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Reiling v. Sun Life Assurance Company of Canada

United States District Court, D. Kansas

December 5, 2014

BRENDA K. REILING, as legal guardian, for and on behalf of B.J.W.R. and M.M.R., minors, Plaintiff,
v.
SUN LIFE ASSURANCE COMPANY OF CANADA, Defendant

Page 1362

[Copyrighted Material Omitted]

Page 1363

For Brenda K. Reiling, minor B. J.W. R., minor M. M. R., Plaintiff: Phillip R. Fields, LEAD ATTORNEY, Law Office Of Phillip R. Fields, Wichita, KS.

For Sun Life Assurance Company of Canada, Defendant: Mark E. Schmidtke, LEAD ATTORNEY, PRO HAC VICE, Ogletree, Deakins, Nash, Smoak & Stewart, PC - Valparaiso, Valparaiso, IN; Shannon L. Cade, LEAD ATTORNEY, Ogletree, Deakins, Nash, Smoak & Stewart, PC - KC, Kansas City, MO.

Page 1364

MEMORANDUM AND ORDER

JULIE A. ROBINSON, UNITED STATES DISTRICT JUDGE.

Plaintiff Brenda Reiling brings this action under the Employee Retirement Income Security Act of 1974 (" ERISA" ), seeking judicial review of Defendant Sun Life Assurance Company's denial of her claim for accidental death benefits. This matter is before the Court on the parties' cross-motions for summary judgment (Docs. 35 and 37). For the reasons stated in detail below, the Court grants Plaintiff's motion for summary judgment and denies Defendant's motion for summary judgment.

I. Background

The late Jennifer Reiling (" Ms. Reiling" ) was a participant in an employee benefit plan sponsored by her employer, Sonic Restaurants, Inc. (" Sonic" ). The plan, which is subject to the provisions of ERISA, provides employees with life and accidental death benefits through a group insurance policy (the " Policy" ) issued by Defendant. The Policy requires Defendant to pay accidental death benefits upon proof that an insured employee died fro an accidental bodily injury. The Policy excludes coverage, however, " for a loss which is due to or results from: . . . committing or attempting to commit an assault, felony or other criminal act." [1] Sonic has delegated to Defendant its entire discretionary authority to construe the Policy's terms and to determine eligibility for benefits claimed under the Policy.

Ms. Reiling died in a car accident on July 1, 2012. The Kansas Motor Vehicle Accident Report states that Ms. Reiling was driving east on U.S. Highway 54 when a westbound vehicle crossed the center line and collided with Ms. Reiling's car. The driver of the westbound vehicle survived, but Ms. Reiling passed away at the crash site. The investigating officer determined that, at the time of the accident, Ms.

Page 1365

Reiling was driving with a suspended license--a class B misdemeanor under Kansas law.[2]

Plaintiff, Ms. Reiling's mother, submitted a claim for accidental death benefits on behalf of Ms. Reiling's two minor children. Ms. Reiling had elected to pay for accidental death coverage totaling $75,000 and seat belt and air bag coverage totaling $26,250. In a letter dated November 16, 2012, Defendant notified Plaintiff that those benefits were not payable: because Ms. Reiling was driving with a suspended license at the time of the accident, Defendant determined that " the injuries resulting in Jennifer's death falls [sic] within the Policy exclusion applicable to 'committing or attempting to commit an assault, felony or other criminal act.'" [3]

Plaintiff appealed. On March 14, 2013, Defendant issued a written decision upholding its denial of accidental death benefits. Defendant had confirmed with the officer in charge of investigating Ms. Reiling's accident that driving with a suspended license was a criminal act under Kansas law, and Defendant therefore affirmed its finding that Ms. Reiling's loss was " due to or result[ed] from" her criminal act. Defendant informed Plaintiff that she had exhausted all administrative remedies available under the Policy. Plaintiff now seeks review in this Court, claiming Defendant's denial of accidental death benefits was arbitrary and capricious.

II. Summary Judgment Standard

Summary judgment is appropriate if the moving party demonstrates that there is no genuine dispute as to any material fact and that it is entitled to judgment as a matter of law.[4] " Where, as here, the parties file cross-motions for summary judgment, [the Court is] entitled to assume that no evidence needs to be considered other than that filed by the parties, but summary judgment is nevertheless inappropriate if disputes remain as to material facts." [5] The Court considers cross-motions separately: the denial of one does not require the grant of the other.[6] " To the extent the cross-motions overlap, however, the Court may address the legal arguments together." [7] The material facts are undisputed in this case, and the legal issues asserted with respect to both motions are identical. The Court will therefore address those issues together.

III. Discussion

Plaintiff contends that Defendant's interpretation of the Policy's criminal-act exclusion was arbitrary and capricious for two reasons: (1) an ordinary plan participant would view driving while suspended as a traffic violation, not a criminal act; and (2) the causal link between Ms. Reiling's death and her driving while suspended is too attenuated to satisfy the causal nexus required under the terms of the criminal-act exclusion. The Court will address each contention in turn. But first

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the Court must determine the appropriate standard for reviewing Defendant's ...


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