VANCEL v. UNICARE LIFE INSURANCE COMPANY
ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT; We conclude that the Appeal Committee's denial of benefits to Ms. Vancel was neither arbitrary nor capricious and that the Appeal Committee's decision was well-reasoned and supported by the evidence. Ms. Vancel is not entitled to benefits under the Policy. We GRANT Defendants' Motion for Summary Judgment Dkt. No. #44 and DENY Plaintiff's Motion for Summary Judgment Dkt. No. #36 . Judgment shall enter accordingly. Signed by Judge Sarah Evans Barker on 3/1/2017. (CKM)
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
UNICARE LIFE INSURANCE
COMPANY, FORD MOTOR COMPANY, )
ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT
Before us are cross motions for summary judgment. Plaintiff Janie Vancel filed a
Motion for Summary Judgment [Dkt. No. 36] to which Defendants Ford Motor Company
(“Ford”) and UniCare Life & Health Insurance Company (“UniCare”) responded and
moved for summary judgment in their favor [Dkt. No. 45]. Plaintiff has not responded to
Defendants’ motion for summary judgment and the time for doing so has passed. For the
following reasons, we GRANT summary judgment in favor of UniCare Life Insurance
Company and the Ford Motor Company and against Janie Vancel.
Neither party disputes the facts presented by the opposing party. Plaintiff seeks a
declaration that the death of her husband, Michael Vancel, was an accident within the scope
of coverage provided in an Accidental Death Benefit policy issued to Mr. Vancel. Ford
The parties agreed in the Case Management Plan that our review would be based on the governing
insurance policy and plan and the administrative record.
and UniCare rejoin that Mr. Vancel’s death was not an accident as defined by the Policy
and, as a result, Ms. Vancel is not entitled to benefits under the policy.
Mr. Vancel was a full-time employee for Ford and a participant in Ford’s Life and
Accidental Death and Disability Plan (the “Plan”). The Plan provides benefits through a
group insurance policy issued by UniCare, Group Policy Number GI-GCC (the “Policy”).
The Policy provides, among other things, accidental death and dismemberment benefits for
its eligible participants. Ms. Vancel is a named beneficiary of the Policy.
Ford is the Plan sponsor and administrator while UniCare insures the Policy,
evaluates claims, and pays benefits due to participants as set forth in the terms of the Policy
and Plan. If a claimant is denied benefits and appeals that decision, the UAW-Ford Group
Life and Disability Appeal Committee (the “Appeal Committee’”) reviews the denial of
The Policy contains the following relevant provision:
ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE
Accidental Death Benefit
The Insurer will pay a benefit if your death occurs under these conditions:
1. the death is a result of your accidental bodily injury; and
2. you were insured by this coverage at the time of such injury and at the time of
3. the death occurred within 2 years of the injury.2
It is undisputed that Mr. Vancel was insured at the time of injury (prong 2) and that his death
occurred within two years of the injury (prong 3). [Dkt. No. 46 at 4, n.4.] It is also undisputed
that Janie Vancel is a named beneficiary under the Policy. [Dkt. No. 37 at 3, ¶ 7.] The only issue
to be resolved in this case is whether Mr. Vancel’s death was the result of accidental bodily injury
(prong 1). [Dkt. No. 46 at 4, n.4; Dkt. No. 37 at 3, ¶ 7.]
[Policy at 27.] The term “accident” is defined by the Policy as “an injury caused by
accidental bodily harm.” [Id. at 11.] Relevant to any entitlement to the above benefits are
several exclusions, including “any death or loss caused wholly or partly, directly or
indirectly by . . . disease or bodily or mental infirmity, or medical or surgical treatment
thereof.” [Id. at 29.] The Plan contains essentially the same eligibility and exclusionary
language as the Policy. [Group Life and Disability Insurance Plan (“Plan”) at § 10
(Administrative Record (“AR”)3 at 1191-93).]
In response to his complaints of right-side pain, Mr. Vancel had a CT scan
performed on January 7, 2013, which revealed cancerous tumors on both of his kidneys.
“After reviewing all therapeutic options, risks and benefits including, but not limited to
bleeding, infection, damage to adjacent organs, open conversion, removal of kidney,
urinary leak, [Mr. Vancel] elected for the [robotic-assisted surgery]”, which took place on
January 28, 2013. [AR at 192-98.] After the surgery, Mr. Vancel’s surgeon, Dr. Jason
Sprunger, reported that Mr. Vancel “tolerated the procedure well” and “[t]here were no
complications.” [Id.] Mr. Vancel “was taken to the recovery room in stable condition” at
10:35 am. [Id. at 192-93.]
While in the recovery room, Mr. Vancel’s condition was monitored by the hospital
staff who administered medication in consultation with Dr. Sprunger. [AR 184, 190, 19698.] Over time, Mr. Vancel’s blood pressure decreased and he became tachycardic
(increased heartrate). Initially believing that Mr. Vancel’s low blood pressure was caused
As used throughout this order, “AR” refers to Ford’s submission of the Administrative Record
found at Docket Numbers 42-6 through -5.
by blood pressure medication his patient had taken that morning, Dr. Sprunger had fluids
administered, but did not return to Mr. Vancel’s bedside immediately. [Id. at 184, 190,
197-98.] When Mr. Vancel’s condition did not improve, Dr. Sprunger returned to treat
him in person and ordered a hemoglobin test to determine if Mr. Vancel was experiencing
internal bleeding. [Id. at 184, 190.] At 1:50 p.m., before the hemoglobin test results were
back, Mr. Vancel became unresponsive and hospital staff began CPR, administered
medication, and began a blood transfusion. [Id. at 185, 190, 197.] When Mr. Vancel did
not respond to CPR, Dr. Sprunger returned him to the operating room to “explore the
kidney that [was] operated on and see if there could be any halting of the bleeding.” [Id.
at 191]. During these efforts, Dr. Sprunger removed Mr. Vancel’s entire left kidney and a
blood clot, but Mr. Vancel remained unresponsive and was finally pronounced dead on
January 28, 2013 at 3:12 pm. [Id. at 185, 191, 197-98.]
Mr. Vancel’s death certificate describes the “chain of events – diseases, injuries, or
complications – that directly caused [his ] death” as follows:
[Death Certificate, Dkt. No. 37-6.] Mr. Vancel’s “Manner of Death” was recorded as
“Natural” as opposed to by “Accident.”
On January 25, 2015, Ms. Vancel, as the beneficiary of Mr. Vancel’s Policy, filed a
claim with UniCare to seek payment of the accidental death benefits. A little over one
week later, on February 3, 2015, acting on behalf of UniCare, Dr. John Wright considered
whether Ms. Vancel’s benefits claim was covered under the Policy, concluding that Mr.
Vancel’s death appeared “to be related to medical complications following a partial and
subsequent total surgical removal of his left kidney” and that “[t]here is no evidence that
an accident or dismemberment played a role in the death of Mr. Vance[l].” [AR at 3.]
UniCare denied Ms. Vancel’s claim by letter dated February 4, 2015 on the grounds that
Mr. Vancel’s death did not result from an injury due to a covered accident as defined in the
Policy. He informed Ms. Vancel of her right to appeal UniCare’s determination, which
she did on March 17, 2015.
In her appeal, Ms. Vancel argued that her husband’s death was the “result of the
negligence of the physicians and staff at the hospital and not due to any underlying disease
or the treatment thereof.” [Dkt. No. 37-12 at 2 (emphasis in original).] It was (and is) Ms.
Vancel’s position that a death resulting from medical negligence is an accident and Mr.
Vancel’s death is therefore covered under the Policy. The Appeal Committee disagreed,
denying her appeal on August 3, 2015. [AR 449-50.] In denying her claim, the Appeal
Committee acknowledged Ms. Vancel’s position; however, upon review of Mr. Vancel’s
medical history, death certificate, and Ms. Vancel’s appeal letter, concluded that “Mr.
Vancel’s death was not a result of an accident as defined by the [Policy], and therefore Mr.
Vancel’s family is not eligible for [Accidental Death] benefits.” [Id.] Ms. Vancel brings
her claim for accidental death benefits under Section 502(a)(1)(B) of the Employee
Retirement Income Security Act (“ERISA”).
Summary Judgment Standard
Summary judgment is appropriate when the record before the Court establishes that
there is “no genuine issue as to any material fact and that the moving party is entitled to
a judgment as a matter of law.” Fed. R. Civ. P. 56(c); Celotex Corp. v. Catrett, 477
U.S. 317, 322 (1986). Disputes concerning material facts are genuine where the
evidence is such that a reasonable jury could return a verdict for the non-moving party.
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). In deciding whether genuine
issues of material fact exist, the Court construes all facts in a light most favorable to the
non-moving party and draws all reasonable inferences in favor of the non-moving
party. Id. at 255. When, as in this case, the parties have filed cross-motions for summary
judgment, “‘we construe the evidence and all reasonable inferences in favor of the party
against whom the motion under consideration is made.’” Cavin v. Home Loan Center, Inc.,
531 F.3d 526, 528-29 (7th Cir. 2008) (quoting Premcor USA v. Am. Home Assurance
Co., 400 F.3d 523, 526 (7th Cir. 2005)). However, neither the “mere existence of some
alleged factual dispute between the parties,” nor the existence of “some metaphysical
doubt as to the material facts,” will defeat a motion for summary judgment. Michas v.
Health Cost Controls of Ill., Inc., 209 F.3d 687, 692 (7th Cir. 2000) (internal citations
The moving party “bears the initial responsibility of informing the district court
of the basis for its motion, and identifying those portions of [the record] which it believes
demonstrate the absence of a genuine issue of material fact.” Celotex, 477 U.S. at 323.
The party seeking summary judgment on a claim on which the non-moving party bears the
burden of proof at trial may discharge its burden by showing an absence of evidence to
support the non-moving party’s case. Id. at 325; Doe v. R.R. Donnelley & Sons, Co.,
42 F.3d 439, 443 (7th Cir. 1994). Summary judgment is not a substitute for a trial on
the merits, nor is it a vehicle for resolving factual disputes. Waldridge v. Am. Hoechst
Corp., 24 F.3d 918, 920 (7th Cir. 1994). But, if it is clear that a plaintiff will be unable
to satisfy the legal requirements necessary to establish his or her case, summary judgment
is not only appropriate, but mandated. Celotex, 477 U.S. at 322; Ziliak v. AstraZeneca LP,
324 F.3d 518, 520 (7th Cir. 2003).
Courts are often confronted with cross-motions for summary judgment, as is the
case here, because Rules 56(a) and (b) of the Federal Rules of Civil Procedure allow both
plaintiffs and defendants to move for such relief. “‘In such situations, courts must consider
each party’s motion individually to determine if that party has satisfied the summary
judgment standard.’” Midwest Title Loans, Inc. v. Ripley, 616 F. Supp. 2d 897, 902 (S.D.
Ind. 2009) (quoting Kohl v. Ass’n. of Trial Lawyers of Am., 183 F.R.D. 475 (D.Md.1998)).
“When evaluating each side’s motion the court simply ‘construe[s] all inferences in favor
of the party against whom the motion under consideration is made.’”
Fennimore, Cause No. 1:09-cv-399-SEB-TAB, 2010 WL 5057418, at *1 (S.D. Ind. Dec.
3, 2010) (quoting Metro. Life Ins. Co. v. Johnson, 297 F.3d 558, 561–62 (7th Cir. 2002)
(quoting Hendricks–Robinson v. Excel Corp., 154 F.3d 685, 692 (7th Cir.1998))).
ERISA Standard of Review
Ms. Vancel’s claim is reviewed pursuant to the Employee Retirement Income
Security Act of 1974 (“ERISA”). Plaintiff contends that we should review Defendant’s
denial of benefits under a de novo standard as opposed to an arbitrary and capricious
standard, because the Plan did not give the administrator discretionary authority. [Dkt. No.
37 at 6-7.] We reject Plaintiff’s position for two reasons, to wit, the parties have previously
agreed that an arbitrary and capricious standard of review applies here and the Plan and
Policy expressly give the administrator discretionary authority to construe the Policy and
adjust claims. [Dkt. No. 20 (Case Management Plan) at § IV(A) (“[T]he administrator’s
decision should be reviewed under an arbitrary and capricious standard of review.”).]
Without a doubt, the Plan expressly grants the Appeal Committee discretionary
authority to determine eligibility for benefits and to construe the terms of the Plan. [Plan
at § 23 (“After review of an appeal, disputed benefits under the applicable Plan will be paid
only if the Appeal Committee decides in its discretion that the claimant is entitled to them
under the terms of the Plan.”); id. (“Any action of the Appeal Committee (within the scope
of its functions) shall be final and conclusive upon any claimant . . . subject only to the
arbitrary and capricious standard of judicial review.”); AR 2790 (Summary Plan
Description) (“The Insurance carrier has discretionary authority to construe, interpret,
apply, and administer the Plan. Decisions of the Insurance carrier and final and conclusive,
and are only subject to the arbitrary and capricious standard of judicial review.”).] Plaintiff
does not refute these facts.
In circumstances such as these, we review the Appeal Committee’s decision under
an arbitrary and capricious standard review, which has been described as the “least
demanding form of judicial review”. Hess v. Reg-Ellen Mach. Tool Corp., 423 F.3d
653, 658 (7th Cir. 2005). When reviewing an administrator’s decision under the arbitrary
and capricious standard, the decision will be overturned only if it is downright
unreasonable and a decision will not be overturned if “(1) it is possible to offer a reasoned
explanation, based on the evidence, for a particular outcome, (2) the decision is based on a
reasonable explanation of relevant plan documents, or (3) the administrator has based its
decision on a consideration of the relevant factors that encompass important aspects of the
problem.” Militello v. Cent. States, Se. and Sw. Areas Pension Fund, 360 F.3d 681, 686
(7th Cir. 2004) (quoting Hess v. Hartford Life & Accident Ins. Co., 274 F.3d 456, 461
(7th Cir. 2001) (internal quotation marks omitted)). It is “not our function to decide
whether we would reach the same conclusion as the Plan or even rely on the same
authority.” Tegtmeier v. Midwest Operating Engineers Pension Trust Fund, 390 F.3d
1040, 1045 (7th Cir. 2004) (quotation and citation omitted). “If the administrator made an
informed judgment and articulates an explanation for it that is satisfactory in light of the
relevant facts, then that decision is final.” Id. (citation omitted).
The issue before us for determination is whether the Appeal Committee made a
reasonable, reasoned conclusion that Mr. Vancel’s death was not an accident as defined by
the Policy and, as a result, Ms. Vancel is not eligible for benefits under the Policy. We can
make short work of the parties’ dispute because the Seventh Circuit has, in the clearest of
terms, concluded that medical mishaps, whether caused by negligence or not, are not
accidents covered by an accidental death insurance policy. Senkier v. Hartford Life & Acc.
Ins. Co., 948 F.2d 1050, 1054 (7th Cir. 1991); Sellers v. Zurich Am. Ins. Co., 627 F.3d 627,
633 (7th Cir. 2010) (relying on Senkier to conclude that because the death was the cause
of an expected complication during medical treatment, it was not an accident under the
terms of the accidental death policy). Plaintiff, who failed to respond to Defendants’
Motion for Summary Judgment, has not provided any arguments that would distinguish
Senkier or Sellers from the facts before us and we see no reason to deviate from the Seventh
Circuit’s reasoning and conclusions in those cases.
The governance of pension and employee benefit trusts, and specifically, accidental
death insurance policies, has been frequently considered by the Seventh Circuit, resulting
in a body of clear and controlling law. In Senkier, the decedent suffered from Crohn’s
Disease and was admitted to the hospital where a catheter was inserted to deliver
nourishment intravenously. 948 F.2d at 1051. The patient died suddenly a few days later
when the catheter became detached and entered her heart, puncturing it. Id. The accidental
death insurance policy expressly excluded from coverage death due to “sickness or
disease” as well as “medical or surgical treatment or a sickness of disease.” Id. The Court
drew two unambiguous conclusions which are relevant and controlling here: “a policy of
accident insurance does not reach iatrogenic injuries” and “the presence of negligence or
other fault does not convert a medical or any other mishap into an accident.” Id. Although
injuries and death resulting from medical procedures are “accidental in the sense of
unintended and infrequent[,] they are not ‘accidents’ as the term is used in insurance
policies for accidental injuries.” Id. at 1051-52.
The unfortunate circumstances of Mr. Vancel’s death fall squarely within the rules
of law pronounced in Senkier. By Ms. Vancel’s own admission, her husband’s death was
caused by the alleged inattentiveness of his physician and the hospital staff. [Dkt. No. 37
at 9 (“The real cause of Michael’s death was a lack of communication from the nurses to
the doctors in his post-operative treatment.”); id. (“Michael’s death was caused wholly by
miscommunication between physicians and nursing staff and general negligence and delay
during his post-operative care.”).]
The record unequivocally demonstrates that Mr.
Vancel’s death was caused by internal bleeding resulting from his kidney surgery.
Specifically, his death certificate describes Mr. Vancel’s manner of death as natural and
his cause of death as the consequence of a chain of events beginning with what was thought
to be an uncomplicated surgery, followed by cardiopulmonary arrest in the recovery room,
subsequent surgery, and then death after failing to respond to surgical and medical
intervention. [Death Certificate.]
Mr. Vancel’s death is not covered under the Policy because it was not an “accident”
as defined by the Policy (“an injury caused by accidental bodily harm”), and, even if it
were an accident, his death was caused, in whole or in part, directly or indirectly, by his
kidney surgery, which is expressly excluded from Policy coverage. See Whetsell v. Mut.
Life Ins., Co. of N.Y., 669 F.2d 955, 956 (2d Cir. 1982); Reid v. Aetna Life Ins. Co., 440 F.
Supp. 1182, 1184 (S.D. Ill. 1972); Litman v. Monumental Life Ins. Co., 682 N.E.2d 135,
140 (Ill. Ct. App. 1997) (Such exclusionary provisions have excluded from coverage deaths
caused by various mishaps occurring during the course of medical treatment.). The alleged
negligence of Dr. Sprunger and/or the hospital staff does not alter this conclusion. If we
were to conclude that Mr. Vancel’s death was an “accident” because it resulted from
medical negligence, we would effectively convert his Accidental Death insurance policy
into one for medical malpractice, which the Seventh Circuit instructs us not to do. See
Senkier, 948 F.2d at 1054. UniCare delivered an informed, reasoned decision in denying
Ms. Vancel’s claim based on a review of the facts; its rejection of Ms. Vancel’s claim was
based on the Policy language opposing her contention that the medical providers’
negligence caused her husband’s death.
Ms. Vancel argues that her husband’s death was not caused by treatment of his
kidneys through surgery, but rather that it was the cessation of treatment after his surgery
that caused his death. [Dkt. No. 37 at 13.] In advancing this theory, Ms. Vancel relies
upon a Missouri Court of Appeals decision, Mayfield v. Metropolitan Life Ins. Co., 585
S.W.2d 163 (Mo. App. 1979), arguing that post-surgical recovery is not “medical or
surgical treatment” that would be excluded from an accidental death policy but a cessation
of treatment which is not subject to the exclusion. [Id.] As Defendants note, the Mayfield
decision is not binding on this court, but even more significantly, the Seventh Circuit
recognized Mayfield as contradicting “numerous cases” classifying a “mishap in the course
of treatment” as “part of the treatment itself” and not an accident. Senkier, 948 F.2d at
1051 (citing, among other decisions, a Southern District of Illinois case affirmed without
opinion by the Seventh Circuit, Reid v. Aetna Life Ins. Co., 440 F. Supp. 1182 (S.D. Ill.
1977)). The Seventh Circuit has rejected the distinction urged by Ms. Vancel that Mr.
Vancel’s surgery and recovery are separate from a cessation of post-operative care through
alleged neglect by the medical staff. The alleged neglect by Dr. Sprunger and the hospital
staff occurred during Mr. Vancel’s post-operative recovery and was part and parcel of his
medical treatment, and thus not an accident under the terms of the Policy and controlling
Seventh Circuit law.
We conclude that the Appeal Committee’s denial of benefits to Ms. Vancel was
neither arbitrary nor capricious and that the Appeal Committee’s decision was wellreasoned and supported by the evidence; indeed, we concur with the Appeal Committee’s
determination that Mr. Vancel’s death, while tragic and accidental in the sense that it was
unintended, was not an accident pursuant to the Policy and therefore Ms. Vancel is not
entitled to benefits under the Policy. Accordingly, we GRANT Defendants’ Motion for
Summary Judgment [Dkt. No. 44] and DENY Plaintiff’s Motion for Summary Judgment
[Dkt. No. 36]. Judgment shall enter accordingly.
SARAH EVANS BARKER, JUDGE
United States District Court
Southern District of Indiana
Kevin Patrick Farrell
CLINE FARRELL CHRISTIE & LEE, PC
Thomas M. Johnson, Jr.
GIBSON, DUNN & CRUTCHER LLP
1050 Connecticut Avenue, N.W.
Washington, DC 20036-5306
CLINE FARRELL CHRISTIE & LEE, PC
GIBSON, DUNN & CRUTCHER, LLP
Blaire Bruns Johnson
EDISON MCDOWELL &
Kristopher N. Kazmierczak
KATZ & KORIN P.C.
Thomas F.A. Hetherington
EDISON MCDOWELL &
Sally F. Zweig
KATZ & KORIN P.C.
Kevin C. Schiferl
FROST BROWN TODD LLC
Naima L. Farrell
GIBSON, DUNN & CRUTCHER LLP
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?