United States District Court, N.D. Texas, Dallas Division
MEMORANDUM OPINION AND ORDER
C. Godbey United States District Judge
Order addresses Defendant, Baylor Health Care System's
(“Baylor”) motion for summary judgment . For
the reasons stated below, the Court grants the motion.
Origins of the Dispute
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
now moves for summary judgment on Hunter's breach of
contract and ERISA claims.
Summary Judgment Standard
“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).
Hunter did not respond to Baylor's motion, the Court
accepts Baylor's facts as undisputed. 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
The Court Grants Baylor's Motion for Summary
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 . Accordingly, the
Court holds that Hunter's state law claims are preempted
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).
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 ...