781 F. Supp. 2d 857
D. Neb.2011Background
- Lobergs seek ERISA benefits for Wade Loberg’s death; LINA denied accidential-death benefits under Policy OK 807266.
- Policy covered Wade as a dependent; Wade’s death occurred in a crash on Sep 4, 2008 in Nebraska; BAC 0.172% noted.
- Denial letter (Dec 5, 2008) asserted Wade’s intoxication meant death was not an accident.
- Plaintiffs filed suit July 2009; case removed to federal court; ERISA §1132(a)(1)(B) governs recovery of benefits.
- Court previously held ERISA preempts state-law claims and converted them to a federal claim; case remanded for Wickman analysis.
- Court ultimately orders return to LINA for initial Wickman-based determination of whether Wade’s death was an accident.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether LINA’s denial should be reviewed under Wickman’s standard | Lobergs contest LINA’s initial rationale. | LINA argues Wickman applies to determine accident status. | Remand for Wickman-based evaluation |
| Whether LINA’s post hoc rationale can sustain denial | LINA changed rationale post-decision. | LINA should be allowed to apply correct standard. | Remand required; not resolved on record |
| Whether the summary-plan-description claim survives | Faulty SPD prejudiced Lobergs. | No extraordinary circumstances shown; claim fails. | Dismissed with prejudice for lack of detrimental reliance |
Key Cases Cited
- Wickman v. Northwestern Nat'l Ins. Co., 908 F.2d 1077 (1st Cir. 1990) (definition of accident under ERISA policy; Wickman test and analysis)
- King v. Hartford Life & Accident Ins. Co., 414 F.3d 994 (8th Cir. 2005) (en banc; Wickman standard; remand when post hoc rationale used)
- Metro. Life Ins. Co. v. Taylor, 481 U.S. 58 (1987) (complete preemption under ERISA §1132(a))
- Conkright v. Frommert, 130 S. Ct. 1640 (2010) (standard of review for plan interpretations; deference to administrator)
- LaAsmar v. Phelps Dodge Corp. Life, Accidental Death & Dismemberment & Dependent Life Ins. Plan, 605 F.3d 789 (10th Cir. 2010) (rejects per se rule that alcohol-related crashes are not accidents)