In its opinion, the appellate court pointed out that the dismissals are based only on the facts presented in the pleadings and not on any outside evidence. However, the district court had considered facts when making its decision based on evidence not presented in the original complaint.
The court said it was sending the case to the district court so that it may properly analyze the motion as a request for summary judgment and give the parties enough chance to put whatever evidence they wish into the record.
The appellate court required that the administrative record, including the papers used by the plan administrator in making its decision to deny benefits, be included to assist the district court in making its summary judgment analysis and allow it to determine whether defendants’ suggested bases for denial of the claims were simply post hoc rationalizations, as the plaintiffs argued.
The complaint of Terry McAuley’s children against Federal Insurance Group alleged that McAuley was enrolled in the Anheuser-Busch Employees Benefits Trust, which is an employee welfare benefit plan; the plan included two accidental loss of life policies; and that those policies covered “accidents” including, but not limited to, “unavoidable exposure to elements arising from a covered hazard;” according to the court opinion.
In addition, the children claimed that McAuley took a lengthy flight; that “[t]he extensive and massive acute bilateral pulmonary thromboemboli suffered by McAuley was a result of embolisms, or blood clots, that formed in his leg(s) during the extended airplane flight;” and that the resulting death was accidental in that it was a sudden and unexpected occurrence that resulted from the extended flight.
The court noted that the complaint contained no mention of “stasis,” no mention of McAuley’s prior health, and no mention of the health of any other passengers on the flight, yet the district court, in its order granting the motion to dismiss, mentioned these things. By including these issues, the appellate court said the district court converted Federal’s motion to dismiss to a motion for summary judgment.
The appellate court reversed the decision to dismiss the case and remanded the case back to the district court “for the creation of a summary judgment record and a better-informed analysis of the issues presented by the parties.”
The opinion is here .
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