Bruce-Thomas v. Hartford Life and Accident Insurance Company

Filing 34

ORDER granting 32 Motion for summary judgment. Signed by Judge Roy B. Dalton, Jr. on 2/20/2015. (VMF)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
ORLANDO DIVISION
GLENDA BRUCE-THOMAS,
Plaintiff,
v.

Case No. 6:14-cv-1194-Orl-37DAB

HARTFORD LIFE AND ACCIDENT
INSURANCE COMPANY,
Defendant.
ORDER
This cause is before the Court on Hartford Life and Accident Insurance Company’s
Amended Motion for Summary Judgment with Statement of Undisputed Material Facts
and Memorandum of Law (Doc. 32), filed January 6, 2015. Upon consideration, the Court
finds that the Motion is due to be granted.
BACKGROUND
On August 18, 2012, Terry Thomas (“Insured”) died due to an overdose of
Oxycodone and Alprazolam. (See Doc. 32-1, pp. 40–41; Doc. 32-2, pp. 1–2.) At that time,
Defendant Hartford Life and Accident Insurance Company (“Hartford”) had in effect a lifeinsurance policy, which insured the life of Terry Thomas (“Policy”). (See Doc. 32-1,
pp. 24–39.) Under the Policy, Plaintiff—the Insured’s wife—would be entitled to death
benefits if the Insured died from an “injury.” (See Doc. 32-1, pp. 24–39; Doc. 32-2, p. 5.)
On November 8, 2012, Plaintiff submitted a “Proof of Loss-Accidental Death” claim
form to Hartford in order to collect on the Policy. (See Doc. 32-2, p. 5.) Hartford denied
Plaintiff’s claim for death benefits. (See id. at 6–8.) It sent Plaintiff a letter explaining that
the Insured’s death “did not result from accidental injury independent of all other causes,

which is a required condition for benefits to become payable under the Policy” because
his death was “due to combined toxicity of oxycodone and alprazolam, a complication of
his prescribed treatment of his medical conditions.” (Id. at 7.) Plaintiff appealed Hartford’s
decision but, after independent review, Hartford re-affirmed its denial of Plaintiff’s claim.
(See id. at 9–11.) In doing so, Hartford explained:
Based upon our review, we find that Mr. Thomas’ death
occurred . . . with the immediate cause of death reported as
combined toxicity of Oxycodone and Alprazolam . . . . [H]e
was prescribed these medications for the treatment of a
sickness or disease; specifically, chronic pain, cervical
radiculopathy and anxiety. As his loss was the result of his
use of medications that were prescribed for treatment of a
sickness or disease; his loss is not the result of an Injury as
defined by the Policy. Therefore we have concluded that no
accidental death benefit is payable . . . .
(Id. at 11.)
On June 23, 2014, Plaintiff initiated the current action in state court to recover
under the Policy. (Doc. 2.) Because suits brought “by a beneficiary to recover benefits
from a covered plan” fall directly under § 1132(a)(1)(B) of the Employee Retirement
Income Security Act (“ERISA”), Hartford timely removed the action to federal court,
asserting federal question jurisdiction. (See Doc. 1.)
On January 6, 2015, Hartford filed an Amended Motion for Summary Judgment
with Statement of Undisputed Material Facts and Memorandum of Law. (See Doc. 32.)
Plaintiff’s response was due by February 9, 2015. (See Doc. 33, p. 2.) To date, Plaintiff
has not responded. Thus, the Motion is deemed unopposed, and the Court takes it under
advisement. 1 See Local Rule 3.01(b).
1The

“mere fact” that a motion for summary judgment is unopposed is an
insufficient basis for “entry of summary judgment.” See Jacoby v. Baldwin Cnty.,

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STANDARDS
I.

Summary Judgment

The Court may resolve a claim or defense by entry of summary judgment “if the
movant shows that there is no genuine dispute as to any material fact and that the movant
is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The movant must support
its assertions “that a fact cannot be” genuinely disputed by “citing to particular parts of
materials in the record, including depositions, documents, electronically stored
information, affidavits or declarations, stipulations . . . , admissions, interrogatory
answers, or other materials.” Fed. R. Civ. P. 56(c)(1)(A). If the movant “fails to properly
support an assertion of fact . . . the court may”: (1) afford the movant an “opportunity to
properly support or address the fact”; (2) “grant summary judgment if the motion and
supporting materials—including facts considered undisputed—show that the movant is
entitled to it”; or (3) “issue any other appropriate order.” Fed. R. Civ. P. 56(e).
II.

ERISA Standard of Review

Review of Hartford’s benefits decisions is governed by 29 U.S.C. § 1132(a)(1)(B).
Plaintiff has the burden to prove her entitlement to benefits under the Policy. See Wilson
v. Walgreen Income Protection Plan for Pharmacists & Registered Nurses, Walgreen Co.,
942 F. Supp. 2d 1213, 1247 (M.D. Fla. 2013). “ERISA itself provides no standard for
courts reviewing the benefits decisions of plan administrators.” Blankenship v. Metro. Life
Ins. Co., 644 F.3d 1350, 1354 (11th Cir. 2011) (citing Firestone Tire & Rubber Co. v.

No. 13-12444, 2014 WL 7399079, at *3 (11th Cir. Dec. 31, 2014). The Court must always
consider the merits of a motion for summary judgment. See id.; see also Trs. of Cent.
Pension Fund of Int’l Union of Operating Eng’rs & Participating Emp’rs v. Wolf Crane
Serv., Inc., 374 F.3d 1035, 1039 (11th Cir. 2004); Fed. R. Civ. P. 56(e)(3).

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Bruch, 489 U.S. 101 (1989)). The Eleventh Circuit therefore established a multi-step
framework to guide courts in reviewing an ERISA plan administrator’s benefits decisions
based on guidance from the Supreme Court in Firestone and Metro. Life Ins. Co. v. Glenn,
54 U.S. 105 (2008). In reviewing a plan administrator’s benefits decision, the Court must
do the following:
(1) Apply the de novo standard to determine whether the
claim administrator’s benefits-denial decision is “wrong”; if
it is not, then end the 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 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 . . . . (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. (5) If there is no
conflict, then end the inquiry and affirm the decision. (6) If
there is a conflict, 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, 644 F.3d at 1355 (citation omitted); see also Williams v. Bellsouth
Telecomms., Inc., 373 F.3d 1132, 1137–38 (11th Cir. 2004), overruled on other grounds
by Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352 (11th Cir. 2008).
DISCUSSION
Hartford argues that its denial of benefits was appropriate because the Insured’s
death was not caused by an “injury” and it is therefore not covered by the Policy.
(See Doc. 32, pp. 6–8.) In support, it asserts that “the Policy unambiguously provides that
the death benefit is payable only for death resulting from an ‘Injury’ as defined in the
Policy.” (Id.) The Court agrees.

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The Policy provides that Hartford will pay 100 percent of the principal sum of the
Policy if the Insured’s death results from “Injury.” (See Doc. 32-1, p. 36.) “Injury” is defined
in the Policy as:
bodily injury resulting directly from accident and
independently of all other causes which occurs while the
Covered Person is covered under the Policy. Loss resulting
from: 1) sickness or disease . . . or b) medical or surgical
treatment of a sickness or disease; is not considered as
resulting from injury.
(See Doc. 32-1, p. 35 (emphasis added).) Accordingly, if an insured’s death results from
medical treatment of a sickness or disease, then his death is not a covered “injury” under
the Policy.
“[M]edical treatment of a condition includes death caused by accidentally
overdosing on a drug prescribed by a doctor for a medical condition.” Raymond v. Life
Ins. Co. of N. Am., 924 F. Supp. 2d 1345, 1350 (S.D. Fla. 2010) (“[A] patient’s . . . mistake
in the administration of drugs medically prescribed to treat a condition or illness is not a
‘covered loss’ in an accidental death policy that contains an exclusion for treatment of a
medical illness.”). It is uncontested that the Insured died from an accidental overdose of
medications, specifically Oxycodone and Alprazolam, prescribed by the Insured’s doctor
to treat his chronic pain, cervical radiculopathy, and anxiety. (See Doc. 32-1, pp. 40–41;
Doc. 32-2, pp. 1–3.) Prescribing medications to alleviate or cure such conditions is
deemed a medical treatment under Hartford’s Policy. See, e.g., Cady v. Hartford Life &
Accidental Ins. Co., 930 F. Supp. 2d 1216, 1228 (D. Idaho 2013) (concluding that a
prescription of Alprazolam, also known as Zanax, to alleviate anxiety constituted medical
treatment under Hartford’s policy).
Further, the conditions for which the insured was prescribed medication—chronic

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pain, cervical radiculopathy, and anxiety (see Doc 32-2, p. 3)—constitute a “sickness or
disease.” See, e.g., Raymond, 924 F. Supp. 2d at 1352 (concluding that chronic pain
constitutes a sickness or disease within the medical treatment exclusion); Foote v.
Chater, 67 F.3d 1553, 1556 (11th Cir. 1995) (stating that cervical radiculopathy is a
disease of the nerve roots). The Insured’s overdose therefore falls within the “medical
treatment of a sickness or a disease” exception to “injury” under the Policy.
Hartford, by examining the Policy (Doc. 32-1, pp. 24–39), Death Certificate (Doc.
32-2, pp. 1–2), and Autopsy and Toxicology Report (Doc. 32-1, pp. 40–46), conducted a
sufficiently thorough investigation to justify its decision to deny benefits. There is no
evidence in the record of any cause of death other than an overdose of medications, nor
has Plaintiff provided any additional evidence to the contrary. Moreover, the language of
the Policy and the undisputed facts, viewed in the light most favorable to Plaintiff, do not
raise any genuine issues of material fact. Thus, after a de novo review, the Court cannot
determine the benefits-denial decision is wrong and ends its inquiry, see Blankenship,
644 F. 3d at 1355; Plaintiff cannot recover under the Policy.
CONCLUSION
Accordingly, it is hereby ORDERED AND ADJUDGED:
1.

Defendant’s Amended Motion for Summary Judgment with Statement of
Undisputed Material Facts and Memorandum of Law (Doc. 32) is
GRANTED.

2.

The Clerk is DIRECTED to enter judgment in favor of Defendant Hartford
Life and Accident Insurance Company and against Plaintiff Glenda BruceThomas and to CLOSE the file.

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DONE AND ORDERED in Chambers in Orlando, Florida, on February 20, 2015.

Copies:
Counsel of Record

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