Krishna v. Nat'l Union Fire Ins. Co. of Pittsburgh, PA

676 F.Supp.3d 494

Deepa KRISHNA, Plaintiff, v. NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA., Defendant.

Civil Action No. H-22-3423

United States District Court, S.D. Texas, Houston Division

Signed June 8, 2023

John Price McNamara, Law Office of J. Price McNamara, Baton Rouge, LA, for Plaintiff.

Matthew John Kolodoski, Thompson Coe et al, Dallas, TX, for Defendant.

MEMORANDUM OPINION AND ORDER

SIM LAKE, SENIOR UNITED STATES DISTRICT JUDGE

This action arises from denial of Plaintiff Deepa Krishna's ("Plaintiff" or "Krishna") application for benefits from the Honeywell International, Inc. Benefit Plan ("Plan"), an employee welfare benefit plan maintained by her husband's employer, Honeywell International, Inc. ("Honeywell"), and governed by the Employee Retirement Income Security Act of 197 4 ("ERISA"), 29 U.S.C. § 1001, et seq. The Plan included Business Travel Accident ("BTA") insurance provided by Defendant National Union Fire Insurance Company of Pittsburgh, PA ("Defendant" or "National"). Pending before the court is Defendant National Union Fire Insurance Company of Pittsburgh, PA's Motion for Summary Judgment ("Defendant's MSJ") (Docket Entry No. 12), and Plaintiff's Motion for Judgment Under Rule 52 and Memorandum in Support ("Plaintiff's Motion for Judgment") (Docket Entry No. 13). Both parties seek judgment based on the Administrative Record ("AR"), which was jointly filed on February 15, 2023 (Docket Entry No. 11). For the reasons stated below, Defendant's MSJ will be granted and Plaintiff's Motion for Judgment will be denied.

I. Factual and Procedural Background

A. Undisputed Facts

Krishna is the widow of Karthik Balakrishnan ("Decedent"), who was hired by Honeywell in August of 2019 as Senior Strategic Marketing Manager based in Morristown, New Jersey.¹ Decedent was a member of the Plan who had BTA insurance coverage valued at five times his base salary of $198,000.00 for a total amount of $990,000.00.² In March of 2020 Honeywell buildings in Morristown, New Jersey closed because of the pandemic, and Decedent's work became remote.³ Because of the pandemic Honeywell stopped all non-essential business travel.⁴ On Sunday, October 25, 2020, Decedent died when the small private airplane in which he was a passenger crashed shortly after takeoff in Texas.⁵ Honeywell neither owned the airplane nor employed the pilot.⁶ Decedent was survived by a four-year old daughter and by Plaintiff, who was Decedent's spouse and is his beneficiary under the Plan.⁷

On February 5, 2021, Plaintiff contacted AIG Travel, Global Assistance Team, requesting information about benefits and coverage for BTA insurance from the Plan stating that Decedent "passed away during a business trip in Texas . . . and [that he] had been working in Texas long term during Covid."⁸ AIG Claims, Inc. is Defendant's authorized claims administrator.⁹ When asked whether Decedent died on a business trip, Honeywell replied that Decedent was not on a business trip when he died, and that Decedent had no approved business travel in 2020.¹⁰ On April 19, 2021, Plaintiff's application for BTA insurance benefits was denied. In pertinent part the denial letter stated that

[W]e must decline payment of this claim as your husband's death did not result from a covered hazard. He was not on a business trip at the time of loss per his employer. His death was reportedly due to being a passenger on a private plane which crashed. Therefore, the loss is not covered. The loss is also excluded from coverage. His death resulted from travel in a vehicle used for aerial navigation which was not a Honeywell aircraft nor was it piloted by a Honeywell pilot, so the loss is specifically excluded from coverage under the policy.¹¹

On April 15, 2022, Plaintiff appealed the denial of her claim, stating in pertinent part: "Your denial is incorrect. My husband was away on a business trip working on Honeywell's business in Longview, Texas when he died in the plane crash accident . . . His work assignment included travel to Texas as needed."¹²

On May 24, 2022, Plaintiff's appeal was assigned to Pamela McConnell, who, on June 27, 2022, advised Plaintiff that the ERISA Appeals Committee was reviewing her claim.¹³ On August 25 and September 1, 2022, AIG's Assistant General Counsel, Joseph Burruano, asked that a complete copy of the claim file be sent to the Wagner Law Group who would serve as ERISA Appeals Committee.¹⁴ On November 1, 2022, Plaintiff's appeal was denied. In pertinent part the denial letter stated that

[t]he ERISA Appeal Committee (the "Committee") of National Union Fire Insurance Company of Pittsburgh, Pa (the "Company") has completed its review of the above referenced claim, which concerns accidental death benefits for Deepa Krishna related to the death of Karthik Balakrishnan. After careful review of the claim, the appeal letter and supporting documents submitted by Ms. Krishna, and the information provided by Honeywell International ("Honeywell"), the Committee has determined that the requested benefits are not payable under the policy. The Committee's decision is based on a full review of the entire administrative record, including pertinent policy provisions.

. . .

In your appeal submission, you seek reversal of the original denial of the claim. We have reviewed the information contained in your appeal submission and find that it does not support a reversal of the original denial. As noted above, Honeywell has confirmed that Mr. Balakrishnan was not on a business trip for Honeywell at the time of the accident and the claim file reflects that he was not traveling on an aircraft owned, leased, or operated by Honeywell.

The policy provides coverage of several Hazards that could be implicated by a death during business travel or as a result of travel on a designated Honeywell aircraft. However, without foreclosing the possibility that other terms of coverage under such Hazards may not be satisfied, the fact that Mr. Balakrishnan was not on an authorized business trip for Honeywell or in a designated aircraft owned or operated by Honeywell at the time of the accident precludes coverage under the terms of all such hazards.

Accordingly, for the reasons set forth above, the Committee finds that it must uphold the denial and deny your appeal. Should Honeywell submit additional information with regard to this claim, we will revisit this determination, but all information submitted to date supports the original denial.¹⁵

B. Procedural Background

Plaintiff filed this action on October 5, 2022, under ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a) (1)(B), seeking BTA insurance benefits, pre- and post-judgment interest, attorneys' fees, and costs.¹⁶ Plaintiff alleges that Defendant abused its discretion by arbitrarily and capriciously denying her claim for BTA insurance benefits under the Plan, that she timely appealed Defendant's denial of benefits, that an unauthorized third-party law firm decided her administrative appeal, and that the appeal decision was untimely because it was not issued within 60 days as required by applicable ERISA regulation, 29 C.F.R. § 2560.503-1(i) (1) (i).¹⁷

On January 17, 2023, the parties filed a Joint Motion to Enter Proposed Rule 16 Scheduling Order for ERISA Benefits Case to be Determined on Administrative Record (Docket Entry No. 9), in which the parties agreed that "[t]he merits of this case will be determined in usual ERISA fashion based [on] the [AR] and crossdispositive motions. The relevant evidence will be limited to the [AR], relevant ERISA documents, as well as any authorized . . . exceptions to that limitation, as determined by the Court."

On January 18, 2023, the court entered a Rule 16 Scheduling Order for ERISA Benefits Case to Be Determined on Administrative Record (Docket Entry No. 10), which directed the parties to file the pending dispositive motions by April 7, 2023. On February 15, 2023, the parties jointly filed the AR.

II. Applicable Law

The Supreme Court directs courts to conduct de novo review when adjudicating ERISA benefit disputes unless the plan documents give "the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan." Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 109 S. Ct. 948, 956-57, 103 L.Ed.2d 80 (1989). De novo review requires the court to apply the same standard as the plan administrator in deciding whether the benefits were owed under the plan's terms. See Connecticut General Life Insurance Co. v. Humble Surgical Hospital, L.L.C., 878 F.3d 478, 483 (5th Cir. 2017), cert. denied, 584 U.S. 979, 138 S. Ct. 2000, 201 L.Ed.2d 251 (2018) (citing Holland v. International Paper Company Retirement Plan, 576 F.3d 240, 246 (5th Cir. 2009)). "A claimant under section 1132 (a) (1) (B) has the initial burden of demonstrating entitlement to benefits under an ERISA plan, or that denial of benefits under an ERISA plan is arbitrary and capricious." Perdue v. Burger King Corp., 7 F.3d 1251, 1254 n. 9 (5th Cir. 1993). Moreover, the administrator "is not under a duty to 'reasonably investigate' a claim because it would be 'not only inappropriate but inefficient to require the administrator to obtain [ ] information [in the claimant's control] in the absence of the claimant's active cooperation." Gooden v. Provident Life & Accident Insurance Co., 250 F.3d 329, 333 (5th Cir. 2001) (quoting Vega v. National Life Insurance Services, Inc., 188 F.3d 287, 298 (5th Cir. 1999) (en banc), overruled on other grounds by Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 128 S. Ct. 2343, 171 L.Ed.2d 299 (2008)). "Once the record is finalized, a district court must remain within its bounds in conducting a review of the administrator's findings, even in the face of disputed facts." Ariana M. v. Humana Health Plan of Texas, Inc., 884 F.3d 246, 256 (5th Cir. 2018) (en banc) (citing Vega, 188 F.3d at 299). Departure from this rule is appropriate "only in very limited...