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Oomrigar v. Unum Life Insurance Co. of America

United States District Court, D. Utah

September 6, 2017

JONATHAN OOMRIGAR, an individual, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, a Maine corporation, Defendant.

          MEMORANDUM DECISION AND ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT AND DENYING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT

          Ted Stewart United States 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.

         I. BACKGROUND

         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.”[1] Sergeant Keith then stopped pursuit. Shortly thereafter, as he continued driving east on University Parkway, Sergeant Keith came upon the scene of the accident.

         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.”[2] The Plan defines “accidental bodily injury” as “bodily harm caused solely by external, violent, and accidental means and not contributed to by any other cause.”[3] The Plan further provides certain exceptions to the coverage. Relevant 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.[4] The Plan grants Unum discretionary authority to make benefit determinations, which includes “determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan.”[5]

         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.”[6] Unum informed Plaintiff of the denial on February 6, 2014.

         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.

         II. STANDARD OF REVIEW

         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.”[7]

         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.”[8] It is undisputed that the Plan grants Unum discretionary authority and that an arbitrary and capricious standard of review is applicable here. “Under the arbitrary and capricious standard, [courts] curtail [their] review, asking only whether the interpretation of the plan was reasonable and made in good faith.”[9] “The Administrators' decision need not be the only logical one nor even the best one. It need only be sufficiently supported by facts within their knowledge to counter a claim that it was arbitrary or capricious.”[10] The court therefore “need only assure that the administrator's decision falls somewhere on a continuum of reasonableness-even if on the low end.”[11] To determine if a decision falls somewhere on a continuum of reasonableness, courts look for “‘substantial evidence' in the record to support the administrator's conclusion, meaning ‘more than a scintilla' of evidence ‘that a reasonable mind could accept as sufficient to support a conclusion.'”[12]

         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.”[13] One of the factors, relevant in this matter, is an administrator's conflict of interest between its own financial interest and the interests of the plan participants. Courts “dial back [their] deference if a benefit plan gives discretion to an administrator or fiduciary who is operating under a conflict of interest.”[14] “To incorporate this factor, [the Tenth Circuit has] ‘crafted a sliding scale approach' where the ‘reviewing court will always apply an arbitrary and capricious standard, but will decrease the level of deference given . . . in proportion to the seriousness of the conflict.'”[15]

         III. DISCUSSION

         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.

         a. Deference Afforded to Unum

         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.'”[16] Plaintiff argues that, based on the conflict, deference afforded to Unum should be significantly decreased because “Unum failed to apply its own policy terms to the analysis and relied almost exclusively on hearsay as the basis for concluding that Jal committed a ‘crime' when his motorcycle crashed, ignoring indications that the foundation for that conclusion should be questioned.”[17]

         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.[18] Plaintiff has not pointed to any conduct that merits a more significant decrease in the deference given to Unum's decision.

         b. The Administrative Record

         The Court's review of the administrative decision is strictly limited to “the rationale asserted by the plan administrator in the administrative record.”[19] In its decision upholding the denial of the AD&D benefit, Unum cited to Officer Denning's report of the accident and the information collected by Ms. Dunham's investigation. Officer Denning's police report stated that Sergeant Keith attempted to initiate a traffic stop on a motorcyclist that was speeding eastbound on University Parkway, but that the motorcyclist “sped up and was weaving in and out of traffic as he approached State Street.”[20]

         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.[21] One witness stated that “[t]he motorcyclist flew by-‘meaning was speeding'- . . . [and was] not obeying traffic laws.”[22] Another witness recalled, they “saw a motorcyclist zoom past [their] vehicle on the left side. He was moving between the cars going at least twice as fast as everyone else.”[23]Another witness stated that they were passed by a motorcyclist who “proceeded to weave between the cars and ignore[] the lanes. As he approached the intersection . . . he lost control of his bike and flew over the handlebars.”[24] Finally, Officer Denning's report states that the motorcycle was impounded by Utah County for “evading deputy.”[25]

         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.[26] He therefore advised that, because Sergeant Keith of the Utah County Sheriff's Department was the officer in pursuit of Jal prior to the accident, the Sheriff's office would be the one to file charges.[27] Based on this information, Ms. Dunham sought to contact Sergeant Keith. Ms. Dunham left numerous messages with Sergeant Keith, but was unable to speak with him directly. Finally, the Sheriff's office advised her that Sergeant Keith received her messages and contacted the county attorney's office about Ms. Dunham's inquiry.[28] Relying on this information, Ms. Dunham contacted the county attorney's office directly and eventually spoke to a representative named Court Griffin, who, upon investigation, reported to Ms. Dunham that he spoke with Sergeant Keith and an unidentified detective and that the detective relayed that he would have referred charges for reckless driving and evading a police officer if Jal had survived the accident.[29] Reckless driving is a class B misdemeanor under Utah law and evading a police officer is a third-degree felony.[30]Based on this information, Unum denied the claim.

         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.[31]

         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 ...


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