Claudia Nelson Family Trust v. Hartford Life and Accident Insurance Company
ORDER AFFIRMING DEFENDANT'S DENIAL OF BENEFITS. The Court ORDERS the Trusts claim for supplemental life insurance benefits is DENIED, the Clerk shall enter final judgment in favor of Hartford; and the parties shall bear their own costs. by Judge William J. Martinez on 07/08/2015. (cthom, )
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
Judge William J. Martínez
Civil Action No. 14-cv-2092-WJM-KLM
THE CLAUDIA NELSON FAMILY TRUST, by Elizabeth A. Spanel, trustee,
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY,
ORDER AFFIRMING DEFENDANT’S DENIAL OF BENEFITS
This case arises under the Employee Retirement Income Security Act of 1974,
29 U.S.C. §§ 1001 et seq. (“ERISA”). Plaintiff, the Claudia Nelson Family Trust
(“Trust”), claims that Defendant Hartford Life and Accident Insurance Company
(“Hartford”) violated ERISA when it issued its final determination letter denying
supplemental life insurance benefits to Claudia Nelson (“Nelson”), who died on January
8, 2013. (ECF No. 1.)
For the reasons set forth below, Hartford’s denial of benefits is affirmed and the
Trust’s claim for disability benefits is denied.
I. FACTS & PROCEDURAL HISTORY
The Plan and the Policy
Nelson was a copy editor for her employer, Swift Communications (“Swift”).
(ECF No. 29 at 7, ¶ 1.) 1 Nelson was therefore a participant in Swift’s group employee
benefits plan (“Plan”). (Id. at 8, ¶ 2.)
Effective January 1, 2013, Hartford funded the Plan through Group Policy No.
GL-872957 (“Policy”). “The Policy [was] incorporated into, and form[ed] a part of, the
Plan.” (Administrative Record (“R.”) (ECF Nos. 21-1 to 21-4 and 37-1 to 37-2) at 35.)
ERISA governs both the Plan and the Policy. (Id. at 26, 35.) The Plan designates
Hartford as the claims fiduciary for benefits provided under the Policy. (Id. at 35.) The
Plan grants Hartford “full discretion and authority to determine eligibility for benefits and
to construe and interpret all terms and provisions of the Policy.” (Id.)
The Supplemental Life Insurance Policy
Sometime in 2012, Nelson developed cancer. (Id. at 194.) Her “actual date last
physically at work” was September 7, 2012. (Id. at 198.) In November 2012, however,
Nelson took advantage of Swift’s open enrollment period for 2013 to enroll for a
supplemental life insurance benefit of $50,000. (Id. at 189.) On January 8, 2013,
Nelson succumbed to her cancer. (Id. at 194.)
The Trust’s Claim
By letter dated May 28, 2013, Nelson’s husband (apparently acting on the Trust’s
behalf) made a claim on Hartford both for basic life insurance benefits in which Nelson
had been enrolled for many years, as well as for the supplemental benefits in which she
had just enrolled. (Id. at 186.) Hartford began to investigate the claim, and in particular
communicated several questions to Swift, including an e-mail asking Swift to clarify
All page citations for ECF documents are to the page number specified in the ECF
header, which does not always match the document’s internal pagination.
whether Nelson’s supplemental life insurance was a continuation of a previous year’s
benefits or whether Nelson instead had enrolled for the first time in the previous year’s
open enrollment period. (Id. at 184.) Swift replied, confirming that Nelson had enrolled
for the first time in the previous year’s open enrollment period, for a policy effective
January 1, 2013. (Id. at 179.) Swift further clarified that Nelson “was off work, but on a
paid medical leave (vacation, sick, MML [Swift’s major medical leave program]) through
December 2012.” (Id. at 174.)
Swift also filled out and sent to Hartford a Hartford-issued “proof of death form.”
(Id. at 198.) One line in that form states, “Provide employee’s actual date last physically
at work,” to which Swift responded, “09/07/2012.” (Id.) The next line of the form states,
“Provide a reason employee did not return to work on their next scheduled workday,”
and provides checkboxes for four responses: “Illness,” “FMLA (provide approval form),”
“Retirement,” and “Other (please explain).” (Id.) Swift checked “FMLA (provide
approval form),” but apparently did not attach any approval form. (Id.)
Through other parts of the form, Swift informed Hartford of Nelson’s earnings,
stating that “[e]ffective . . . 01/09/2013” (i.e., the day after Nelson’s death) her “[r]egular
hours scheduled to work” were “40.” (Id.)2 Swift also reported that Nelson’s insurance
was “discontinued” as of “01/31/2013.” (Id.)
Hartford’s Denial of Supplemental Life Insurance Benefits
By letter dated July 16, 2013, Hartford informed the Trust that it had approved
Nelson’s basic life insurance benefits but denied Nelson’s supplemental life insurance
The Trust interprets this to mean that Swift was paying Nelson her regular wages
through January 9, 2013. (ECF No. 30 at 3.)
benefits (“Denial Letter”). (Id. at 71–75.) Noting that Nelson’s supplemental life benefit
was scheduled to become effective January 1, 2013, at the earliest, Hartford pointed to
the following portion of the Policy regarding circumstances in which that effective date
could be deferred:
Deferred Effective Date: When will my effective date for
coverage or a change in my coverage be deferred?
If, on the date You are to become covered:
1) under The Policy;
2) for increased benefits; or
3) for a new benefit;
You are not Actively at Work such coverage will not start
until the date You are Actively at Work.
(Id. at 72 (quoting id. at 11) (formatting in original).) Hartford’s Denial Letter then
quoted the definition of “Actively at Work”:
Actively at Work means at work with Your Employer on a
day that is one of Your Employer’s scheduled workdays. On
that day, You must be performing for wage or profit all of the
regular duties of Your job:
1) in the usual way; and
2) for Your usual number of hours.
We will also consider You to be Actively [a]t Work on any
regularly scheduled vacation day or holiday, only if You were
Actively [a]t Work on the preceding scheduled work day.
(Id. at 73 (quoting id. at 27) (formatting in original).)
The Denial Letter then provided the following explanation:
We based our decision to deny your claim for benefits on
Policy Language and all documents contained in
Ms. Nelson’s claim file, viewed as a whole, including the
following specific information:
State of Colorado death certificate for Claudia Jane
Proof of Death Claim form completed by a
representative of Swift Communications[.]
Supplemental Life Insurance Enrollment form dated
January 1, 2013.
E-mail verification of coverage from a representative
of Swift Communications.
The State of Colorado death certificate for Claudia Nelson’s
[sic] indicates her date of death was January 8, 2013.
The Proof of Death Claim form completed by a
representative of Swift Communications indicates that
Ms. Nelson’s date last physically worked was September 7,
2012 due to FMLA.
The documentation on file indicates that Ms. Nelson elected
Supplemental Life Insurance for an effective date of January
1, 2013. Based on the information reviewed, Ms. Nelson’s
last day actively at work was September 7, 2012 due to
FMLA and there is no indication that she returned to work
prior to her death on January 8, 2013 . . . . Accordingly,
since Ms. Nelson was not Actively at Work on the date the
Supplemental Life was to become effective, on January 1,
2013, and she did not return to work as an Active Employee
at any time after this date, the Supplemental Group Life
Insurance benefits are not payable.
(Id. at 73–74.)
The Denial Letter went on to inform the Trust of its right to appeal: “If you do not
agree with the reason why your claim was denied, in whole or part, and you wish to
appeal our decision, you must write to us within sixty (60) days of the date of this letter.”
(Id. at 74.)
According to the Denial Letter’s 60-day appeal deadline, the Trust had until
September 14, 2013 to submit its appeal. It did not do so by that date. Rather,
Hartford and the Trust communicated several times about information needed to pay
the basic life insurance benefits. (Id. at 58–59, 69, 70.) On October 3, 2013, Nelson’s
husband called Hartford regarding this issue and also stated the Trust’s intent to
dispute Hartford’s denial of supplemental benefits. (Id. at 59.) On December 23, 2013,
the Trust sent written materials to Hartford regarding the basic life insurance benefits
and also stated, “we will be filing an appeal” of the supplemental life denial. (Id. at 92.)
The Trust “requested that you [Hartford] provide a complete copy of the policies for
Claudia’s Standard and Supplemental Life Policies for review.” (Id.)
Finally, on January 27, 2014, the Trust, through its attorney, submitted a written
appeal. (Id. at 78–79.) The Trust argued as follows:
Swift Communications is subject to the Family Medical
Leave Act (“FLMA” [sic]). The FMLA entitles covered
employees to up to 12 weeks of leave each year for their
own serious illness. Hartford’s Policy extends coverages for
12 weeks of FMLA leave. Claudia’s last date physically at
work was September 7th 2012. Ms. Nelson was on
approved leave the next working day after September 7th
2012. Claudia was required by Swift’s Extended Medical
Leave Program to first exhaust her vacation time, personal
leave time, and sick leave before beginning FMLA leave.
Claudia was absent from work after September 7th 2012
due to a physical condition.. [sic] She was on regularly
scheduled vacation leave beginning September 10th, which
was her next regularly scheduled work day. She then
exhausted her sick leave and personal leave before
beginning FMLA leave. She was within the twelve week
period of FMLA leave at the time of her death. . . .
This assertion does not accurately summarize the Policy’s application to this case, as
discussed in Part III.D, infra.
Claudia was considered to be Actively at Work for purposes
of coverages, including supplemental Group Life Insurance,
from September 10th 2012 until her death on January 8,
2013 pursuant to the terms of the Policy since she was on
regularly scheduled leave, sick leave, personal leave, and
then FMLA leave.
(Id.) The Trust also repeated a request for “a copy of the complete Hartford Policy
issued to Swift.” (Id. at 79.)
By letter dated February 10, 2014, Hartford responded that the appeal was
“submitted beyond the specified 60-day appeal period and, because of the late appeal
submission, cannot be considered.” (Id. at 66.) In argument to this Court, the Trust
claims that it finally received a complete copy of the Policy from Hartford eight days
later. (ECF No. 28 ¶ 4.)
II. LEGAL STANDARD
ERISA governs employee benefit plans, including disability benefit plans.
29 U.S.C. §§ 1101 et seq. “When an individual covered by the plan makes a claim for
benefits, the administrator gathers evidence, including the evidentiary submissions of
the claimant, and determines under the plan’s terms whether or not to grant benefits. If
the administrator denies the claim, the claimant may bring suit to recover the benefits
due to him under the terms of his plan.” Jewell v. Life Ins. Co. of N. Am., 508 F.3d
1303, 1308 (10th Cir. 2007) (internal quotation marks omitted; alterations incorporated).
Federal courts have exclusive jurisdiction over such suits, as ERISA preempts most
relevant state laws. 29 U.S.C. § 1144(a).
The Supreme Court has held that “a denial of benefits challenged under [the civil
enforcement provision of ERISA, 29 U.S.C.] § 1132(a)(1)(B)[,] is to be reviewed under a
de novo standard unless”—as is the case here (see R. at 35)—“the benefit plan gives
the administrator or fiduciary discretionary authority to determine eligibility for benefits
or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101, 115 (1989). In such a situation, the Court determ ines whether the denial of
benefits was arbitrary and capricious. Id.4
Under the arbitrary and capricious standard, the administrator’s decision need
not be the only logical one or the best one; the decision will be upheld provided that it is
“grounded on any reasonable basis.” Kimber v. Thiokol Corp., 196 F.3d 1092, 1098
(10th Cir. 1999). “The reviewing court need only assure that the administrator’s
decision falls somewhere on a continuum of reasonableness—even if on the low end.”
Nance v. Sun Life Assurance Co. of Can., 294 F.3d 1263, 1269 (10th Cir. 2002).
Here, Hartford both evaluates and pays any claim for benefits. (R. at 35.) It
therefore has an inherent conflict of interest between its own desire to turn a profit and
its fiduciary duty to fairly evaluate all claims. Metro. Life Ins. Co. v. Glenn, 554 U.S.
105, 112 (2008). The effect of that conflict of interest, if any, is one factor that this
Court must consider when evaluating whether Hartford’s denial was arbitrary and
capricious. Id. at 117.
Supplemental Record Materials
Magistrate Judge Kristen L. Mix granted the Trust’s motion to supplement the
As discussed in greater detail below at Part III.A, Magistrate Judge Kristen L. Mix
entered an order in this matter describing circumstances in which this appeal could be subject
to de novo review. (ECF No. 33 at 6.) The Trust concedes, however, that the arbitrary and
capricious standard applies. (ECF No. 31 at 1–2.)
administrative record. (ECF No. 33.) The Trust thereby obtained permission to
introduce (1) Nelson’s payroll records, (2) a document describing “Swift’s ‘Extended
Medical Leave Program,’” and (3) “evidence of Ms. Nelson being on an approved leave
of absence.” (ECF No. 25 ¶ 6; see also R. at 203–13.) The purpose of these
documents is to “prove that Ms. Nelson was Actively [a]t Work on September 7, 2012
and from September 8, 2012 was on regularly scheduled vacation, sick leave, and
major medical leave, after which she was on FMLA.” (ECF No. 25 ¶ 6.) The Trust
asserts that establishing the foregoing also establishes its right to Nelson’s
supplemental life insurance benefits under the language of the Policy. (Id.)
Although the Magistrate Judge allowed these materials into the record, it is highly
uncertain whether this Court may consider them when reviewing Hartford’s denial. If
this Court was conducting a de novo review, there are limited circumstances in which it
may admit additional material into the record “when necessary to enable the court to
understand and evaluate the decision under review.” Jewell, 508 F.3d at 1309; see
also Hall v. UNUM Life Ins. Co. of Am., 300 F.3d 1197, 1203 (10th Cir. 2002) (“The
party seeking to supplement the record bears the burden of establishing why the district
court should exercise its discretion to admit particular evidence by showing how that
evidence is necessary to the district court’s de novo review.”). But the Trust concedes
that the Court’s review in this case is under the arbitrary and capricious standard. (ECF
No. 34 at 1–2.) Under that standard, Tenth Circuit “case law prohibits courts from
considering materials outside the administrative record where the extra-record materials
sought to be introduced relate to a claimant’s eligibility for benefits.” Murphy v. Deloitte
& Touche Grp. Ins. Plan, 619 F.3d 1151, 1162 (10th Cir. 2010). 5
Here, the Trust’s supplemental record materials “relate to [Nelson’s] eligibility for
benefits.” (See R. at 203–13.) Indeed, the Trust wants those materials considered
specifically to demonstrate that Nelson satisfied the terms of the Actively at Work
requirement. (ECF No. 25 ¶ 6.) Under the Murphy decision, that would appear to be
an impermissible purpose. But the Court cannot be entirely confident with that
conclusion because the supplemental materials are no longer extra-record. The
Magistrate Judge admitted them into the record (ECF No. 33), and Hartford waived any
challenge to that decision when it failed to timely object. Fed. R. Civ. P. 72(a) (“A party
may serve and file objections to the order within 14 days after being served with a copy.
A party may not assign as error a defect in the order not timely objected to.”).
In addition, the Trust has also asserted other purposes for the supplemental
record material. In particular, the Trust claims that those materials show “procedural
irregularities,” referring to its position that Hartford treated the Trust unfairly with respect
to the appeal. (See, e.g., ECF No. 34 at 3–4.) The Trust argues that these alleged
procedural irregularities show a conflict of interest, which the Court is obligated to
consider when determining whether Hartford’s decision was arbitrary and capricious.
See Glenn, 554 U.S. at 112, 117.
Murphy specifically dealt with requests for discovery as part of the district court review
process, see id. at 1154, but discussed the question in the context of “extra-record
supplementation” generally, id. at 1159. As to the Tenth Circuit’s holding that district courts
may not consider “materials outside the administrative record where the extra-record materials
sought to be introduced relate to a claimant’s eligibility for benefits,” id. at 1162, this Court sees
no reasoned distinction between pre-existing extra-record materials and those sought to be
developed through discovery.
The Trust’s invocation of procedural irregularities, however, is misdirected.
Procedural irregularities are a reason for a court to apply de novo review even when the
applicable plan would normally receive arbitrary and capricious review. See LaAsmar v.
Phelps Dodge Corp. Life, Accidental Death & Dismemberment & Dependent Life Ins.
Plan, 605 F.3d 789, 796–800 (10th Cir. 2010). T hat is not an issue here. The Trust
has repeatedly stated that arbitrary and capricious is the appropriate review standard.
(ECF No. 30 at 8–9; ECF No. 32 at 3; ECF No. 34 at 1–2.)
Nonetheless, the Trust’s invocation of procedural irregularities in the appeals
process could be construed as a reference, however inartful, to the idea that a plan
administrator such as Hartford “may be found to have abused its discretion where it
refuses to consider materials submitted for its review by the plan participant.” Murphy,
619 F.3d at 1159 n.3. 6 Such refusal would seem to be independent evidence of
potential arbitrariness or capriciousness, as well as evidence of a conflict of interest (at
least in the general sense that refusal to consider relevant materials is consistent with a
desire to avoid fully and fairly evaluating a claim, which is in turn consistent with an
inference that the plan administrator is putting its own interests ahead of the
Given the ambiguity in this situation, the Court has evaluated its conclusions
below in light of the record as originally filed and the record as supplemented by the
Trust. The Court finds that it would reach the same conclusions either way.
“Abuse of discretion” and “arbitrary and capricious” are “interchangeable” in the context
of ERISA review. Weber v. GE Grp. Life Assur. Co., 541 F.3d 1002, 1011 n.10 (10th Cir. 2008)
(internal quotation marks omitted).
Accordingly, the Court will treat the supplemental record materials as part of the
“Regularly Scheduled Vacation Day or Holiday”
The Trust argues that Nelson was “Actively at Work” at the time of her death
because Swift supposedly classified Nelson as an active employee until her death.
(ECF No. 30 at 10; ECF No. 32 at 6; ECF No. 34 at 10.) Althoug h an employer’s
classification is potentially relevant evidence, see Weber, 541 F.3d at 1014, Swift’s
classification of Nelson makes no difference under the circumstances because it has no
connection to the Policy’s definition of “Actively at Work.”
The Policy provides two ways that a plan participant can satisfy the Actively at
Work requirement. First, the participant can perform all of his or her regular job duties
“in the usual way” and for that participant’s “usual number of hours.” (R. at 27.) The
Trust does not claim that Nelson satisfied this requirement.
Second, a participant will be considered Actively at Work if he or she meets the
foregoing requirements on the “scheduled work day” before a “regularly scheduled
vacation day or holiday.” (Id.) The Trust interprets this to mean that “[t]he Policy
In support of its “procedural irregularities” argument, the Trust repeatedly asserts that,
in phone conversations after the Denial Letter, Hartford repeatedly told Trust representatives
that it (Hartford) would accept any appeal from the Denial Letter, including new documentation
submitted with that appeal, even if submitted after the 60-day appeal deadline had expired.
(ECF No. 30 at 7–8; ECF No. 32 at 2, 6–7.) In support, however, the Trust cites only Hartford’s
telephone call log for October 22 and October 31, 2013. The October 22 entry reads: “recd call
from Mr. Spanel [Nelson’s husband]. He apologized for delay, he is still working on [sic] with
his attorney. He has had difficulty with everything that has happened.” (R. at 59.) The October
31 entry reads: “adjusted diary based on prior call.” (Id.) The Court finds that these two cryptic
call log entries are insufficient to support the claim that Hartford agreed to consider an untimely
appeal. Nonetheless, even if the Court assumed for the sake of argument that the Trust’s claim
had support in the record, it would not alter the Court’s conclusions below.
deem[ed] Ms. Nelson to be ‘Actively at Work’ while on vacation and other leave.” (ECF
No. 32 at 5 (emphasis added).) However, this Court is required to give the words of the
Policy “their common and ordinary meaning, as a reasonable person in the position of
the plan participant (not the actual participant) would have understood them.” Pirkheim
v. First Unum Life Ins., 229 F.3d 1008, 1010 n.2 (10th Cir. 2000). W hile the Policy
certainly deemed Nelson to be Actively at Work while on “vacation,” the Trust has
offered no argument on how an individual in the position of the plan participant could
reasonably assume that “vacation” implicitly extended to “other leave,” and to medical
leave in particular. Failure to offer any such argument could be deemed a waiver. See
D.C.COLO.LCivR 7.1(d) (“a motion involving a contested issue of law shall . . . be
supported by a recitation of legal authority incorporated into the motion”). In any event,
the Court does not believe that a reasonable participant could derive this meaning.
To begin, the entire relevant phrase is “regularly scheduled vacation day or
holiday.” This phrase unambiguously points to “vacation” in the typical sense of “a
period of time that a person spends away from home, school, or business usually in
order to relax or travel.” See Merriam-Webster Online, s.v. “vacation,”
http://www.merriam-webster.com/dictionary/vacation. The modifier “regularly
scheduled” also undermines any assumption that “vacation” extends to “other leave,”
given that such other leave (e.g., sick days) usually is not regularly scheduled. Finally,
the Policy already refers to various types of what one might call “other leave,” including
“a documented leave of absence,” “Family and Medical Leave,” and “Military Leave of
Absence.” (R. at 12.) None of these other types of leave is mentioned in connection
with “regularly scheduled vacation day or holiday.” See Pirkheim, 229 F.3d at 1010 n.2
(“[i]n interpreting the terms of an ERISA plan we examine the plan documents as a
whole” (internal quotation marks omitted; alteration in original)). Accordingly, “regularly
scheduled vacation day” does not encompass “other leave,” at least in the sense of
medical leave. Or, at a minimum, Hartford did not exercise its discretion arbitrarily or
capriciously by interpreting “regularly scheduled vacation day” to exclude individuals on
medical leave. Winchester v. Prudential Life Ins. Co. of Am., 975 F.2d 1479, 1486
(10th Cir. 1992) (“deference must be accorded to the plan administrator in its
interpretation of the plan”).
Under that interpretation and the circumstances of this case, the Trust was
required to establish an unbroken chain of “regularly scheduled vacation day[s] or
holiday[s]” (i.e., non-medical leave days) from September 7, 2012, until January 1,
2013. The Trust did not meet that requirement and therefore did not establish that
Nelson had been Actively at Work on any day in which her supplemental life benefits
could have become effective.
“Due to FMLA”
The Trust nonetheless argues that the following sentence from the Denial Letter
demonstrates an error: “Ms. Nelson’s last day actively at work was September 7, 2012
due to FMLA and there is no indication that she returned to w ork prior to her death on
January 8, 2013.” (R. at 74.) The Trust specifically takes issue with “due to FMLA.”
The Trust argues that, in reality, Nelson was at work on September 7, 2012 and then
began her time off, first through vacation days, then through sick days, then through
Swift’s major medical leave policy. (ECF No. 30 at 3.) But “[s]he was not on FMLA
[leave as of September 7, 2012].” (Id.)
The relevance of this argument is unclear. The Trust appears to be saying that
Hartford was mistaken if it denied Nelson’s benefits under the assumption that she
began FMLA leave on September 7, 2012. The Trust also argues that Hartford had a
duty to investigate further—i.e., although the Proof of Death form specified “FMLA” as
Nelson’s status after her last day physically at work, (a) that same form required Swift to
attach a written FMLA authorization, but no such authorization was attached, and
(b) e-mail correspondence from Swift to Hartford stated that Nelson actually progressed
through vacation hours, sick hours, and major medical leave hours. (ECF No. 30 at 11;
ECF No. 32 at 4–6; ECF No. 34 at 2–3.) Had Hartf ord seriously considered that
evidence, the Trust argues that Hartford would have requested information such as the
payroll records that are now part of the administrative record due to the Magistrate
Judge’s ruling, and Hartford would have somehow concluded that Nelson had been
Actively at Work. (See id.)
In certain circumstances, an ERISA fiduciary has a duty to go beyond the
materials actually submitted and investigate on its own. See Gaither v. Aetna Life Ins.
Co., 394 F.3d 792, 808 (10th Cir. 2004). But even if Nelson was on vacation (rather
than FMLA leave) for the first few weeks following September 7, 2012, and even if
Hartford had requested information such as the payroll records that have now been
added to the administrative record, the outcome would not have changed. The Trust’s
contributions to the administrative record show that Nelson had exhausted her vacation
hours by the end of October. (R. at 206.) She then began using Swift’s “major medical
leave” hours, but appears to have exhausted those in November. (Id.) Finally, the
Trust’s attorneys admit that she moved from major medical leave to FMLA leave, and
remained on FMLA leave until her death. (Id. at 79.) Thus, no later than January 1,
2013 (the first date on which Nelson’s supplemental life insurance could have
potentially become effective), Nelson was on FMLA leave and never returned to work
before her death. FMLA leave is not within the Policy’s definition of Actively at Work.
(See Part III.B, supra.)8
Continuation of Coverage
The Trust also appears to argue that, under the Policy, approved FMLA leave
entitles plan participants to have their life insurance coverage “continued for up to 12
weeks.” (ECF No. 30 at 5 (quoting R. at 13).) But that portion of the Policy has no
effect in this case because Nelson’s supplemental life insurance coverage never
became effective, and therefore could not be “continued.” Accordingly, the Policy’s
provision for FMLA leave is irrelevant under the circumstances.
Conflict of Interest
Finally, this Court must consider what effect, if any, Hartford’s conflict of interest
The record contains a bit of conflict regarding precisely when Nelson began FMLA
leave. In e-mail communications between Swift and Hartford, a Swift representative stated that
Nelson had been on paid leave through December 2012. (R. at 174.) However, Swift’s payroll
records show that Nelson was paid in October 2012 based on vacation and major medical leave
hours, and was paid in November 2012 based on her remaining major medical leave hours, but
was paid nothing in December 2012. (R. at 206.) This suggests unpaid FMLA leave beginning
in December 2012. Regardless, even if the record is viewed in the light most favorable to the
Trust, Nelson was on major medical leave through December 31, 2012, and then on FMLA
leave from January 1, 2013, until her death. Because FMLA leave is not within the Policy’s
definition of Actively at Work, Nelson was never Actively at Work on any day before her death
in which she could have become eligible for the supplemental life insurance.
had on its decision. Glenn, 554 U.S. at 117. Having reviewed the administrative record
and the arguments of the parties, the Court finds that Hartford’s conflict of interest had
no bearing on the outcome of the Trust’s claim for benefits. The language of the Policy
is clear and Hartford applied it according to its terms. Consequently, Hartford’s conflict
of interest does not provide a basis to find that Hartford acted arbitrarily or capriciously.
For the reasons set forth above, the Court ORDERS as follows:
The Trust’s claim for supplemental life insurance benefits is DENIED;
The Clerk shall enter final judgment in favor of Hartford; and
The parties shall bear their own costs.
Dated this 8th day of July, 2015.
BY THE COURT:
William J. Martínez
United States District Judge
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