TED STEWART, District Judge.
This matter is before the Court on the parties' cross-motions for summary judgment regarding Plaintiff Jonathan Oomrigar's ("Plaintiff") ERISA claim. For the reasons set forth below, the Court will deny Plaintiff's Motion and grant Defendant Unum Life Insurance Company of America's ("Unum") Motion.
Plaintiff's son, Jal Oomrigar ("Jal"), the insured, was involved in a motor vehicle accident on May 20, 2013. According to the police report, Sergeant Wayne Keith of the Utah County Sheriff's Department observed Jal speeding eastbound on his motorcycle on University Avenue in Orem, Utah. Sergeant Keith turned on his lights to initiate a traffic stop, but observed that Jal "sped up and was weaving in and out of eastbound traffic at a high speed."
Sergeant Keith was the first officer to arrive at the scene. However, because the accident occurred in Orem City, Officer Kirk Denning of the Orem City Police Department investigated the incident. Witnesses reported that Jal had entered the right shoulder of the roadway where at least one car was stopped, waiting to make a right turn onto State Street. The precise details are unclear, however it seems Jal then lost control of the motorcycle as he attempted to avoid collision with the stopped vehicle and was thrown from the motorcycle onto the pavement. Paramedics treated Jal at the scene of the accident and then transported him to Utah Valley Regional Medical Center where, tragically, he passed away as a result of blunt force injuries sustained in the accident.
At the time of the accident, Jal was employed by SolarWinds Worldwide, LLC ("SolarWinds"). During his employment, Jal elected to enroll in the SolarWinds Worldwide, LLC Plan ("the Plan"), which was administered by Unum. The Plan provided Jal with a life benefit and an accidental death and dismemberment ("AD&D") benefit. For purposes of these cross-motions for summary judgment, the Court is concerned only with the AD&D benefit.
The Plan provides that the AD&D benefit will issue "only if an accidental bodily injury results."
On July 23, 2013, SolarWinds submitted a claim to Unum under the life and AD&D provisions of the Plan. Plaintiff, as Jal's beneficiary, initiated contact with Unum on July 29, 2013. Unum requested that Plaintiff submit certain information to Unum, which was eventually provided. An Unum representative, Ms. Carol Dunham, thereafter investigated the circumstances surrounding the accident to determine if Jal would have been charged with a crime had he survived.
Based on all the information provided by Plaintiff and the information collected by Ms. Dunham, Unum ultimately determined that it would issue the life benefit, but would not issue the AD&D benefit. Unum found that Jal was driving recklessly, evading an officer, and speeding and/or going too fast for the conditions in violation of Utah law. Therefore, Unum denied the benefit because Jal's death "was caused by, contributed to by, or result[ed] from . . . an attempt to commit or commission of a crime."
Plaintiff appealed the decision. Unum found the initial decision to deny the AD&D benefit was correct. Plaintiff thereafter filed an ERISA claim in this Court.
ERISA allows an individual participant of an employee benefit plan, or their beneficiaries, to sue in federal court "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of [his] plan."
Where a plan grants discretionary authority to the plan administrator, courts "employ a deferential standard of review, asking only whether the denial of benefits was arbitrary and capricious."
Furthermore, a district court's review of an ERISA case involves the consideration of "several different, often case-specific, factors, reaching a result by weighing all together."
Unum denied the AD&D benefit based on the crime exclusion stated in the Plan. Unum found that the record supported that Jal was speeding, evading a police officer, and driving recklessly in violation of Utah's traffic laws, each, of which constitute a "crime" under Unum's interpretation of the language of the Plan. Plaintiff argues the record does not support that Jal was driving recklessly or evading a police officer, but only that he might have been charged with driving too fast for the conditions and/or speeding, which he argues does not constitute a "crime" under a reasonable interpretation of the Plan.
As both the payor of the benefit and the plan administrator, it is undisputed that Unum operated with a conflict of interest in this case. As previously discussed, "if a conflict of interest exists, the reviewing court `must decrease the level of deference given to the conflicted administrator's decision in proportion to the seriousness of the conflict.'"
Given Unum's position as both the administrator and payor, the Court will weigh Unum's conflict of interest "as a factor in determining the lawfulness of the benefits denial," but will still apply the arbitrary and capricious standard.
The Court's review of the administrative decision is strictly limited to "the rationale asserted by the plan administrator in the administrative record."
The witness reports contained in Officer Denning's report further support that Jal was operating his motorcycle in an unsafe manner. Five of the witnesses accounted that the motorcyclist appeared to be speeding and five also stated that he was weaving in and out of lanes, not obeying traffic laws, and/or driving on the dotted line between the cars.
In making its final determination, Unum also relied on the information obtained in Ms. Dunham's investigative phone calls. Ms. Dunham first spoke with Sergeant Baily of the Orem Police Department who informed Ms. Dunham that the Orem Police were only called to the scene of the accident because the accident occurred in their jurisdiction.
Sometime after the initial claim denial, Officer Denning of the Orem City Police Department returned a call to Ms. Dunham and left a message stating that, "if anything," Jal would have only been charged with speeding and/or going too fast for the conditions.
Taking Officer Denning's message into account on appeal, Unum still found that the evidence showed that Jal was speeding, evading a police officer, and driving recklessly in violation of Utah law, and was therefore in the commission of a crime that caused, contributed to, or resulted in his death. Plaintiff argues this is an arbitrary and capricious conclusion.
Drawing from Officer Denning's police report and Ms. Dunham's conversations with Court Griffin and Sergeant Bailey, Unum found that Jal would have been charged with evading a police officer and reckless driving. Plaintiff argues Unum's findings are flawed because the record contains conflicting evidence. Namely, Officer Denning's voicemail stating that Jal may have been charged with driving too fast for the conditions or speed in general, "if anything."
The record contains substantial evidence supporting Unum's finding that Jal was evading a police officer and driving recklessly. Officer Denning's police report stated that Jal "sped up and was weaving in and out of eastbound traffic at a high speed"
Plaintiff also argues that Unum cited no evidence on the record to support that Jal's alleged criminal activity caused or contributed to his death, as required by the language in the Plan. As discussed, the record supports that Jal was driving his motorcycle at a high speed and in an otherwise unsafe manner just prior to the accident. Nothing in the record supports that some intervening factor was the true cause of the accident. It therefore stands to reason that Jal's driving at a high rate of speed or in an otherwise unsafe manner caused, or, at a minimum, contributed to the accident. Therefore, Unum's denial of the AD&D benefit is supported by substantial evidence.
Where the interpretation of an ERISA plan's term is at issue, "the arbitrary and capricious review encompasses the contract law standard of ambiguity."
Here, the Plan provides that "any accidental losses caused by, contributed to by, or resulting from . . . an attempt to commit or commission of a crime" will not be covered by the AD&D benefit.
Reckless driving and evading a police officer are both chargeable as a misdemeanor or felony, respectively, in Utah.
Assuming, for the sake of argument, that the record did not support that Jal engaged in reckless driving or evading a police officer, Unum's interpretation of the term to encompass speeding and/or going too fast for the conditions is reasonable. Unum's reliance on the Merriam-Webster Dictionary to define the term "crime" is consistent with courts' methods of discerning the common and ordinary usage of a term.
Unum defined crime, in part, as "an illegal act for which someone can be punished by the government."
Because Unum's factual findings are supported by the record and because Unum's interpretation of the term "crime" is reasonable, the Court finds that Unum's decision to deny the AD&D benefit was not arbitrary and capricious and will therefore grant summary judgment in favor of Defendant Unum.
Plaintiff requests an award of reasonable attorney's fees and court costs pursuant to 29 U.S.C. § 1132(g)(1). Because Plaintiff is not the prevailing party in this matter, the Court will deny Plaintiff's request.
It is therefore
ORDERED that Defendant Unum's Motion for Summary Judgment (Docket No. 26) is GRANTED and Plaintiff Jonathan Oomrigar's Motion for Summary Judgment (Docket No. 25) is DENIED.