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Hetty A. Viera, As the Civil Action Executrix of the Estate of Frederick A. Viera, and Hetty A. Viera, Individually v. Life Insurance Company of North America

May 14, 2012

HETTY A. VIERA, AS THE CIVIL ACTION EXECUTRIX OF THE ESTATE OF FREDERICK A. VIERA, AND HETTY A. VIERA, INDIVIDUALLY,
PLAINTIFF,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, DEFENDANT.



The opinion of the court was delivered by: Eduardo C. Robreno, J.

MEMORANDUM

I. INTRODUCTION

Plaintiff Hetty Viera ("Plaintiff") brings this action pursuant to the Employee Retirement Income and Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B) (2006), seeking payment of benefits under an accidental death and dismemberment policy arising from the death of her husband, Frederick Viera ("Viera"). Defendant Life Insurance Company of North America ("Defendant") denied benefits under the accidental death and dismemberment policy. The case is on remand to this Court from the United States Court of Appeals for the Third Circuit.

Currently before the Court is Plaintiff's request for additional discovery in order for the Court to conduct a de novo review of Defendant's denial of benefits. For the reasons that follow, the Court will deny Plaintiff's request.

II. BACKGROUND

On October 14, 2008, Viera was involved in a motorcycle accident in Grand Junction, Colorado. Viera suffered serious injuries as a result of the accident. He was treated at St. Mary's Hospital and Medical Center ("St.Mary's") for approximately three hours and was subsequently pronounced dead.

On the date of his death, Viera maintained two insurance policies, which were purchased on his behalf by his employer, Hornbeck Offshore Operators, L.L.C. These insurance policies consisted of an employer-provided life insurance policy, and an employer-provided accidental death and dismemberment policy (the "AD & D Policy" or the "Policy"). The claims administrator for each of these policies is Defendant. Only the AD & D Policy is the subject of the instant litigation.

Viera had a pre-existing chronic condition known as atrial fibrillation before Defendant issued the AD & D Policy. See Def.'s Br. in Supp. of Mot. for Summ. J. Ex. C, at 123-25, 210, ECF No. 29. As part of the medical treatment for his atrial fibrillation, Viera received a medication called Coumadin (also known as Warfarin).*fn1 See id. at 135-38.

Plaintiff is Viera's wife and the executrix of his estate. On November 3, 2008, Plaintiff submitted a claim for benefits under the AD & D Policy to Defendant, but Defendant denied this claim.*fn2 Defendant's position was that Viera's death was not a covered event under the express terms of the AD & D Policy. One relevant provision of the AD & D Policy, defines a "Covered Loss" as:

A loss that is all of the following:

1. the result, directly and independently of all other causes, of a Covered Accident;

2. one of the Covered Losses specified in the Schedule of Covered Losses;

3. suffered by the Covered Person within the applicable time period specified in the Schedule of Benefits.

Id. at 27 (emphasis in original). Another relevant provision of the AD & D Policy defines a "Covered Accident" as:

A sudden, unforeseeable, external event that results, directly and independently of all other causes, in a Covered Injury or a Covered Loss and meets all of the following conditions:

1. occurs while the Covered Person is insured under this Policy;

2. is not contributed to by disease, Sickness, mental or bodily infirmity;

3. is not otherwise excluded under the terms of this Policy.

Id. The AD & D Policy also contains a provision that specifically excludes the following ...


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