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Cole v. Guardian Life Insurance Co.

United States District Court, Third Circuit

August 6, 2013

FRANCINE COLE, individually and as co-administrator of the Estate of Bevelyn D. Cole, Plaintiff,
v.
GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, Defendant.

OPINION

JOSE L. LINARES, District Judge.

This case concerns the death of Bevelyn D. Cole. Her sister, Francine Cole, brings this suit pursuant to the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001, et. seq., challenging Defendant Guardian Life Insurance Company of America's non-payment of an accidental death benefit following Bevelyn's death. Defendant Guardian has filed a motion for summary judgment pursuant to Federal Rule of Civil Procedure 56. The Court has considered the submissions made in support of and in opposition to the instant motion. No oral argument was heard. Fed.R.Civ.P. 78. Based on the reasons that follow, Defendant's motion [Docket Entry No. 56] is granted.

BACKGROUND

The following relevant facts are not in dispute unless noted otherwise.

A. The ERISA Plan

During all relevant times, Bevelyn Cole was employed at the Bonnie Brae School ("BBS"). (Def. 56.1 Stmt., ¶ 2); (Pl. Response, ¶ 2). Guardian provides Basic Group Term Life Insurance and Basic Accidental Death benefits to eligible employees of the Bonnie Brae School under the Bonnie Brae Group Insurance Plan ("the Plan"). ( Id. ). Thus, there are two life insurance components to the Plan: (1) a Basic Life benefit, and (2) an Accidental Death benefit. The Plan is an employee welfare plan governed by ERISA, 29 U.S.C. § 1001, et seq. ( Id., ¶ 4). Guardian is a fiduciary of the Plan established by BBS with respect to claims administration and is conferred discretionary authority to interpret the terms of the Plan and to determine eligibility for Basic Life and Accidental Death claims. ( Id., ¶ 5).

The Plan provides that benefits will be paid to a beneficiary and explains who is a beneficiary of the Basic Life and Accidental Death Insurance. ( Id., ¶ 10). It provides:

Your Basic Group Term Life Insurance
Basic Life Benefit
If you die while insured for this benefit, we will pay your beneficiary the amount shown in the schedule.
Your Beneficiary
You decide who gets this insurance if you die. You should have named a beneficiary on your enrollment form. You can change your beneficiary at any time by giving your employer written notice, unless you have assigned the insurance. But the change will not take effect until the employer gives you written confirmation of the change.
If you named more than one person, but did not tell us what their share should be, they will share equally. If someone named dies before you do, his or her share will be divided equally by the beneficiaries still alive, unless you have told us otherwise.
***
Your Basic Accidental Death and Dismemberment Benefits
Benefit Amounts
For covered loss of life, we'll pay the full amount shown in the schedule for the plan you have elected, to the same beneficiary who gets your employee group term life insurance.

( Id., ¶ 10).

For payment of Basic Life and Accidental Death benefits, the Plan provides the following:

Your Benefit
We'll pay the benefits described below if you suffer a covered loss due to an accident that occurs while you are insured.
***
Covered ...

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