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Hunter v. Baylor Health Care System

United States District Court, N.D. Texas, Dallas Division

August 14, 2019



          David C. Godbey United States District Judge

         This Order addresses Defendant, Baylor Health Care System's (“Baylor”) motion for summary judgment [23]. For the reasons stated below, the Court grants the motion.

         I. Origins of the Dispute

         Plaintiff, Kathleen Hunter, was an employee of Baylor when she was injured while assisting a patient to the restroom. Hunter alleges that when she saw a light fixture falling from the bathroom ceiling, she threw her body over the patient. Hunter alleges that the light fixture then struck her, causing injuries to her head, neck, and left shoulder. Baylor denied Hunter benefits on the basis that her condition was a pre-existing medical condition that did not meet the plan's definition of an injury. Hunter then filed a breach of contract and denial of ERISA benefits suit, alleging that Baylor should have paid for her shoulder surgery.

         Baylor now moves for summary judgment on Hunter's breach of contract and ERISA claims.

         II. Summary Judgment Standard

         Courts “shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact[, ] and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247 (1986). In making this determination, courts must view all evidence and draw all reasonable inferences in the light most favorable to the party opposing the motion. United States v. Diebold, Inc., 369 U.S. 654, 655 (1962). The moving party bears the initial burden of informing the court of the basis for its belief that there is no genuine issue for trial. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986).

         Because Hunter did not respond to Baylor's motion, the Court accepts Baylor's facts as undisputed.[1] Eversley v. Mbank Dallas, 843 F.2d 172, 174 (5th Cir. 1988). Normally, a “summary judgment nonmovant who does not respond to the motion is relegated to its unsworn pleadings, which do not constitute summary judgment evidence.” People's Capital & Leasing, Corp. v. Weir Bros., Inc., 2013 WL 12100733, at *1 (N.D. Tex. May 30, 2013) (citing Bookman v. Schubzda, 945 F.Supp. 999, 1002 (N.D. Tex. 1996)). If a party fails to respond to a motion for summary judgment, the inquiry must be whether the facts presented by the moving party create an appropriate basis to enter summary judgment against the nonmoving party. Adams v. Travelers Indem. Co. of Conn., 465 F.3d 156, 164 (5th Cir. 2006).

         III. The Court Grants Baylor's Motion for Summary Judgment

         A. ERISA Review

         The Court notes at the outset that Hunter does not dispute that her breach of contract and denial of benefits claims are preempted by ERISA. Baylor created a Baylor Health Care System Occupational Injury Benefit Plan (the “Plan”) that is covered by the Employee Retirement Income Security Act of 1974 (“ERISA”). Hunter's claims involve the right to receive benefits under the terms of an ERISA plan, and her beach of contract claim arises from the existence of the plan, as she seeks damages for Baylor's failure to pay medical bills and lost wages under the terms and conditions of the plan. Pl.'s Am. Compl. at ¶ 4.7 [15]. Accordingly, the Court holds that Hunter's state law claims are preempted by ERISA.

         In reviewing Baylor's denial of benefits, the Court holds that an abuse of discretion standard applies. ERISA permits a person who was denied benefits under an employee benefit plan to challenge that denial in federal court. 29 U.S.C. § 1132(a)(10)(B). The United States Supreme Court has held that the denial of benefits under an ERISA plan is “reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989) (italics omitted); see also Ariana M. v. Humana Health Plan of Texas, Inc., 884 F.3d 246, 255 (5th Cir. 2018) (holding that a plan administrator's denial of benefits is subject to de novo review, regardless of whether the denial is based on a legal or factual determination).

         The Plan in this case grants to the Claims Administrator and the Appeals Committee “discretionary and final authority to interpret and implement the provisions of the Plan, including but not limited to, making all factual and legal determinations . . . .” Def.'s App. A-1, Bates Label 000891 [23-3]. The Plan also states that:

There shall be no de novo review by any arbitrator or court of any decision rendered by the Appeals Committee and any review of such decision shall be limited to whether the decision was so arbitrary ...

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