United States District Court, E.D. North Carolina, Southern Division
T'ERRENCE W. BOYLE, UNITED STATES DISTRICT JUDGE.
cause comes before the Court on defendant's motion for
summary judgment and plaintiffs request for entry of summary
judgment in her favor. The appropriate response and reply
have been filed, and the matter is ripe for ruling. For the
reasons that follow, defendant's motion is granted.
case arises under the Employment Retirement Income Security
Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq.
Robert Frank Ellis, the decedent, was employed by May
Exterminating Company prior to his death on June 2, 2015. May
Exterminating sponsored an employee welfare benefit plan for
eligible employees, which included group life and accidental
death and dismemberment benefits. These benefits were funded
by a group insurance policy issued by defendant to May
Exterminating. The group life benefit through the plan was
$25, 000 and the total amount of accidental death and
dismemberment benefit available was $25, 000. Following Mr.
Ellis' death defendant admitted to liability for the $25,
000 in death coverage but has denied liability for accidental
death and dismemberment coverage, claiming that Mr.
Ellis' death was not the result of an accident as that
term is defined by the policy. Plaintiff is the mother of Mr.
Ellis and a beneficiary under both the group life and
accidental death and dismemberment benefits. The employee
welfare benefit plan grants defendant discretionary authority
to determine eligibility for participation or benefits and to
interpret the terms of the policy. Plaintiff seeks review of
defendant's denial of accidental death and dismemberment
benefits pursuant to 29 U.S.C. § 1132(a)(1)(B).
Ellis died after being stung by a bee. A corrected death
certificate issued on November 23, 2015, indicates that Mr.
Ellis' death was accidental and lists the following
causes of death: anoxic encephalopathy, cardiac arrest,
anaphylactic response, and bee sting(s). [DE 21-1 at
50].Anoxic encephalopathy is listed as the
final disease or condition resulting in death and bee
sting(s) is listed as the underlying cause. In denying
plaintiffs claim, defendant relied on the bodily infirmity
exclusion under the policy. The policy excludes payment of
accidental death and dismemberment benefits when a loss is
caused directly or indirectly by:
disease, bodily or mental infirmity, or infection ....
is further limited to losses due to injury independent of all
other causes, and the term accident or injury is defined as
Accidental bodily injury sustained by the covered person
while insured under the policy which is the direct cause of
the loss, independent of disease or bodily infirmity or any
[DE 21-2 at 27; 7].
motion for summary judgment may not be granted unless there
are no genuine issues of material fact for trial and the
movant is entitled to judgment as a matter of law.
Fed.R.Civ.P. 56(a). The moving party bears the initial burden
of demonstrating the absence of a genuine issue of material
fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323
(1986). If that burden has been met, the non-moving party
must then come forward and establish the specific material
facts in dispute to survive summary judgment. Matsushita
Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574,
588 (1986). In determining whether a genuine issue of
material fact exists for trial, a trial court views the
evidence and the inferences in the light most favorable to
the nonmoving party. Scott v. Harris, 550 U.S. 372,
378 (2007). "A dispute is genuine if a reasonable jury
could return a verdict for the nonmoving party.... and [a]
fact is material if it might affect the outcome of the suit
under the governing law." Libertarian Party of
Virginia v. Judd, 718 F.3d 308, 313 (4th Cir. 2013)
(internal quotations and citations omitted).
parties agree that the plan at issue provides defendant with
the discretion to interpret the plan language and determine
benefit eligibility, and thus that this Court reviews
defendant's decision for abuse of discretion. See
Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101,
111 (1989); Woods v. Prudential Ins. Co. of Am., 528
F.3d 320, 322 (4th Cir. 2008). When determining whether a
plan administrator or fiduciary abused its discretion,
a court may consider, but is not limited to, such factors as:
(1) the language of the plan; (2) the purposes and goals of
the plan; (3) the adequacy of the materials considered to
make the decision and the degree to which they support it;
(4) whether the fiduciary's interpretation was consistent
with other provisions in the plan and with earlier
interpretations of the plan; (5) whether the decisionmaking
process was reasoned and principled; (6) whether the decision
was consistent with the procedural and substantive
requirements of ERISA; (7) any external standard relevant to
the exercise of discretion; and (8) the fiduciary's
motives and any conflict of interest it may have.
Booth v. Wal-Mart Stores, Inc. Associates Health and
201 F.3d 335, 342-43 (4th Cir. 2000). A
court cannot disturb the policy administrator's decision
if it was reasonable, even if the court would have reached a
different conclusion. Id. at 341. "The
administrator's decision is reasonable if it is the
result of a deliberate, principled reasoning process and if
it is supported by substantial evidence, which is evidence
which a reasoning mind would accept as sufficient to support
a particular conclusion." DuPerry v. Life Ins. Co.
of N.A.,632 F.3d 860, 869 (4th Cir. 2011) (internal
quotations and citations omitted). A court reviewing the plan
administrator's decision for abuse of discretion is