Nicole argues that the denial of her claim was arbitrary and capricious. On the other hand, the BAC (on behalf of itself and the other defendants) asks us to affirm the judgment in its favor, but separately contends that the district court erred in the imposition of a penalty against the BAC as the Plan administrator. For the reasons set forth below, we AFFIRM the judgment of the district court in all respects.
Benefits are payable under the Plan if a covered person suffers an “injury” as a result of an “accident.” An accident is defined in the policy as “an unintended or unforeseeable event or occurrence which happens suddenly and violently.” But not every accident is covered under the Plan. One of the Plan’s exclusions, Exclusion 12, provides that no benefits will be paid if the “Covered Person [is] deemed and presumed, under the law of the locale in which the Injury is sustained, to be under the influence of alcohol or intoxicating liquors.” (emphasis in original).
Judge(s): Ronald Lee Gilman
Jurisdiction: U.S. Court of Appeals, Sixth Circuit
Related Categories: Administrative Law , Contracts , Criminal Justice , Expert Witness , Health Care , Insurance , Transportation
|Circuit Court Judge(s)|
|Trial Court Judge(s)|
|Appellant Lawyer(s)||Appellant Law Firm(s)|
|Kelly Lawrence||Frantz Ward LLP|
|Mark Rodio||Frantz Ward LLP|
|Michael Smith||Frantz Ward LLP|
|Appellee Lawyer(s)||Appellee Law Firm(s)|
|Lisa Kathumbi||Littler Mendelson PC|
|Daniel Srsic||Littler Mendelson PC|