision is reversed, and Ms. Moore should obtain full
access to benefits under the plan.

26

*

*

*

An appropriate judgment in favor of Ms. Moore and
against Metropolitan Life and the other defendants will
be entered.
DONE, this the 10th day of June, 2013.
/s/ Myron H. Thompson
UNITED STATES DISTRICT JUDGE