UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA
March 5, 2003
JULIA E. CRAIGHILL, INDIVIDUALLY AND AS PERSONAL REPRESENTATIVE OF THE ESTATE OF SORNRATANA GOODLUCK TEMBUNKIART, PLAINTIFF,
CONTINENTAL CASUALTY COMPANY, ET AL., DEFENDANTS.
This is an action arising under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. The plaintiff, Ms. Julia E. Craighill, claims entitlement to $525,000 in Broad Business Trip Coverage benefits as beneficiary of a policy of insurance issued by defendant Continental Casualty Company (Continental) to RTKL Associates, Inc. (RTKL), the former employer of Ms. Craighill's deceased husband.*fn1 Ms. Craighill claims that her husband was killed while on a business trip for RTKL and, therefore, benefits are payable under the policy. RTKL claims that it is not liable for payment of the benefits because Continental has the sole obligation to pay benefits that become due under the terms of the policy. Continental in turn claims that Ms. Craighill's husband was killed while traveling from work to home and, therefore, benefits are not payable.
Having fully reviewed the briefs of the parties and the entire record herein, the Court finds that Continental properly denied Ms. Craighill's application for benefits under the Broad Business Trip Coverage plan and has not violated ERISA. The Court grants Continental's motion for summary judgment and denies Ms. Craighill's cross motion for summary judgment. In addition, the Court finds that RTKL has no obligation to pay benefits because Continental has the sole authority to administer the claims process and determine benefits eligibility. The Court therefore grants RTKL's motion for summary judgment and denies Ms. Craighill's motion for summary judgment.
The decedent, Sornratana Goodluck Tembunkiart, was a Vice President of RTKL and worked in RTKL's Washington, D.C., office.*fn2 On Sunday, September 20, 1998, Mr. Tembunkiart drove from his Chevy Chase residence to RTKL's Washington, D.C. office. After working quite late into the evening, Mr. Tembunkiart left work to drive home. At approximately 12:05 a.m. on September 21, 1998, while en route to his home, Mr. Tembunkiart was involved in a vehicular collision and died shortly thereafter.*fn3 Mr. Tembunkiart was 44 years old at the time of his death.
As an officer of RTKL, Mr. Tembunkiart was covered by policy number SR-83106275 ("Policy") issued by Continental to RTKL with a term beginning May 1, 1998 and ending May 1, 1999. Under the Policy, Continental has the sole authority to administer the claims process and determine whether benefits are payable. In the event a covered loss results in death of an insured person aged 69 or younger, and all other terms of the Policy are met, $500,000 becomes payable to the insured person's beneficiary. Mr. Tembunkiart had designated Ms. Craighill as his beneficiary.
The Policy provided Broad Business Trip Coverage, described as follows:
This Description of Hazards covers the Insured Person for injury sustained while on a business trip made on behalf of the Holder (excluding vacations and travel to and from work).
The trip shall begin when the Insured Person leaves his residence or regular place of employment, whichever last occurs, for the purpose of going on the business trip. Such trip shall end on the first of the following to occur:
1. when the Insured Person returns to his residence; or
2. when the Insured Person returns to his regular place of employment.
Coverage provided under this Description of Hazards includes riding as a passenger in any aircraft being used for the transportation of passengers, subject to the EXCLUSIONS below.
The term 'on a business trip made on behalf of the Holder' as used in this Description of Hazards means travel and sojourn authorized by or at the direction of the Holder for the purpose of furthering the business of the Holder.
The Policy also provides that payments will be made only after Continental receives "due written proof of loss."
By letter dated October 6, 1998, RTKL sent Continental various documents in connection with Ms. Craighill's claim for benefits under the Policy. These included a Claimant's Statement for Accidental Death signed by Ms. Craighill on October 4, 1998. In response to the question, "What was the deceased doing at the time of the accident?" Ms. Craighill responded, "driving home." Defendants' Stmt. of Material Facts Not in Dispute ¶ 18.
In the cover letter from RTKL to Continental, RTKL advised, "Mr. Tembunkiart was a Vice President with our firm and was traveling home after working in our Washington, D.C. office at the time of the accident." Id.
By letter dated November 5, 1998, Continental notified Ms. Craighill that her claim had been denied. It explained that the information it received indicated that Mr. Tembunkiart "was commuting back to your home on Sunday night after working at his office that day and as commutation is not covered by the business travel policy, we are unable to allow a payment." Id. at ¶ 19. Continental advised Ms. Craighill of her appeal rights.
By letter dated December 21, 1998, Ms. Craighill requested reconsideration of Continental's decision, asserting that "Mr. Tembunkiart was not commuting at the time of this unfortunate collision that led to his death," so the Policy covered his death. Id. at ¶ 20 (emphasis on original). On December 24, 1998, Continental asked for further information to support the request for reconsideration "since the information we have been given by his employer is that he was working at his regular place of employment on the day of the accident and that he was returning home from that office when the accident occurred." Id. at ¶ 21.
Through counsel, Ms. Craighill responded on June 2, 1999, that her husband was on a business trip that began earlier that day when he left his residence, and would not have concluded until he returned to his residence. He was not involved in 'travel to and from work,' and had not been working at his regular place of employment. Mr. Tembunkiart had been requested by his employer to work on Sunday, September 20, because of work needed, and a presentation to be made on Monday September 21, regarding the U.S. Capitol Visitor Center. This was not regular work for him. Id. at ¶ 22 (emphasis in original).
Counsel later supplied copies of the cases on which he based his argument that coverage existed under the Policy because "[t]his was not regular work for him."*fn4
After review of the request for reconsideration and the case law, Continental refused to change its mind. Despite further appeals, benefits were denied. Finally, by letter dated January 11, 2000, Continental advised that a "comprehensive review of the claim has been completed and we have determined that the Company's decision to deny benefits was correct." Id. at ¶ 27.
This lawsuit was filed the following June.
Claims Against RTKL
In her Complaint Ms. Craighill asserts both RTKL and Continental have breached the insurance contract and are obligated to pay the full amount of coverage. See Compl. ¶¶ 19-20. RTKL argues that it is not a proper party defendant because Ms. Craighill admittedly made the claim for coverage to Continental, not RTKL, and that Continental, not RTKL, denied the claim. RTKL further argues that Continental has the sole obligation to pay Plaintiff's claim and RTKL therefore could not have breached any contractual obligation. The Court agrees with RTKL.
Unless a plaintiff shows that an employer controls the administration of an ERISA plan, that employer is not a proper party to a suit arising under 29 U.S.C. § 1132(a)(1)(B). See, e.g., Layes v. Mead Corp., 132 F.3d 1246, 1249-50 (8th Cir. 1998); Best v. Nissan Motor Corp., 973 F. Supp. 770, 775 (M.D.Tenn 1997); Marcum v. Zimmer, 887 F. Supp. 891, 894 (S.D.W. Va. 1995). Ms. Craighill has not shown that RTKL in any way controls or influences the administration of claims filed under the Policy. Rather, the evidence shows that RTKL merely forwarded the requisite claim documents to Continental, and was not involved at all in the decision to deny benefits. All the correspondence that followed was between Ms. Craighill and CNA Group Benefits. Because Ms. Craighill has presented no evidence that RTKL controls the administration of the plan, RTKL is entitled to judgment as a matter of law.
The parties disagree as to which of two standards of review under ERISA should be applied by the Court.
Continental argues that the Policy's requirement that a claimant submit "due proof" of loss is sufficient to give it discretion and entitle it to deferential review under an "arbitrary and capricious" standard. See Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989) (normal review of benefit denials is de novo but if the terms of a benefit plan give the administrator discretionary authority to determine eligibility, an arbitrary and capricious standard is applied); Block v. Pitney Bowes, Inc., 952 F.2d 1450, 1453 (D.C. Cir. 1992) ("no magic words" required to establish discretion).
Ms. Craighill cites Firestone but also relies on Fitts v. Federal National Mortgage Association, 236 F.3d 1 (D.C. Cir. 2001), and its holding that requiring "proof of eligibility" does not confer sufficient discretion because such proof is required under nearly every insurance policy and the exception would swallow the rule. She also notes that the Fitts court cited with approval Herzberger v. Standard Ins. Co., 205 F.3d 327, 332 (7th Cir. 2000), which found that a requirement of "satisfactory proof" was insufficient to confer true discretion. She argues that "due proof" and "satisfactory proof" are one and the same and that the Court should apply de novo review to the denial of benefits here.
The Court finds that the exact standard of review does not have to be determined because, under either formulation, it would find that Continental legitimately denied Ms. Craighill's claim.
Arguing for a de novo review of Continental's decision to deny benefits, Ms. Craighill relies on "the case law interpreting the pertinent terms contained in the policy at issue," i.e., Duffer v. American Home Assurance Co., 512 F.2d 793 (5th Cir. 1975); McNeilly v. Lumbermens Mutual Casualty Co., 647 F. Supp. 1567 (E.D. Mich. 1986); Ligo v. Continental Casualty Co., 338 F. Supp. 519 (W.D. Pa. 1972); and Morningstar v. Insurance Co. of North America, 295 F. Supp. 1342 (S.D.N.Y. 1969). These are the cases Ms. Craighill cited to Continental during the appeal process. Unfortunately for Ms. Craighill's argument, each of the cited cases is readily distinguishable because the pertinent terms are different from the Policy.
To recap, the Policy stated that "travel to and from work" was excluded from coverage. In McNeilly, the policy excluded coverage for "day to day travel to and from work." 647 F. Supp. at 1568. The insured in McNeilly normally worked Monday through Friday but was killed on his way to work on a Saturday morning. The court concluded that Saturday travel "represented a deviation in time" from "day-to-day" travel. See 647 F. Supp. at 1569. The policy in Duffer excluded coverage for "every day travel to and from work," which the Fifth Circuit determined did not include evening work outside the norm where the insured deviated from his normal route of travel. See 512 F.2d at 797. Ligo also involved a travel insurance policy that excluded coverage for "everyday travel to and from work." 338 F. Supp. at 520. Morningstar excluded coverage for "commutation travel," 295 F. Supp. at 1343, but the insured was traveling in the morning from his home to the office of a company with which he sought to conduct business on behalf of his employer. The court held that this was not his regular commute and therefore the exclusion did not apply. Id. at 1345.
The Policy excludes all travel to and from work without the nuances of descriptors contained in the cases upon which Ms. Craighill relies. Thus, while it is true the Mr. Tembunkiart was working on a Sunday evening outside his normal business hours, he was in fact and as admitted in transit between his normal office and his home at the time of his death. Because the Policy language has a plain and ordinary meaning, the Court is constrained to apply it as written and deny benefits.*fn5
It is true that Continental repeatedly referred to the exclusion as a "commutation" exclusion in its correspondence with RTKL and Ms. Craighill. Were that term contained in the Policy itself, the interpretation of Morningstar might apply. However, it is the Policy language that governs and the Policy excludes "travel to and from work" without any limitation as to time, day of the week, hour of the day or habit of the insured. Because the language of the Policy is unambiguous, the Court will not look to the extrinsic evidence found in the correspondence to create ambiguity. See District-Realty Title Ins. Corp. v. Ensmann, 767 F.2d 1018, 1022 (D.C. Cir. 1985) (courts may not consider extrinsic evidence to alter the terms of an unambiguous contract, and ambiguity does not exist merely because parties disagree over the meaning of a term).
Reviewing de novo the decision to deny benefits, the Court finds that denial was proper because Mr. Tembunkiart was traveling between his normal office and his home at the time of his death, which falls within the unambiguous Policy exclusion for"travel to and from work."
If, as Continental argues, the arbitrary and capricious standard of review applies, the result is the same. Under this deferential standard of review, the focus is on the reasonableness of Continental's claim determination. Block, 952 F.2d at 1454 ("The reasonableness of the Plan Committee's decision is our polestar...."). Because the Policy clearly and unambiguously does not cover losses occurring during "travel to and from work," and Mr. Tembunkiart was definitely and admittedly traveling from work to his home on the occasion of the accident that caused his death, the Court cannot conclude that Continental was unreasonable in denying benefits to Ms. Craighill.
For the above-stated reasons, RTKL and Continental's motion for summary judgment  is GRANTED and Ms. Craighill's cross-motion for summary judgment  is DENIED.*fn6 A separate order will accompany this memorandum opinion.
ROSEMARY M. COLLYER United States District Judge