Hampton v. Standard Ins. Co.

400 F.Supp.3d 805

Herman HAMPTON, Plaintiff,

v.STANDARD INSURANCE COMPANY, Defendant.

Case No. 19-0242-CV-W-FJG

United States District Court, W.D. Missouri, Western Division.

Signed September 4, 2019

Herman Hampton, Lee's Summit, MO, pro se

Richard J. Pautler, Thompson Coburn LLP, St. Louis, MO, for Defendant

ORDER

Fernando J. Gaitan, Jr., United States District Judge

Pending before the Court is Defendant's Motion for Summary Judgment (Doc. No. 6). For the following reasons, this motion is granted and the case is dismissed.

I. Background/Facts¹

Plaintiff, Herman Hampton ("Hampton"), is a citizen of Missouri, resides within this District and at one time was an employee of the Missouri Department of Transportation ("MoDot"). Standard is a citizen of Oregon having been incorporated pursuant to the laws of the State of Oregon and maintaining its principal place of business in Portland, Oregon. This Court has jurisdiction pursuant to 28 U.S.C. § 1332.

On November 12, 2015, Hampton sustained a work-related injury to his right eye (hereinafter "Injury"). Standard issued Policy Number 643110-A to The Missouri Department of Transportation and Highway Patrol Employees Retirement System ("MPERS") (hereinafter "Policy"). The Policy insured MPERS's commitment to pay disability benefits to certain of its employees who were covered by the Policy (hereinafter "Member"), who qualified for benefits under the Policy (e.g. who were "Disabled" within the meaning of the Policy), and who complied with all the terms and conditions of the Policy (e.g. submitted a Proof of Loss). In November 2015, Hampton was a Member of the Policy as that term is defined in the Policy. The Policy provided that in the event the Injury suffered was "Work Related," there was a Benefit Waiting Period which was:

The longer of:

(a) The period of paid sick leave to which you are entitled under the Employer's sick leave program; or

(b) The period ending on the date of the determination that you have reached your maximum medical improvement under the Missouri Worker's Compensation Law.

Doc. No. 7, Ex. A at p. 2 (STND 19-04604-00011)). A "work related" injury was one for which the Member was receiving benefits under a workers' compensation law because of the Member's partial or total disability, whether permanent or vocational, arising out of or in the course of the employment with the Employer. Doc. No. 7, Ex. A at p. 2 (STND 19-04604-00011)).

Hampton sustained his injury while performing work for MoDot and he received workers' compensation benefits as a result of his injury. Hampton was determined to have reached Maximum Medical Improvement ("MMI") under Missouri Workers' Compensation law on August 4, 2016. Hampton submitted to Standard a claim under the Policy for Work Related Disability Benefits. Standard denied that claim.

In November 2015, Hampton, as a result of his employment with MoDot, was a participant in the MoDot & Patrol Employees' Retirement System (hereinafter "MPERS Pension Plan"). On June 9, 2016, Hampton applied to have his entire distribution in the MPERS Pension Plan paid directly to him. (hereinafter "Request"). On June 9, 2016, Hampton was not receiving Policy disability benefits.

The Request provided on the first page above Hampton's signature:

I have read and understand the Terms of Request (on the reverse side of this form) related to requesting this distribution and hereby apply to withdraw my contribution from MPERS. By electing a refund, I understand that I am forfeiting all my creditable service and future rights to receive benefits from MPERS, including disability benefits (if applicable).

Doc. No. 7, Exs. A and B. The Request provided on the reverse side the "Terms of Request," one of which was:

Those requesting a refund of employee contributions forfeit all creditable service and future rights to receive benefits from the system and will not be eligible to receive disability benefits.

Id.

Missouri Revised Statutes at § 104.1091 controls the MPERS Retirement Plan and provides, inter alia :

A vested former member or a former member who is not vested who receives a refund shall forfeit all the member's credited service and future rights to receive benefits from the system and shall not be eligible to receive any long-term disability benefits; provided that any member or vested former member receiving long-term disability benefits shall not be eligible for a refund.

Missouri Revised Statutes at § 104.1091.

Jamie Mullen, an employee of MPERS, advised Standard that Standard should deny Hampton's claim for disability benefits because he was not eligible for such benefits as a result of his signing and submitting the Request. The Policy grants discretion to Standard and includes the following provision:

RESERVATION OF AUTHORITY

Except for those functions which the Group Policy specifically reserves to the Policyholder, [Standard Insurance Company reserves] full and exclusive authority to control and manage the Group Policy, to administer claims, and administration, interpretation, and Request of the Group Policy.

Our authority includes, but is not limited to:

1. The right to resolve all matters when a review has been requested:

2. The right to establish and enforce rules and procedures for the administration of the Group Policy and any claim under it:

3. The right to determine:

a. Eligibility for Insurance;

b. Entitlement to benefits;

c. The amount of benefits payable; and

d. The sufficiency and the amount of information we may reasonably require to determine a., b., or c., above.

Doc. No. 7, Ex. A at p. 17 (STND 19-04604-00026)).

II. Standard

Summary judgment is appropriate if the movant demonstrates that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law. Celotex Corp. v. Catrett, 477 U.S. 317, 327, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The facts and inferences are viewed in the light most favorable to the nonmoving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586–90, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The moving party must carry the burden of establishing both the absence of a genuine issue of material fact and that such party is entitled to judgment as a matter of law. Matsushita, 475 U.S. at 586–90, 106 S.Ct. 1348.

A nonmoving party must establish more than "the mere existence of a scintilla of evidence" in support of its position. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

The nonmovant must do more than simply show that there is some metaphysical doubt as to the material facts, and must come forward with specific facts showing that there is a

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