The opinion of the court was delivered by: A. CAPUTO, District Judge
Presently before the Court are Defendant Aetna Life Insurance
Company's Motion for Summary Judgment (Doc. 30) and Plaintiff
Janet Scott's Motion for Summary Judgment (Doc. 35). For the
reasons set forth below, the Court will grant Defendant's motion
and deny Plaintiff's motion. The Court has jurisdiction over this
matter pursuant to 28 U.S.C. § 1331.
Plaintiff enrolled herself and her spouse in a life insurance
plan ("the Plan") governed by the Employee Retirement Income
Security Act, 29 U.S.C. §§ 1001, et seq., ("ERISA").
Plaintiff's employer, Thomson Education Direct ("Thomson"),
administered the plan. (Doc. 31, Ex. 1, Aetna-00033.) Defendant
Aetna administered claims under the Plan. Id.
On September 15, 1997, Plaintiff elected "spouse coverage" in
the amount of $60,000.00 for her husband. (Doc. 31, Ex. 2.) Under
the terms of the Plan, the maximum amount for a spouse may not
exceed twice the employee's annual earnings after being rounded
to the next higher $10,000. (Doc. 31, Ex. 1, Aetna-00030.) Furthermore, one can become insured with respect to a dependant
for an amount of Life Insurance in excess of $35,000 only if one
submits evidence of that dependent's good health to Aetna and
such evidence is approved by Aetna. Id. Plaintiff did not meet
either of these requirements upon electing coverage for her
husband in the amount of $60,000.00, however, Plaintiff submitted
evidence that premiums were deducted from her paychecks by
Thomson for this level of coverage. (Doc. 31, Ex. 7,
On October 13, 2001, Plaintiff and Mr. Scott divorced. (Doc. 11
¶ 11.) Plaintiff informed her employer, Thomson, that the divorce
was finalized. (Doc. 37 ¶ 8.) Plaintiff, however, did not inform
Aetna directly of the change in her marital status. Plaintiff
submitted evidence that Thomson told her that her former
husband's insurance would continue through December 31, 2001.
(Doc. 37 ¶ 9; Doc. 31, Ex. 7, Aetna-00064.) Thomson also
continued to deduct premiums from Plaintiff's paycheck for life
insurance for Mr. Scott through the end of December, 2001. (Doc.
31, Ex. 4, Aetna-00066.)
Mr. Scott died suddenly on December 27, 2001. (Doc. 31, Ex. 5,
Aetna-00086.) Following Mr. Scott's death, Plaintiff submitted a
claim to Aetna for life insurance benefits. (Id. at Ex. 3,
Aetna 00056-57.) Aetna denied Plaintiff's claim for benefits
after it determined that Mr. Scott ceased to be an eligible
dependent as of the date that Mr. and Mrs. Scott's divorce became
final. (Id. at Ex. 6, Aetna-00062.) Plaintiff appealed the
denial of her claim.
On February 5, 2002, the Aetna claims examiner authored the
DC INDICATED THAT DECEDENT WAS DIVORCED FROM THE
EMPLOYEE JANET SCOTT CALLED CLAIRE AT PH OFFICE . . .
TALKED TO HER ABOUT COVERAGE SHE INDICATED THAT
ALTHOUGH EE WAS DIVORCED THE HR AREA HAD NOT BEEN NOTIFIED AND THE LOCATION WHERE EE WORKS THOUGHT THAT
COVERAGE WOULD CONTINUE FOR 90 DAYS TOLD HER THAT
TO THE BEST OF MY KNOWLEDGE COVERAGE WOULD HAVE ONLY
BEEN IN FORCE TO 30 DAYS AFTER DIVORCE. ALSO CHECKED
WITH CONVERSION UNIT TO SEE IF THEY HAD APPLIED TO
CONVERT THE SPOUSE COVERAGE AT THE TIME OF THE
DIVORCE PER PH THEY WERE DIVORCED IN OCTOBER 2001
NOTHING WAS RECV'D IN CONVERSIONS PH WANTS TO
RELEASE TO EXAMINER TO SEE IF PAYMENT CAN BE MADE.
(Doc. 37 ¶ 12; Doc. 36, Ex. 1.) Following further investigation,
Aetna upheld the denial of Plaintiff's claim. Id.
Plaintiff then filed the present suit pursuant to ERISA, which
was removed to this Court on March 23, 2004. (Doc. 1.) On June
10, 2004, Plaintiff filed an Amended Complaint. (Doc. 11.) On
August 31, 2004, the Court granted a Motion to Dismiss
Plaintiff's employer, Thomson, from suit. (Doc. 23.) On June 30,
2005, Defendant Aetna filed a motion for summary judgment. (Doc.
30.) Plaintiff filed a motion for summary judgment on July 15,
2005. (Doc. 35.) Both motions are fully briefed and ripe for
Summary judgment is appropriate if "the pleadings, depositions,
answers to interrogatories, and admissions on file, together with
the affidavits, if any, show that there is no genuine issue as to
any material fact and that the moving party is entitled to a
judgment as a matter of law." FED. R. CIV. P. 56(c). A fact is
material if proof of its existence or nonexistence might affect
the outcome of the suit under the applicable substantive law.
See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). Where there is no material fact in dispute, the moving party
need only establish that it is entitled to judgment as a matter
of law. Where, however, there is a disputed issue of material
fact, summary judgment is appropriate only if the factual dispute
is not a genuine one. See id. at 248. An issue of material fact
is genuine if "a reasonable jury could return a verdict for the
nonmoving party." Id.
Where there is a material fact in dispute, the moving party has
the initial burden of proving that: (1) there is no genuine issue
of material fact; and (2) the moving party is entitled to
judgment as a matter of law. See CHARLES ALAN WRIGHT & ARTHURR.
MILLER, FEDERAL PRACTICE AND PROCEDURE: CIVIL 2D § 2727 (2d ed.
1983). The moving party may present its own evidence or, where
the nonmoving party has the burden of proof, simply point out to
the Court that "the nonmoving party has failed to make a
sufficient showing of an essential element of her case." Celotex
Corp. v. Catrett, 477 U.S. 317, 323 (1986).
All doubts as to the existence of a genuine issue of material
fact must be resolved against the moving party, and the entire
record must be examined in the light most favorable to the
nonmoving party. See White v. Westinghouse Elec. Co.,
862 F.2d 56, 59 (3d Cir. 1988). Once the moving party has satisfied its
initial burden, the burden shifts to the nonmoving party to
either present affirmative evidence supporting its version of the
material facts or to refute the moving party's contention that
the facts entitle it to judgment as a matter of law. See
Anderson, 477 U.S. at 256-257.
The Court need not accept mere conclusory allegations, whether
they are made in the complaint or a sworn statement. Lujan v.
Nat'l Wildlife Fed'n, 497 U.S. 871, 888 (1990). In deciding a motion for summary judgment, "the judge's
function is not himself to weigh the evidence and determine the
truth of the matter but ...