Garwood v. Sun Life Assurance Company of Canada

Background

Brandon Garwood sought long-term disability benefits under an employee benefit plan established by PIE Consulting and Engineering, Inc. and funded in part by group insurance issued by Sun Life Assurance Company of Canada. The plan is governed by the federal Employee Retirement Income Security Act (ERISA). Garwood initially received short-term disability benefits, but Sun Life denied his application for long-term disability benefits under a plan exclusion for disability or other loss caused by, contributed to by, or resulting from the insured’s committing or attempting to commit an assault, felony, or other criminal act.

The dispute arose from an April 23, 2020 incident in which Garwood entered the unlocked home of his former girlfriend and roommate, Mary Graham, to retrieve property. After a verbal confrontation involving Graham, Brandin Foos, and others, Garwood returned to his truck. According to the administrative record, surveillance video showed him rapidly turning the truck from the street into the driveway, striking a motorcycle occupied by Michael Voorhies. People moved out of the truck’s path, and George Hunnicutt fired seven shots toward the truck. Garwood suffered multiple gunshot wounds and lower-extremity paraplegia. He was later charged with aggravated assault with a deadly weapon, but the charge was dismissed based on prosecutorial discretion.

Motions and standard of review

The parties filed cross-motions for summary judgment, which the court treated as motions for judgment on the administrative record. Sun Life also moved to exclude evidence outside that record. Garwood argued that the plan’s reference to Colorado law invalidated Sun Life’s discretionary authority and required de novo review, meaning the court would decide the benefit issue independently. The court assumed, without deciding, that de novo review applied because it would reach the same result under either standard.

The court denied as moot in part and granted in part Sun Life’s motion to exclude extra-record evidence. It denied as moot the portion concerning Garwood’s award of Social Security disability benefits because that evidence was irrelevant to whether the exclusion applied. It granted the portion concerning Garwood’s claim that he was merely making a three-point turn because Garwood had not shown good cause for failing to present that evidence during the administrative review. The court therefore did not consider that evidence.

Court’s analysis

The court applied Texas law to the plan’s criminal-act exclusion. Under the Texas assault statute, an assault includes intentionally or knowingly threatening another person with imminent bodily injury. The court explained that intent may be inferred from circumstantial evidence, including a person’s acts, words, and conduct.

The court found that the administrative record supported an inference that Garwood intended to commit an assault. It relied on evidence that he had been involved in a heated verbal altercation, knew people and motorcycles remained in the driveway, and then rapidly drove his truck toward the group before striking a motorcycle. The court concluded that Garwood acted intentionally and knowingly because he was aware that his conduct was reasonably certain to cause the relevant result. It also found no contrary evidence in the administrative record.

The court rejected Garwood’s argument that dismissal of the criminal charge showed that he had not committed or attempted to commit an assault. The exclusion focused on his conduct and did not require a criminal prosecution or conviction. The court found the warrant reliable and concluded that the record supported the conclusion that Garwood instigated the situation and committed or attempted to commit an assault.

Disposition

The court concluded that the exclusion applied and that Sun Life’s denial of long-term disability benefits was supported by the administrative record. It DENIED Garwood’s motion for summary judgment, GRANTED Sun Life’s motion for summary judgment, DENIED AS MOOT IN PART and GRANTED IN PART Sun Life’s motion to exclude extra-record evidence, and DISMISSED Garwood’s complaint WITH PREJUDICE. The court ordered judgment to be entered accordingly.