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Vancel v. Unicare Life Insurance Co.

United States District Court, S.D. Indiana, Indianapolis Division

March 3, 2017

JANIE VANCEL, Plaintiff,
v.
UNICARE LIFE INSURANCE COMPANY, FORD MOTOR COMPANY, Defendants.

          ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT

          SARAH EVANS BARKER, JUDGE

         Order Before us are cross motions for summary judgment. Plaintiff Janie Vancel filed a Motion for Summary Judgment [Dkt. No. 36] to which Defendants Ford Motor Company (“Ford”) and UniCare Life & Health Insurance Company (“UniCare”) responded and moved for summary judgment in their favor [Dkt. No. 45]. Plaintiff has not responded to Defendants' motion for summary judgment and the time for doing so has passed. For the following reasons, we GRANT summary judgment in favor of UniCare Life Insurance Company and the Ford Motor Company and against Janie Vancel.

         Facts[1]

         Neither party disputes the facts presented by the opposing party. Plaintiff seeks a declaration that the death of her husband, Michael Vancel, was an accident within the scope of coverage provided in an Accidental Death Benefit policy issued to Mr. Vancel. Ford and UniCare rejoin that Mr. Vancel's death was not an accident as defined by the Policy and, as a result, Ms. Vancel is not entitled to benefits under the policy.

         Mr. Vancel was a full-time employee for Ford and a participant in Ford's Life and Accidental Death and Disability Plan (the “Plan”). The Plan provides benefits through a group insurance policy issued by UniCare, Group Policy Number GI-GCC (the “Policy”). The Policy provides, among other things, accidental death and dismemberment benefits for its eligible participants. Ms. Vancel is a named beneficiary of the Policy.

         Ford is the Plan sponsor and administrator while UniCare insures the Policy, evaluates claims, and pays benefits due to participants as set forth in the terms of the Policy and Plan. If a claimant is denied benefits and appeals that decision, the UAW-Ford Group Life and Disability Appeal Committee (the “Appeal Committee'”) reviews the denial of benefits.

         The Policy contains the following relevant provision:

         ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE Accidental Death Benefit

         The Insurer will pay a benefit if your death occurs under these conditions:

1. the death is a result of your accidental bodily injury; and
2. you were insured by this coverage at the time of such injury and at the time of loss; and
3. the death occurred within 2 years of the injury.[2]

[Policy at 27.] The term “accident” is defined by the Policy as “an injury caused by accidental bodily harm.” [Id. at 11.] Relevant to any entitlement to the above benefits are several exclusions, including “any death or loss caused wholly or partly, directly or indirectly by . . . disease or bodily or mental infirmity, or medical or surgical treatment thereof.” [Id. at 29.] The Plan contains essentially the same eligibility and exclusionary language as the Policy. [Group Life and Disability Insurance Plan (“Plan”) at § 10 (Administrative Record (“AR”)[3] at 1191-93).]

         In response to his complaints of right-side pain, Mr. Vancel had a CT scan performed on January 7, 2013, which revealed cancerous tumors on both of his kidneys. “After reviewing all therapeutic options, risks and benefits including, but not limited to bleeding, infection, damage to adjacent organs, open conversion, removal of kidney, urinary leak, [Mr. Vancel] elected for the [robotic-assisted surgery]”, which took place on January 28, 2013. [AR at 192-98.] After the surgery, Mr. Vancel's surgeon, Dr. Jason Sprunger, reported that Mr. Vancel “tolerated the procedure well” ...


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