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HOWARD v. NATIONAL EDUC. ASS'N OF NEW YORK

December 21, 1995

CAROLE C. HOWARD, Plaintiff, against NATIONAL EDUCATION ASSOCIATION OF NEW YORK and HARTFORD LIFE INSURANCE COMPANY, Defendants.


The opinion of the court was delivered by: MCAVOY

 I. INTRODUCTION

 Plaintiff Carole C. Howard originally filed this action in New York State Supreme Court, Broome County, but defendants National Education Association of New York ("NEANY") and Hartford Life Insurance Company ("Hartford Life") removed the case to this Court pursuant to 28 U.S.C. § 1441. Plaintiff seeks accidental death benefits under an insurance policy issued by Hartford Life on her husband, who died of a heart attack. Hartford Life now moves for dismissal of the Complaint or, in the alternative, for summary judgment.

 II. BACKGROUND

 Richard C. Howard, plaintiff's deceased husband, was an employee of defendant NEANY. He was also a member of the Staff Organization of New York Educators ("SONYE"), the recognized collective bargaining unit for employees of NEANY. Pursuant to a collective bargaining agreement between NEANY and SONYE, NEANY provided Mr. Howard with life insurance, accidental death and dismemberment insurance, and common carrier coverage at no cost. Plaintiff is the beneficiary of the insurance policy issued by defendant Hartford Life upon Mr. Howard.

 On or about September 23, 1990, Mr. Howard died suddenly as the result of a heart attack. Some evidence indicates that he may have been the victim of heart disease, and other evidence suggests that job-related stress may have been a factor. In a litigated workers' compensation proceeding, an administrative law judge ("ALJ") determined that the heart attack occurred in the course of employment because it was related to job stress. Plaintiff consequently believes that she is entitled to be paid the accidental death insurance benefit enumerated in her husband's policy, equivalent to three times Mr. Howard's basic annual earnings.

 Plaintiff filed her claim for such benefit with Hartford Life, but the company denied payment on the claim. *fn1" Defendant's proffered reason for the denial was that Mr. Howard actually died from heart disease rather than an "accident," and the policy in question only related to accidental deaths. Plaintiff thereafter commenced legal action against defendants in New York State Supreme Court, Broome County, seeking payment of the accidental death benefits that were denied by Hartford Life. After plaintiff commenced her suit, defendants filed a Notice of Removal with this Court and successfully opposed plaintiff's motion for remand.

 Defendant Hartford Life now moves for dismissal of the Complaint pursuant to Fed. R. Civ. P. 12(b)(6) or for summary judgment pursuant to Fed. R. Civ. P. 56. Hartford Life contends that its denial of benefits should be subject to an "arbitrary and capricious" standard of review. Under that standard, the company reasonably could have determined that plaintiff's husband died from natural, rather than accidental, causes. Plaintiff counters that the Court should review the case de nova, with no deference to the determinations of Hartford Life. Plaintiff also argues that a genuine issue of material fact exists in regard to the causes of her husband's death. As a result, from plaintiff's perspective, dismissal and summary judgment should be denied.

 III. DISCUSSION

 A. RULE 12(b)(6) MOTION BY DEFENDANT

 On a motion to dismiss, the facts alleged by plaintiff are assumed to be true and must be liberally construed in the light most favorable to plaintiff. Easton v. Sundram, 947 F.2d 1011, 1014 (2d Cir. 1991), cert. denied, 504 U.S. 911, 118 L. Ed. 2d 548, 112 S. Ct. 1943 (1992). The Court's inquiry merely is directed to whether plaintiff's allegations constitute a statement of claim under Fed. R. Civ. P. 8, which calls for "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed. R. Civ. P. 8(a). After reviewing the complaint, the Court finds that plaintiff could in fact prove a set of facts that would entitle her to relief. See, e.g., Guisti v. General Elec. Co., 733 F. Supp. 141 (N.D.N.Y. 1990). As a result, defendant Hartford Life's motion for dismissal of the Complaint pursuant to Fed. R. Civ. P. 12(b)(1) is DENIED and the Court will focus on defendant's motion for summary judgment.

 B. RULE 56(c) MOTION BY DEFENDANT

 Pursuant to Fed. R. Civ. P. 56(c), a trial judge may grant summary judgment "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits . . . show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 91 L. Ed. 2d 202, 106 S. Ct. 2505 (1986). The moving party has the initial burden of informing the Court of the basis for its motion and identifying the matter that it believes demonstrates the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986). The substantive law determines which facts are material to the outcome of a particular case. See Anderson, 477 U.S. at 250. In determining whether summary judgment is appropriate, the Court must resolve all ambiguities, and draw all reasonable inferences, against the moving party. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 89 L. Ed. 2d 538, 106 S. Ct. 1348 (1986).

 If the moving party satisfies its burden, the burden then shifts to the non-moving party to come forward with "specific facts showing that there is a genuine issue for trial." Fed. R. Civ. P. 56(e). The non-moving party must do more than simply show "that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at 586. Only when the Court finds it apparent that no rational finder of fact could find in favor of the non-moving party because the evidence to support its case is ...


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