United States District Court, W.D. Tennessee, Western Division
H. MAYS, JR. UNITED STATES DISTRICT JUDGE
Shelton Sherrod Marzette brings this action against Defendant
The Lincoln National Life Insurance Company (“Lincoln
National”), challenging the denial of insurance
the Court is Lincoln National's Motion for Judgment on
the Administrative Record, dated March 27, 2017. (ECF No. 27;
cf. ECF No. 27-1.) Marzette responded on April 19, 2017. (ECF
No. 28.) Lincoln National replied on April 25, 2017. (ECF No.
reasons below, the Motion for Judgment on the Administrative
Record is GRANTED.
was employed by Pat Salmon and Sons, Inc.
(“Salmon”) as a tractor trailer truck driver.
(ECF No. 22-6 at 869.) Plaintiff participated in a group
voluntary accidental death and dismemberment insurance plan
(“Plan”) available to Salmon employees. (ECF No.
22-2 at 58-60.) Defendant provided the Plan benefits.
the Plan, insured persons like Plaintiff are entitled to
benefits if they “sustain[ed] a covered accidental
bodily injury while insured” that caused, among other
things, a “Loss of Hearing in One Ear.”
(Id. at 84.) The Plan defines loss of hearing as
“permanent and total deafness in [one] ear” that
“cannot be corrected to any functional degree by any
aid or device.” (Id. at 85.) The loss of
hearing “must result directly from the injury and from
no other causes.” (Id. at 84.)
has the authority to “manage this Policy and administer
claims under it” and to “interpret the provisions
and resolve questions arising under this Policy.”
(Id. at 100.) Defendant's decisions are
“conclusive and binding, ” subject to the insured
person's right to sue. (Id.)
represents that, on July 31, 2014, while driving to Denver,
Colorado for Salmon, he became dizzy and began experiencing
pain in his left ear. (ECF No. 22-6 at 870.) On August 1,
2014, Plaintiff visited the Emergency Department at the
Veterans Administration Hospital to consult a doctor about
his condition. (Id. at 819.) Hospital records from
that visit show that Plaintiff said he had felt “dizzy
since [July 31] when he woke up and thought it would go
away.” (Id. at 818.) Plaintiff also told
doctors that his left ear was stopped-up. (Id.)
Plaintiff was diagnosed with vertigo, given a prescription,
and discharged from the hospital. (Id.)
returned to the doctor on August 3, 2014, and complained that
he felt dizzy and that his left ear was stopped-up.
(Id. at 813-14.) Plaintiff was again diagnosed with
vertigo and discharged. (Id. at 811.)
returned to the doctor on August 5, 2014, and complained that
his vertigo continued. (Id. at 807.) Plaintiff told
doctors that a virus might be causing his condition.
(Id.) Plaintiff was given a work excuse and
August 7, 2014, Plaintiff went to the doctor for an audiology
consultation. (Id. at 804.) Plaintiff complained of
“sudden left ear hearing loss and dizziness (nausea,
vomiting, unsteadiness, ‘drunk feeling') which
first started last week.” (Id. at 803.)
Plaintiff was given an audiology exam, which revealed some
hearing loss in the left ear. (Id. at 806.) The
hearing loss was described as “a precipitous
high-frequency deficit at 4khz to 8khz.” (Id.)
The exam revealed that Plaintiff had “[n]ormal hearing
through speech frequencies.” (Id.) Plaintiff
was told to return in a week for another exam and
returned to the doctor on August 14, 2014. (Id. at
802.) Plaintiff reported that “his vertigo/imbalance
seems to have improved some, ” but complained of
hearing loss in his left ear. (Id. at 800.)
September 22, 2014, Plaintiff received another hearing
evaluation. (Id. at 793.) The evaluation
“revealed normal hearing sensitivity” and
“excellent” speech recognition for both ears.
(Id.) Plaintiff asked the doctor for hearing aids,
but the doctor said that hearing aids were “not
warranted at this time since there ...