Fields v. Ashford et al

Filing 55

ORDER Granting Life Insurance Company of North America's 32 Motion for Summary Judgment. Signed by District Judge Matthew F. Leitman. (HMon)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION
ANGELA J. FIELDS,
Plaintiff,

Case No. 17-cv-11812
Hon. Matthew F. Leitman

v.
PIERRE OCTAVIUS ASHFORD, et al.,
Defendants.
__________________________________________________________________/
ORDER GRANTING LIFE INSURANCE COMPANY OF NORTH
AMERICA’S MOTION FOR SUMMARY JUDGMENT (ECF #32)
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

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Fields originally filed this action in state court. The Defendants timely removed
the action to this Court. (See Notice of Removal, ECF #1.)

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 #321 at Pg. ID 255.) LINA never made a formal decision to finally deny any claim for

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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

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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. App'x 6, 11 (3d Cir. 2012) (“Dismissal of
the claims as moot without considering the plaintiffs’ entitlement to interest was
error. Voluntary payment of withheld benefits after initiation of a lawsuit does not
necessarily moot the plaintiffs’ claims, since they have requested interest in their
complaint.” (collecting cases and authority)).

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B
LINA next argues that Fields’ claim is “not ripe for judicial review because
[Fields] did not exhaust her administrative remedies.” (Mot. for Summ. J., ECF #32
at Pg. ID 253.) The Court agrees.
“Federal law requires that where administrative remedies are available they
must be exhausted as a precondition to filing a suit under ERISA.” Cage v. Gen.
Motors Defined Ben. Salaried Plan, 98 F. Supp. 2d 803, 808 (E.D. Mich. 1999).
LINA has submitted evidence that Fields did not exhaust her remedies before filing
suit (see Mekkelsen Decl. at ¶6, ECF #32-1 at Pg. ID 256), and Fields has not
submitted any evidence to the contrary. Instead, Fields argues that she was not
required to administratively exhaust her claim because doing so would have been
futile. Fields is incorrect.
The futility exception to the administrative exhaustion requirement is “quite
restricted.” Dozier v. Sun Life Assur. Co. of Canada, 466 F.3d 532, 535 (6th Cir.
2006) (internal quotations omitted). “Generally speaking,” the Sixth Circuit has
“applied the administrative-futility doctrine in two scenarios: (1) when the
[p]laintiffs’ suit is directed to the legality of the plan, not to a mere interpretation of
it, and (2) when the defendant lacks the authority to institute the decision sought by
[p]laintiffs.” Id. (internal quotations and citations omitted). Moreover, to establish
futility, “[a] plaintiff must show that it is certain that his claim will be denied on

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appeal, not merely that he doubts that an appeal will result in a different decision.”
Fallick v. Nationwide Mut. Ins. Co., 162 F.3d 410, 419 (6th Cir. 1998).
Fields has not even attempted to show how her circumstances or the facts of
this case fit into or satisfy the Sixth Circuit’s test for futility. Accordingly, the Court
declines to excuse her failure to exhaust administrative remedies on the basis of
futility.
IV
For the reasons explained above, Count V of the Complaint fails against LINA
(and Cigna) because Fields did not exhaust her administrative remedies.
Accordingly, the Court GRANTS LINA’s Motion for Summary Judgment (ECF
#32).
IT IS SO ORDERED.

s/Matthew F. Leitman
MATTHEW F. LEITMAN
UNITED STATES DISTRICT JUDGE

Dated: May 2, 2018

I hereby certify that a copy of the foregoing document was served upon the
parties and/or counsel of record on May 2, 2018, by electronic means and/or
ordinary mail.
s/ Holly A. Monda
Case Manager
[phone]

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