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Howard v. Prudential Insurance Co. of America

United States District Court, W.D. Kentucky, Louisville

March 29, 2017

JAMES W. HOWARD II PLAINTIFF
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA DEFENDANT

          MEMORANDUM OPINION

          Charles R. Simpson III, Senior Judge.

         I. Introduction

         This matter is before the Court on the partial motion of Defendant the Prudential Insurance Company of America (“Prudential”) to dismiss Count II of the first amended complaint and on its motion to strike the requests for extra-contractual and punitive damages, as well as the jury demand under Federal Rule of Civil Procedure 12(b)(6), ECF No. 15. Plaintiff James W. Howard II did not respond. For the reasons explained below, the Court will grant Prudential's partial motion to dismiss Count II. The Court will also grant Prudential's motion to strike the requests for extra-contractual and punitive damages, and the jury demand.

         II. Allegations in the First Amended Complaint

         In May 2015, Howard was operating his vehicle in Louisville Kentucky. First Am. Compl. ¶ 4, ECF No. 13. He was traveling eastbound on Greenwood Road. Id. Howard experienced a medical emergency and became incapacitated at the wheel. Id. His son, a juvenile, was a passenger in the vehicle. Id. ¶ 5. The son attempted to take control of the steering wheel as the vehicle continued to accelerate. Id. The vehicle veered off the roadway's right shoulder, struck a culvert, severed a utility pole, and collided with a fence. Id. ¶ 6. It then crossed Russell Avenue, and stuck a street sign, fire hydrant, large shrubbery, and finally another utility pole. Id.

         Howard was mechanically extracted from the vehicle and taken to the University of Louisville Hospital with life-threatening injuries. Id. ¶ 7. As a result of these injuries, his left hand was amputated at the wrist. Id. ¶ 8. It was determined that Howard had suffered a seizure while operating his vehicle, which resulted in his incapacitation and the subsequent collision. Id. ¶ 9. Howard had been diagnosed with Type I diabetes and might have been hypoglycemic at the time of the motor vehicle accident. Id. ¶ 10.

         Also at the time of the motor vehicle accident, Howard was employed by the United Parcel Service. Id. ¶ 11. He was insured under an Accidental Death and Dismemberment Policy (“the policy”) issued by Prudential. Id. Within ninety days of his motor vehicle accident, Howard made a valid claim for payment of benefits under the policy because of his left hand's amputation. Id. ¶¶ 12, 15.

         The policy pays benefits for “accidental loss, ” meaning the loss of a person's hand or foot by severance at or above the wrist or ankle. Id. ¶ 13. The loss of the beneficiary's hand or foot must result directly from an accidental bodily injury and occur within ninety days after the accident. Id. ¶ 14. The policy does not, however, pay benefits for losses resulting from sickness, or from medical or surgical treatment of sickness. Id. ¶ 16.

         In February 2016, Howard was notified that Prudential had denied his claim for benefits under the policy. Id. ¶ 12. Prudential explained that it had denied the claim because the loss of Howard's left hand resulted indirectly from sickness, or from the medical or surgical treatment of sickness. Id. ¶ 17. According to Prudential, Howard's insulin treatment for diabetes caused him to become hypoglycemic, which led to his seizure and eventual loss of his hand. Id.

         Prudential also explained that it had denied the claim for benefits under the policy because the loss of Howard's hand resulted directly from sickness, or from the medical or surgical treatment of sickness. Id. ¶ 18. Prudential asserts that Howard's insulin treatment for diabetes caused him to become hypoglycemic, which then caused him to suffer a seizure that led to the motor vehicle accident, which caused him to sustain an injury to his left hand that then led to the amputation of the hand. Id. Howard's medical records, however, indicate only that he became incapacitated while driving because of a possible seizure and that his left hand was amputated as a direct result of injuries he sustained in the motor vehicle accident. Id. ¶ 19.

         Howard asserts two causes of action against Prudential in the first amended complaint. First, Howard claims that Prudential's denial of his claim for benefits under the policy violates the Employment Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1132(a)(1)(B) (Count I). Id. ¶ 24. Second, Howard alleges that Prudential's actions violated the Kentucky Unfair Claims Settlement Practices Act (KUCSPA), Ky. Rev. Stat. § 304.12-230 (Count II). Id. ¶ 25. Howard requests a jury trial, an award of exemplary, compensatory, and punitive damages, an award of reasonable costs and attorney fees, and any other appropriate relief. Id. 4-5.

         III. Discussion

         Prudential now moves to dismiss Howard's claim asserted under the KUCSPA and to strike the requests for extra-contractual and punitive damages, and the jury demand under Federal Rule of Civil Procedure 12(b)(6). Mot. Dismiss 1, ECF No. 15. Rule 12(b)(6) provides that a party may move to dismiss a cause of action for “failure to state a claim upon which relief can be granted.” To survive a motion to dismiss, a complaint must contain sufficient facts to state a claim that is “plausible on its face.” Bell Atl. Corp. v. Twombly, 55 U.S. 544, 570 (2007). A complaint states a plausible claim for relief when the court may “draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). A court is not required to accept legal conclusions or “threadbare recitals of the elements of a cause of action.” Id. When resolving a motion to dismiss, the court must “construe the complaint in the light most favorable to the plaintiff, accept its allegations as true, and draw all reasonable inferences in favor of the plaintiff.” Wesley v. Campbell, 779 F.3d 421, 428 (6th Cir. 2015) (quoting Directv, Inc. v. Treesch, 487 F.3d 471, 476 (6th Cir. 2007)).

         Prudential argues that the Court should dismiss Howard's claim asserted under the KUCSPA and requests for extra-contractual and punitive damages because they are preempted by ERISA as a matter of law. Mem. Supp. Mot. Dismiss 4-9, ECF No. 15-1. Prudential also claims that the Court should strike ...


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