1

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

Annabelle McCombs and Marlene

McCombs, as Mother and General 

Guardian of Anthony McCombs, 

Plaintiffs,

v.

Reliance Standard Life Insurance Co.,

Defendant

No. 20 CV 3746

Judge Lindsay C. Jenkins

MEMORANDUM OPINION AND ORDER

Plaintiffs, Annabelle McCombs and Marlene McCombs, as Mother and General 

Guardian of Anthony McCombs (“Plaintiffs”) bring suit against Reliance Standard 

Life Insurance Company (“Reliance Standard” or “Defendant”) under § 502 of the 

Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132.1

Plaintiffs seek a declaratory judgment that Annabelle and Anthony are entitled to 

payment of life insurance benefits under a Reliance Standard group life insurance 

policy that covered their late father, Jeffrey McCombs. Plaintiffs also seek an order 

compelling Defendant to pay the full amount of life benefits, reasonable attorney fees 

and costs pursuant to ERISA § 502(g)(1), 29 U.S.C. § 1132(g)(1), and prejudgment 

interest. Currently before the Court are the parties’ cross-motions for summary 

judgment [Dkts. 12, 20].

1 To avoid confusion, the Court refers to members of the McCombs family by their first names. 

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For the reasons explained below, the Court grants Plaintiffs’ motion [Dkt. 20] 

and denies Defendant’s motion [Dkt. 12]. Plaintiffs are entitled to payment of life 

insurance benefits in the amount of $130,000, plus attorney fees, costs and 

prejudgment interest. 

I. Background

The following facts are taken from the parties’ Local Rule 56.1 statements 

[Dkts. 14, 19, 25] and the administrative record [Dkts. 11 through 11-7] and are 

undisputed except where a dispute is noted. 

Plaintiffs Annabelle and Anthony McCombs are the children of Marlene

McCombs. All three have been residents of Illinois at all times relevant to the 

complaint. Annabelle and Anthony’s father, Jeffrey, died in July 2016. At that time, 

Jeffrey and Marlene were divorced and Annabelle and Anthony were still minors. 

At the time of his death, Jeffrey was employed by Transunion, LLC 

(“Transunion”) as a Senior Manager. [Dkt. 19, ¶ 6.] Transunion sponsored and 

maintained an employee welfare benefit plan for its eligible employees, including 

Jeffrey. The plan is governed by ERISA. [Id., ¶ 3.] The plan includes life insurance 

benefits, which were funded by Defendant Reliance, an insurance company licensed 

to do business in Illinois. [Id., ¶ 4.]

There are at least three documents pertinent to the life insurance benefits 

offered by Transunion: the life insurance plan, the plan summary, and the policy.2

2 The Seventh Circuit has explained that “confusion” about what is included in an ERISA plan 

“is all too common in ERISA land,” and that “often the terms of an ERISA plan must be inferred from 

a series of documents none clearly labeled as ‘the plan.’” Health Cost Controls of Illinois, Inc. v. 

Washington, 187 F.3d 703, 712 (7th Cir. 1999). Where, as here, an ERISA plan includes an insurance 

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The TransUnion LLC Basic Life Insurance Plan (the “Plan”) was executed effective 

December 15, 2005 and identifies TransUnion LLC as the plan administrator. [Dkt. 

19, ¶ 30; see also Dkt. 11-6 at 104-17.] Section 5.2 of the Plan [Dkt. 11-6 at 108] 

provides:

5.2 Determination by Plan Administrator or Insurer Binding.

The insurer(s) (to the extent benefits are provided under an insurance 

contract) or the Plan Administrator or its delegate shall have complete 

discretionary authority to determine the standard of proof required in 

any case, to determine eligibility for Plan and Plan Program benefits, to 

apply, construe and interpret the terms of the Plan and Plan Program 

Documents, to resolve any disputes arising from Plan or Plan Program 

Document language and to interpret any ambiguous or uncertain terms 

therein. No benefits shall be paid under the Plan or a Plan Program 

Document unless the Plan Administrator, it delegate, or any insurer or 

other third party to whom authority to decide claims has been delegated, 

has approved them. The decisions of the Plan Administrator, its 

delegate or any insurer or third party to whom authority to decide claims 

has been delegated shall be final and binding. To the extent required by 

law, the Plan Administrator shall administer the Plan on a reasonable 

and nondiscriminatory basis and shall apply uniform rules to all persons 

similarly situated. Notwithstanding any provision of the Plan to the 

contrary, the Plan Administrator’s authority shall not extend to any 

benefits matter with respect to which authority to make claims 

determinations has been delegated to an administrator, insurer or other 

third party. 

The parties agree that this provision “delegates express discretionary authority to 

the insurer for benefits provided under an insurance contract.” [Dkt. 19, ¶ 30.]

Section 5.4 of the Plan, which Reliance calls the “proof of loss requirement,” 

states: 

policy, “[w]e sometimes equate the ERISA ‘plan’ with the insurance policy,” but “[m]ore commonly ... 

refer to an insurance policy as a ‘plan document’ that implements the plan.” Larson v. United 

Healthcare Ins. Co., 723 F.3d 905, 912 (7th Cir. 2013) citing Raybourne v. Cigna Life Ins. Co. of N.Y.,

576 F.3d 444, 448 (7th Cir. 2009); Ruiz v. Cont'l Cas. Co., 400 F.3d 986, 991 (7th Cir. 2005); Health

Cost Controls of Illinois, Inc. v. Washington, 187 F.3d 703, 712 (7th Cir. 1999).

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5.4 Records, Evidence of Loss. As a condition of receiving benefits 

payable under the Plan, a Participant, a Participant’s representative or 

a beneficiary may be required to provide the Plan Administrator, its 

delegate or the insurer with such evidence and records as the Plan 

Administrator, its delegate or the insurer shall from time to time specify 

to determine entitlement to benefits under the Plan. To the extent 

permitted under the Plan Program Documents and applicable law, 

additional evidence and records may be requested from time to time as 

reasonably required to determine the Participant’s continued eligibility 

for benefits.

[Dkt. 19, ¶ 31; Dkt. 11-6 at 109.] 

Section 9.2 of the Plan further provides: 

Notice and Proof of Claim. Unless another such limitations period is 

provided in an applicable Plan Program Document, written proof 

covering the occurrence, character and extent of the loss or condition for 

which claim is made must be filed with the Plan Administrator or its 

delegate within 12 months after the date the loss or expense is incurred, 

or the condition occurs, for which the claim is made. Failure to give 

notice or proof within the time fixed in this Section will not invalidate 

or reduce any claim if it shall be shown that it was not reasonably 

possible to furnish such notice or proof on time and that it was furnished 

as soon as was reasonably possible. In addition, except to the extent a 

shorter period applies under the applicable Plan Program Document or 

under any applicable statute of limitations, no legal action may be 

brought to obtain benefits under the Plan any later than 3 years after 

the condition occurs or the loss or expense is incurred for which the 

action is brought.” 

[Dkt. 11-6 at 111-12.]

The Plan also contains a provision concerning “conflict of terms,” which 

provides that, “[i]n the event of a conflict of terms between an insurance company 

contract and the Plan (including the Plan Program Documents), the insurance 

company contract shall govern[.]” [Dkt. 11-6 at 110, § 7.6.]

The Plan includes a Summary Plan Description, which describes group life 

insurance benefits funded by group insurance policies issued by Reliance. [See Dkt. 

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19, ¶ 35; Dkt. 11-6 at 100-103.] The Summary Plan Description does not contain the 

notice and proof of loss deadlines set out in the Plan (as well as the Policy, as 

explained below). Rather, the Summary Plan Description contains the following 

language: “How to file a claim: Contact your Plan Administrator when making a claim 

for benefits under the Plan.” [Dkt. 11-6 at 102.]

The life insurance benefits offered under the Plan were provided pursuant to 

the terms of Group Life Insurance Policy No. GL144794 (the “Policy”). [Dkt. 19, ¶ 1; 

see also Dkt. 11-1 at 1 et seq.] The Policy provides basic life insurance coverage in the 

amount of “[o]ne (1) times Earnings, rounded to the next higher $1,000, subject to a 

maximum Amount of Insurance of $250,000.” [Id., ¶ 9.] “Earnings” is defined as the 

“Insured’s annual salary received from you on the Policy Anniversary Date just before 

the date of loss” but does not include “commissions, overtime pay, bonuses or any 

other special compensation not received as basic salary.” [Id., ¶ 10.] The Policy 

contains the following terms pertinent to this litigation [Id., ¶ 11; Dkt. 11-1 at 22]:

NOTICE OF CLAIM: Written notice must be given to us within thirtyone (31) days after the Loss occurs, or as soon as reasonably possible. 

The notice should be sent to us at our Administrative Offices or to our 

authorized agent. The notice should include the Insured’s name, the 

Policy Number and your name. [...]

PROOF OF LOSS: For any covered Loss, written proof must be sent to 

us within ninety (90) days. If it is not reasonably possible to give proof 

within ninety (90) days, the claim is not affected if the proof is sent as 

soon as reasonably possible. In any event, proof must be given within 1 

year, unless the claimant is legally incapable of doing so. 

PAYMENT OF CLAIMS: Payment will be made as soon as proper proof 

is received. All benefits will be paid to the Insured if living. Any benefits 

unpaid at the time of death, or due to death, will be paid to the 

beneficiary. [...] 

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LEGAL ACTION: No legal action may be brought against us to recover 

on this Policy within sixty (60) days after written proof of loss has been 

given as required by this Policy. No action may be brought after three 

(3) years [...] from the time written proof of loss is required to be 

submitted.

Jeffrey enrolled in TransUnion’s Plan in early 2016, designating his children 

Annabelle and Anthony as his primary beneficiaries in equal parts. [Dkt. 19, ¶ 13.] 

Jeffrey died on July 29, 2016. [Id., ¶ 14.] At the time of his death, his annual salary—

and thus his basic life insurance coverage—was $130,000. [Dkt. 1, ¶ 15.] 

The record is unclear concerning exactly what communications Transunion 

had with Plaintiffs following Jeffrey’s death. But at some point, Rebecca Harvey, a 

Benefits Analyst for Transunion, became involved and reached out to Reliance on 

behalf of Plaintiffs and their mother. More particularly, on the afternoon of August 

1, 2016, Harvey sent the following email to Michelle Orr, Key Client Manager at 

Reliance [Dkt. 11-2 at 9]:

Hi Michelle,

Unfortunately, we had another employee pass away last Friday 

unexpectedly. 

His beneficiaries on his life insurance were his two children who are 

both minors (13 and 15 years).

His ex-spouse is the guardian of the children. From a life claim 

perspective, what is needed in terms of signing the life benefit claim 

form if his beneficiaries are minors? Usually the beneficiary would sign 

the claim form, but since his beneficiaries are kids, I assume their 

guardian would be the one to sign instead.

Is there a special form that their mother would need to complete since 

she is not a beneficiary but is the guardian of the beneficiaries?

Thanks for your help!

Rebecca Harvey

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The parties dispute how this email should be characterized. Plaintiffs describe

it as “written notice that Mr. McCombs had died unexpectedly on July 29, 2016,” but 

Reliance denies that the email constitutes “written notice” as required by the Policy. 

[See Dkt. 25, ¶ 40.] 

The next day, August 2, Orr responded to the email, copying Christine Wild 

(“Wild”), Reliance Standard’s Manager for Life/AD&D Claims. [See Dkt. 11-2, at 10.] 

Orr included Wild on the email so that Wild could “provide ... direction on the minors 

as beneficiaries and what the process is for us to be able to release a benefit to their 

guardian and so forth.” [Id.] Orr requested that Wild “let us know what the next step 

is.” [Id.] Wild responded:

Hi Rebecca, 

We extend our condolences to the family of Mr. McCombs in their loss. 

As guardian of the minor beneficiaries, they may sign the claim form 

(Part B & C) providing the minor’s social security number, date of birth, 

address, etc.

However, in order for the proceeds to be released, we require a court 

order appointing the guardian of the minor’s estate/property. If this 

court order is not received, the proceeds for the minor will be held with 

Reliance Standard until the minor attains the legal age of majority and 

requests the proceeds.

I hope this helps. 

Christine Wild, Manager

Life/AD&D Claims 

[Dkt. 11-2 at 10] (emphasis added). There was no further communication between 

Reliance Standard and Transunion at that time. [See Dkt. 19, ¶ 18.]

Nearly four years later, on March 3, 2020, Harvey sent another email to 

Reliance concerning Jeffrey’s death benefits. Harvey sent the email to 

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LifeClaimsScan@rsli.com, copying Orr, using the subject line “Life Claim - Jeff 

McCombs. [Dkt. 11-2, at 4.] The email stated:

Hello,

On July 29, 2016, we had an associate, Jeff McCombs pass away. His 

minor children were listed as his beneficiaries. 

One of the minor children, Annabelle, is now 18 years old and is filing 

the claims for the death benefits.

See attached for the signed life claim form for Annabelle along with the 

copy of the certified death certificate. 

Additionally, I had the mother of the other beneficiary, Anthony, sign 

the life claims form on the minor child’s behalf (see attached.)

I also included the supporting documentation for salary and 

beneficiaries from PeopleSoft which was our HRIS system at the time of 

Jeff’s passing.

Please let me know if you require any additional information and keep 

me updated on the progress of the claim(s). 

On March 5, 2020, Reliance denied the children’s claims. The denial letter was 

from Patrice Wilson, Life Claims Department at Reliance, to Harvey at TransUnion. 

Wilson informed Harvey that the McCombs’ claims were being denied because “the 

claim was not received in our office until March 4, 2020 more than 3 years after the 

date of death,” which failed to comply with the Group Life Insurance Policy’s 

provisions for “NOTICE OF CLAIM” and “PROOF OF LOSS.” [Dkt. 11-1 at 72-73.] 

On March 16, 2020, Harvey requested to appeal Reliance’s denial of benefits 

to the McCombs children. She referred to and enclosed a copy of her email 

correspondence with Orr and Wild at the beginning of August 2016, pointing out that 

“[t]here was no mention of a timeline” in that correspondence. [Dkt. 11-2 at 11.] She

also specifically objected to the two reasons Defendant gave for its denial. First, 

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Harvey asserted that the “Notice of Claim” provision did not bar the McCombs’ claims 

because Reliance received notice on August 1, 2016—just three days after Jeffrey

died. Second, Harvey argued that the “Proof of Loss” provision did not bar the 

children’s claims because proof is required within one year “unless the claimant is 

legally incapable of doing so,” and Annabelle was “not able to legally file the life 

insurance claim since she was a minor child at the time of the passing” and thus 

“legally incapable of doing so.” [Id. at 12.]

On March 26, 2020, Reliance responded to Harvey and informed her that it 

was unable to process her appeal request because she did not have the required 

“specific relationship ... to the claim.” [Dkt. 19, ¶ 22.] 

On April 2, 2020, Marlene sent an appeal letter to Reliance, using the same 

wording as Harvey. [See Dkt. 19, ¶ 23.] Reliance received the appeal the next day, 

[id., ¶ 24], and denied the appeal on April 7, 2020. The denial letter is signed by 

Cynthia Pietrowski, Senior Benefits Analyst. Petrowski asserted that the earlyAugust 2016 email exchange “does not contain any directive to delay sending proof of 

loss. Reference to court order was made with regard to the release of proceeds, once 

the claim had been processed. The email does advise that the guardian can file on the 

beneficiaries behalf. Regardless, as indicated above, the policy does indicate that 

proof of loss must be submitted within one (1) year.” [Dkt. 11-6 at 37; see also Dkt. 

19, ¶ 36.] The letter also asserts that “while we address and have addressed your 

appeal here, we have not yet received an appeal request from Ms. Annabelle 

McCombs.” [Dkt. 11-6 at 38.]

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Plaintiffs retained counsel. On April 8, 2020, counsel requested a copy of plan 

documents from Reliance. On April 16, 2020, he requested an extension of time to file 

an appeal. [Dkt. 19, ¶ 27.] On April 30, 2020, Pietrowski responded that Anthony was 

not entitled to a second appeal and that it “cannot honor an extension” of time for 

Annabelle to appeal. [Dkt. 11-6, at 60.] Nonetheless, on May 1, 2020, Plaintiffs’ 

counsel filed an appeal on behalf of Annabelle and Anthony, asserting that Marlene 

could not submit a valid appeal on behalf of Anthony and that the appeal was timely 

to the extent it appealed the denial on behalf of Annabelle. [Dkt. 19, ¶ 29.] Counsel

also argued that the denial violated Illinois law, 50 Ill. Admin. Code §1405.40(g)(1), 

and was contrary to the terms of the Policy. [Dkt. 19, ¶ 29.]

In correspondence dated June 10, 2021, Reliance upheld its denial of Plaintiffs’ 

claims. [See Dkt. 11-1 at 83.] Repeating language from its April 7, 2020 denial letter, 

Reliance stated that it did not provide “any directive to delay sending proof of loss”; 

rather, “[r]eference was ... made to court order with regard to the release of proceeds 

once the claim had been processed” and “[t]he email advised that the guardian could 

file on behalf of the beneficiaries.” [Id. at 84.] Reliance reiterated that proof of loss 

was not submitted within a year, as required by the Policy. [Id.; see also Dkt. 19, ¶¶ 

36-37.] 

Plaintiffs filed this lawsuit on June 25, 2020. In their single-count complaint, 

Plaintiffs allege that Reliance’s denial of benefits was arbitrary and capricious and 

amounts to a breach of the contract for insurance. Plaintiffs seek a declaratory 

judgment pursuant to ERISA § 502(a)(1)(B), 29 U.S.C. 1132(a)(1)(B), an order 

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compelling Defendant to pay the full amount of life benefits owed under Jeffrey’s 

policy, attorney fees and costs pursuant to ERISA, and prejudgment interest. 

II. Legal Standards

Summary judgment is proper where “the movant shows that there is no 

genuine dispute as to any material fact and the movant is entitled to judgment as a 

matter of law.” Fed. R. Civ. P. 56(a); see Celotex Corp. v. Catrett, 477 U.S. 317, 323 

(1986). A genuine issue of material fact exists if “the evidence is such that a 

reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty 

Lobby, Inc., 477 U.S. 242, 248 (1986); see also Birch|Rea Partners, Inc. v. Regent 

Bank, 27 F.4th 1245, 1249 (7th Cir. 2022). The Court “must construe all facts and 

draw all reasonable inferences in the light most favorable to the nonmoving party.” 

Majors v. Gen. Elec. Co., 714 F.3d 527, 532 (7th Cir. 2013) (citation omitted). Where, 

as here, the parties have cross-moved for summary judgment, the Court is required 

to “‘construe all inferences in favor of the party against whom the motion under 

consideration [was] made.’” Ten Pas v. Lincoln Nat’l Life Ins. Co., 31 F.4th 541, 545 

(7th Cir. 2022) (quoting Hess v. Reg-Ellen Mach. Tool Corp., 423 F.3d 653, 658 (7th 

Cir. 2005)). The Court “‘may not make credibility determinations, weigh the evidence, 

or decide which inferences to draw from the facts; these are jobs for a factfinder.’” 

Johnson v. Rimmer, 936 F.3d 695, 705 (7th Cir. 2019) (quoting Payne v. Pauley, 337 

F.3d 767, 770 (7th Cir. 2003)).

Summary judgment “is the ‘put up or shut up’ moment in a lawsuit, when a 

party must show what evidence it has that would convince a trier of fact to accept its 

version of events.” Wade v. Ramos, 26 F.4th 440, 446 (7th Cir. 2022) (quoting Schacht 

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v. Wis. Dept’ of Corr., 175 F.3d 497, 504 (7th Cir. 1999)). A party opposing summary 

judgment must go beyond the pleadings and “set forth specific facts showing that 

there is a genuine issue for trial.” Liberty Lobby, 477 U.S. at 250. Summary judgment 

is proper if the nonmoving party “fails to make a showing sufficient to establish the 

existence of an element essential to that party’s case, and on which that party will 

bear the burden of proof at trial.” Ellis v. CCA of Tennessee LLC, 650 F.3d 640, 646 

(7th Cir. 2011) (quoting Celotex, 477 U.S. at 322). The non-moving party “must do 

more than simply show that there is some metaphysical doubt as to the material 

facts.” Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 586 

(1986). The “mere existence of a scintilla of evidence in support of the [non-movant’s] 

position will be insufficient; there must be evidence on which the jury could 

reasonably find for the [non-movant].” Liberty Lobby, 477 U.S. at 252. 

The parties are in agreement that the ERISA plan at issue grants discretionary 

authority to the claim administrator—here, Reliance—“triggering deferential review” 

under ERISA. Ten Pas, 31 F.4th at 545; see also Estate of Jones v. Children’s Hospital 

& Health System Inc. Pension Plan, 892 F.3d 919, 923 (7th Cir. 2018); Dragus v.

Reliance Standard Life Ins. Co., 882 F.3d 667, 672 (7th Cir. 2018). This creates a 

“high hurdle” for Plaintiffs and requires the Court to uphold the denial of benefits if 

“(1) it is possible to offer a reasoned explanation, based on the evidence, for a 

particular outcome, (2) the decision is based on a reasonable explanation of relevant 

plan documents, or (3) the administrator has based its decision on a consideration of 

the relevant factors that encompass the important aspects of the problem.” Ten Pas, 

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31 F.4th at 545. Where policy terms are ambiguous, the Court “defer[s] to an 

administrator’s construction ‘if it falls within the range of reasonable interpretations’ 

or if it is ‘compatible with the language and the structure of the plan document.’” Id. 

at 546 (quoting Bator v. Dist. Council 4, 972 F.3d 924, 929 (7th Cir. 2020)).

“This standard is deferential but ‘not a rubber stamp,’ and ‘we will not uphold 

a [decision] when there is an absence of reasoning in the record to support it.’” Hennen 

v. Metro. Life Ins. Co., 904 F.3d 532, 539 (7th Cir. 2018) (quoting Holmstrom v. 

Metropolitan Life Ins. Co., 615 F.3d 758, 766 (7th Cir. 2010)); see also Ten Pas, 31 

F.3d at 546; Jones, 892 F.3d at 923; Canter v. AT&T Umbrella Benefit Plan No. 3, 33 

F.4th 949, 955 (7th Cir. 2022) (“an administrator must explain its basis for 

discounting evidence presented by the claimant, even though an administrator is 

entitled to make a reasoned decision when there is evidence cutting in both 

directions”). “In conducting this review, we remain cognizant of the conflict of interest 

that exists when”—as in this case—“the administrator has both the discretionary 

authority to determine eligibility for benefits and the obligation to pay benefits when 

due.” Dragus, 882 F.3d at 673 (quoting Jenkins v. Price Waterhouse Long Term

Disability Plan, 564 F.3d 856, 861 (7th Cir. 2009)); see also Lacko v. United of Omaha 

Life Ins. Co., 926 F.3d 432, 440 (7th Cir. 2019). While the standard of review remains 

the same, “the conflict of interest is ‘weighed as a factor in determining whether there 

is an abuse of discretion.” Dragus, 882 F.3d at 673 (quoting Metro Life Ins. v. Glenn, 

554 U.S. 105, 115 (2008)); see also Zall v. Standard Insurance Co., 58 F.4th 284, 291 

n.1 (7th Cir. 2023); Hennen, 904 F.3d at 539. “The Supreme Court has directed us 

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that a conflict of interest should ‘act as a tiebreaker when the other factors are closely 

balanced.’” Dragus, 882 F.3d at 673 (quoting Glenn, 554 U.S. at 117); see also Lacko, 

926 F.3d at 440 (providing examples of circumstances that increase or decrease the 

likelihood that a conflict of interest impacted the determination of benefits).

“Federal common law, which embraces general principles of contract 

interpretation, governs a plan’s interpretation to the extent it is consistent with 

ERISA.” Jones, 892 F.3d at 923; see also Smith v. Bd. of Directors of Triad 

Manufacturing, Inc., 13 F.4th 613, 618 (7th Cir. 2021). Plan language is therefore 

“given its plain and ordinary meaning, and the plan must be read as a whole, 

considering separate provisions in light of one another and in the context of the entire 

agreement.” Schultz v. Aviall, Inc. Long Term Disability Plan, 670 F.3d 834, 838 (7th 

Cir. 2012). “[O]rdinary contract rules should be used to flesh out provisions on which 

ERISA or a plan are silent or ambiguous.” Central States, Southeast & Southwest 

Areas Health & Welfare Fund v. Haynes, 966 F.3d 655, 658 (7th Cir. 2020). 

The claim administrator’s decisions on questions of law—including “legal 

questions of statutory construction”—are not entitled to deference and will be 

reviewed de novo. See Central States, Southeast & Southwest Areas Pension Fund v. 

Bell Transit Co., 821 F. Supp. 1266, 1270 (N.D. Ill. 1993) (“Legal rulings are not 

discretionary determinations; the Fund does not have the discretion to ignore the 

statute.”); see also Sellers v. Zurich American Ins. Co., 627 F.3d 627, 631 (7th Cir. 

2010) (“Where ... the denial of benefits determination is based on an interpretation 

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of law, we apply a de novo standard of review.”); Silvernail v. Ameritech Pension Plan, 

439 F.3d 355, 357 (7th Cir. 2006) (same). 

III. Analysis

Reliance takes the position that it reasonably denied benefits to Annabelle and 

Anthony McCombs because they failed to provide timely notice of claim and proof of 

loss, as required by the Policy and the Plan. Plaintiffs challenge that decision as 

arbitrary and capricious and an abuse of discretion. 

A. Notice of Claim 

The Policy’s “notice of claim” provision states:

NOTICE OF CLAIM: Written notice must be given to us within thirtyone(31) days after the Loss occurs, or as soon as reasonably possible. The 

notice should be sent to us at our Administrative Offices or to our 

authorized agent. The notice should include the Insured’s name, the 

Policy Number and your name. 

Plaintiffs say that Harvey’s August 1, 2016 email to Reliance’s employee Orr met the 

requirements for notice of claim. It is undisputed that Harvey provided the Insured’s 

name, Jeffrey McCombs, and the policy number and informed Orr that Jeffrey had 

died, leaving his two minor children as his beneficiaries. Reliance nonetheless argues 

that the email did not constitute notice of loss, and therefore Plaintiffs forfeited their 

right to the insurance proceeds, for multiple reasons. 

First, Reliance claims that sending an email to Orr wasn’t sufficient because 

Orr “was not ... Reliance Standard’s authorized agent and Plaintiffs cannot point to 

anything saying differently.” [Dkt. 13 at 11.] This is the entirety of Reliance’s 

argument. Reliance never explains who would qualify as authorized agent under its 

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interpretation of the notice of claim provision, or why Orr could not satisfy that 

standard. The Court finds this to be arbitrary and capricious due to its lack of 

reasoning. See Aviation West Charters, LLC v. Health and Welfare Plan for Employees 

of Ajinomoto USA, Inc., 425 F. Supp. 3d 1016, 1025 (N.D. Ill. 2019) (“[T]he 

administrator must weigh the evidence for and against [the denial or termination of 

benefits], and within reasonable limits, the reasons for rejecting evidence must be 

articulated if there is to be meaningful appellate review.”) 

Given the lack of analysis from the plan administrator, the Court looks to the 

Policy for guidance on who should be considered an authorized agent. The Policy 

provides that it is to be interpreted pursuant to Illinois law to the extent not 

preempted by ERISA. [Dkt. 11-6 at 110 (Article 7.5 of the Plan).] Under Illinois law, 

“[g]enerally, the knowledge and conduct of agents are imputed to their principals.” 

Pack v. Maslikiewicz, 144 N.E.3d 37, 63 (Ill. App. 2019). The question of whether an 

agency relationship exists and the scope of the purported agent’s authority are 

questions of fact. Id. Agency can be actual or apparent. “Actual agency consists of a 

principal/agent, master/servant, or employer/employee relationship and the 

principal’s control or right to control the conduct of the agent, servant, or employee.” 

McNerney v. Allamuradov, 84 N.E.3d 437, 453 (1st Dist. 2017); see also Spitz v. 

Proven Winners North America, LLC, 759 F.3d 724, 731-32 (7th 2014); Wilson v. 

Edward Hosp., 981 N.E.2d 971, 978 (Ill. Sup. Ct. 2012). “Apparent agency liability 

occurs when a purported principal has created the appearance that someone is his or 

her agent, and an innocent third party has reasonably relied on such appearance to 

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his or her detriment.” McNerney, 84 N.E.3d at 453; see also Curto v. Illini Manors, 

Inc., 940 N.E.2d 229, 235 (Ill. App. 2010). 

Against this backdrop, the Court concludes based on the undisputed facts in 

the record, Reliance’s claim that Orr was not its authorized agent was arbitrary and 

capricious. All the relevant facts point to a finding of agency: Reliance and Orr have 

an employer-employee relationship. See McNerney, 84 N.E.3d at 453. As its employee, 

Reliance had a right to control Orr’s conduct. Id. The record shows Orr was acting 

within the scope of her employment when providing information to Reliance’s 

customer, Transunion. Orr was answering questions from a policyholder whose 

covered employee recently died. Orr responded to Harvey’s email and put her in 

contact with Wild, who provided an answer: the guardian of Plaintiffs “may sign the 

claim form ... providing the minor’s social security number, date of birth, address, 

etc.” but “in order for the proceeds to be released, we require a court order appointing 

the guardian of the minor’s estate/property” and, “[i]f this court order is not received, 

the proceeds for the minor will be held with Reliance Standard until the minor attains 

the legal age of majority and requests the proceeds.” All these facts point to the

conclusion that Orr was an agent of Reliance when interacting with Harvey or, at the 

very least, had apparent authority to bind Reliance as the principal. By contrast, 

there is no evidence pointing against a finding of agency. Indeed, even if Orr wasn’t 

Reliance’s agent, Reliance doesn’t argue that Wild was unauthorized, and Wild is the 

employee who advised Harvey that Reliance would hold the proceeds until the 

children reached the age of majority. 

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The second reason that Reliance gives for its conclusion that Harvey’s email 

did not constitute notice of loss is that, although the email did “contain[] the 

Decedent’s name and the Group Policy number, it did not provide any information 

about the beneficiaries.” [Dkt. 13 at 11.] But Reliance points to nothing in the policy 

that requires details about the beneficiaries; the notice of loss provision does not say 

this. The notice simply must include the insured’s name, the Policy Number and “your 

name.” [Dkt. 11-1 at 22.] Harvey, acting as a representative of Transunion, provided 

her name and contact information; Orr and Wild interacted with her and gave no 

indication that they viewed her as unauthorized to communicate on Plaintiffs’ behalf. 

Further, Reliance’s claim that the email did not have “any information” about the

beneficiaries is contrary to the record; Reliance was informed that the beneficiaries 

were Jeffrey McComb’s two children, and that they were both minors. 

As a third, “most important[],” reason for finding Harvey’s email insufficient 

to constitute a notice of claim, Reliance argues that the notice was “not given by the 

Plaintiffs but by the Decedent’s employer [Transunion], who is neither authorized to 

act on behalf of Plaintiffs nor has a specific relationship to the claim.” [Dkt. 13 at 11.] 

There is no support in the record for this conclusion. Reliance cites to paragraph 22 

of its Local Rule 56.1 statement, but the communication referred to in that paragraph

concerns who is authorized to file an appeal of a claim denial, not who is authorized 

to provide notice of loss. [Dkt. 19 at ¶ 22.] More particularly, in 2020, when Harvey 

tried to file an appeal, Reliance told Harvey the appeal could only be processed if 

submitted by certain individuals with a “specific relationship” to the claim: “an 

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individual who has filed a claim for benefits”; “An authorized representative of an 

individual who has filed a claim for benefits”; “A claimed beneficiary”; and “An 

executor of an estate.” There is nothing in the record to suggest that Reliance ever 

informed Plaintiffs (who were minors at the time) that the notice of loss had to come 

directly from them or their right to benefits would be forfeited. 

The Court also finds relevant that the Plan Summary does not contain the 

Notice request and proof of loss deadlines that Reliance relies upon. Federal 

regulations governing ERISA plans specify that the summary plan description “must 

accurately reflect the contents of the plans,” including specifically the “procedures for 

filing claim forms” and “applicable time limits.” 29 C.F.R. 2520.102-3(s). Here, the 

Plan Summary states in the “How to File a Claim” section that participants should

“Contact your Plan Administrator when making a claim for benefits under the Plan.” 

[Dkt. 11-6 at 102.] That’s what Harvey did when she reached out to Orr. 

Viewing the administrative record as a whole and in the light most favorable 

to Reliance (as the Court must do when assessing whether Plaintiffs are entitled to 

summary judgment), the Court concludes that Reliance’s decision to deny benefits 

based on Plaintiffs’ alleged failure to comply with the “Notice of Loss” provision was 

arbitrary and capricious. Reliance did not provide a “reasoned explanation, based on 

the evidence,” for concluding that Plaintiffs failed to provide timely notice, and its 

denial is not based on “a reasonable explanation of relevant plan documents.” Ten 

Pas, 31 F.4th at 545. Reliance did not focus on the text of the notice of loss provision, 

it defined key terms without reference to the record and relevant law, and it gave no 

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effect to the Plan Summary. The Court is also “cognizant of the conflict of interest 

that exists” because Reliance “has both the discretionary authority to determine 

eligibility for benefits and the obligation to pay benefits when due.” Hennen, 904 F.3d 

at 539. As noted, the Court weighs this “as a ‘factor in determining whether there is 

an abuse of discretion.’” Id. (quoting Glenn, 554 U.S. at 115). Given the deficiencies 

in the Plan administrator’s reasoning and the structural conflict of interest, the Court 

concludes that Reliance abused its discretion by denying life insurance benefits based 

on Plaintiffs’ purported failure to comply with the Policy’s notice of loss provision. 

B. Proof of Loss

The second reason that Reliance provided for denying Plaintiffs’ claim is that 

Plaintiffs failed to submit proof of loss within 1 year of their father’s death. The proof 

of loss provision of the Policy on which Reliance relies provides:

PROOF OF LOSS: For any covered Loss, written proof must be sent to 

us within ninety (90) days. If it is not reasonably possible to give proof 

within ninety (90) days, the claim is not affected if the proof is sent as 

soon as reasonably possible. In any event, proof must be given within 1 

year, unless the claimant is legally incapable of doing so. (Emphasis 

added.)

Plaintiffs take the position that their proof of loss, given in 2020, was timely because 

they were “legally incapable” of giving notice before they became adults. Plaintiffs 

point out that under Illinois law—which governs interpretation of the Policy—“it is 

well-established that a minor lacks legal capacity” and “does not have the legal 

capacity to initiate, pursue or maintain legal action in her own name.” [Dkt. 18 at 12 

(citing Sullivan v. OHIC, 2014 IL App (1st) 111125, ¶ 122 (2014); Doe v. Montessori 

School, 678 N.E.2d 1082 (Ill. App. 1997); Stevenson v. Hawthorne Elementary School, 

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East St. Louis School District No. 189, 579 N.E.2d 852 (Ill. Sup. Ct. 1991)]. And in 

Illinois, statutes of limitation for minors are all tolled until “2 years after the person 

attains the age of 18 years” 735 ILCS 5/13-211(a).3

Reliance does not address these sources of authority but instead asserts that 

“[l]egally incapable as referenced in the Group Policy ... refers to lacking legal 

qualification as a result of incapacity,” not “a lack of legal capacity as a result of not 

being of age.” [Dkt. 24 at 9, n.1.] Reliance relies solely on Webster’s online dictionary’s 

second definition for the term “incapable,” which is “lacking legal qualification or 

power (as by reason of mental incompetence).” https://www.merriamwebster.com/dictionary/incapable (last visited May 31, 2023). This is the only 

authority Reliance cites, and it does not support Reliance’s reading the term “legally 

incapable” to include legal incapacity only by reason of mental disability. The 

definition Reliance offers is of the term “incapable,” not “legal incapacity,” which is 

the term used in the relevant Policy provision. “Mental incompetence” is provided as 

but one example of “incapable,” such as one “lacking legal qualification or power.”

Both minors and persons who are “mentally incompetent” are “lacking legal 

qualification or power”; that is why the law affords them special, more protective 

treatment. For instance, minors are routinely referred to as “legally incapable” of 

certain acts and decisions. See, e.g., In re Adoption of S.S., 657 N.E.2d 935, 941 (Ill. 

Sup. Ct. 1995) (minors legally incapable of forming intent to establish domicile); 

Mount Zion State Bank & Trust v. Consol. Comm’ns, Inc., 660 N.E.2d 863, 866-87 (Ill. 

3

 Fed R. Civ. Pro. 17(c) also recognizes that both “minors” and “incompetent persons” lack 

capacity to sue or defend an action.

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Sup. Ct. 1995) (six year old legally incapable of exercising due care for his own safety); 

Santiago v. Package Machinery Co., 260 N.E.2d 89, 93 (Ill. App. 1970) (minor under 

seven is legally incapable of being contributorily negligent); People v. Logan, 2022 IL 

App (1st) 190021-U, ¶ 31, 2022 WL 4310690, at *5 (Ill. App. 2022) (minor was legally 

incapable of consent in any sexual context); People v. Harrison, 2017 IL App (4th) 

170100-U, ¶ 45, 2017 WL 5496037, at *6 (Ill. App. 2017) (minor legally incapable of 

conveying interest in real property).

Reliance tacitly recognizes that minors are, in fact, “legally incapable” of 

providing proof of loss by arguing that despite their age, “Plaintiffs could most 

certainly make a claim for life insurance proceeds through their mother, their natural 

guardian and next of kin, in 2016.” [Dkt. 24 at 8 (emphasis added).] But as minors, 

Plaintiffs did not control their mother’s decision not to file proof of claim within one 

year or her decision not to become a court-appointed guardian. Instead, the children, 

relied on Wild’s direction that if a “court order is not received, the proceeds for the 

minor will be held with Reliance until the minor attains the legal age of majority and 

requests the proceeds.” [Dkt. 11-2 at 10.] It makes little sense to consider Plaintiffs 

“legally incapable” of filling out forms themselves, but still “legally capable” of making 

sure their mother correctly and timely completed and submitted the forms and made 

the proper decision on whether to become a court-appointed guardian. Reliance’s 

narrow reading of the term “legally incapable” punishes minor children for their 

parents’ choices—as well as the bad advice given to their parents—which is an 

outcome that is inconsistent with the protective rationale for treating minors as 

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“lacking in legal capacity” in the first place. Given these concerns and the lack of 

support in the record for Reliance’s construction of the Policy, the Court concludes 

that Reliance’s reading of “legally incapable” to exclude legal incapacity due to 

minority was arbitrary and capricious and an abuse of discretion. 

Even if Reliance’s reading of the Policy were otherwise reasonable, Plaintiffs 

have argued convincingly that it would be foreclosed by the Illinois insurance law. 

The Policy provides that where any section of the Policy “conflicts with the laws of 

the state in which the Policy is issued,” it is “amended to meet the minimum 

requirements of those laws.” [Dkt. 11-1 at 14 (AR 14).] The construction of Illinois 

insurance regulations is a question of law and therefore Reliance’s determination on 

this issue is not entitled to deference. See Sellers, 627 F.3d at 631; Silvernail, 439 

F.3d at 357. The regulation at issue here, 50 Ill. Admin. Code 1405.40(g), provides: 

Time Limit on Claims

1) Filing of Death Claims -- There is no time limit for filing death 

claims if the claim is not conditioned upon other contingencies, i.e., prior 

disability or accident. Section 224(1)(j) of the Code requires, when there 

is a claim on a policy due to the death of the insured, settlement shall 

be made upon receipt of due proof of death. For purposes of this 

subsection (g)(1), due proof consists of sufficient evidence to establish in 

a court a prima facie case for payment of the claim. Therefore, any 

limitation with respect to death claims arising during and contingent 

upon the insured’s continued disability must be limited to a requirement 

that proof of disability be furnished within a stipulated period as a 

condition precedent to consideration of a death claim. (Emphasis added.)

Reliance argues that it was free to disregard this provision and require proof 

of claim within one year because this regulation applies only to individual life 

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insurance policies, not group life policies like the one at issue here. Plaintiffs 

maintain the regulation applies to both group and individual life insurance policies. 

There is no language in paragraph (g) indicating whether it applies only to 

individual life policies or also to group life policies. The Court is therefore guided by 

the broader regulatory framework in which section 1405.40(g) is contained. This 

provision is part of Part 1405 of the Illinois Administrative Code, which “implements 

Section 143 of the Illinois Insurance Code,” 215 ILCS 5/143, “by establishing a ‘Policy 

Form Manual’ designed to make uniform the requirements and practices in the filing 

of certain policy forms with the Director.” 50 Ill. Admin. Code. 1405.10. Section 143 

is contained in Article IX of the Illinois Insurance Code, which contains “Provisions 

Applicable to All Companies.” Section 143 requires companies providing life 

insurance to file policies and other documentation with the Director of Insurance; it 

does not differentiate between individual and group life policies. 215 ILCS 5/143(1); 

see also 215 ILCS 5/4(a). This overall structure indicates that 1405.40 applies to both 

group and individual life insurance policies.

A closer reading of section 1405.40 also points to paragraph (g) applying to both 

individual and group life insurance policies. Paragraph (j) of section 1405.40, which 

concerns dividend provisions, expressly provides that it “is applicable to individual 

policy forms.” 50 Ill. Admin. Code 1405.40(j). And paragraph (p) applies to 

“Combination Life and Accident and Health Coverages in Individual Policies.” Ill. 

Admin. Code 1405.40(p). The specific references to individual policies in paragraphs

(j) and (p) strongly suggest that, if paragraph (g) applied only to individual policies, 

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it would say so, too. But paragraph (g) provides that “[t]here is no time limit for filing 

death claims if the claim is not conditioned upon other contingencies, i.e., prior 

disability or accident” with no reference to individual policies. See, e.g., Namuwonge 

v. Kronos, Inc., 418 F.Supp.3d 279, 285 (N.D. Ill. 2019) (“Where the legislature uses 

certain words in one instance and different words in another, it intended different 

results.” (quoting Dana Tank Container, Inc. v. Human Rights Comm’n, 687 N.E.2d 

102, 104 (Ill. App. 1997))); People v. Santiago, 925 N.E.2d 1122 (Ill. Sup. Ct. 2010) 

(use of “certain language in one instance and wholly different language in another ... 

indicates that different results were intended”). In addition, another provision of Part 

1405, which concerns information about preparing policy forms, explains that “[o]n 

group forms, variable material may be indicated for language that may vary from 

case to case,” such as “benefit provisions and benefit levels.” 50 Ill. Admin. Code 

1405.20(d). The reference to group forms is yet another indication that group life 

insurance is not excluded from the coverage of paragraph (g) or § 1405.40 more 

generally. 

In contrast to the regulations concerning insurance forms, the “standard 

provisions” for individual life insurance, 215 ILCS 5/224, and the “standard 

provisions” for group life insurance, 215 ILCS 5/231.1, are set out separately in 

Article XIV of the Insurance Code, “Legal Reserve Life Insurance.” The provision 

governing each type of life insurance (individual or group) specifically states that it 

is not applicable to the other type. This is more evidence that where legislators and 

regulators intended for provisions of the insurance laws to apply to only a particular

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type of life insurance, they know how to say so. See Costa v. Mauro Chevrolet, Inc., 

390 F. Supp. 2d 720, 727 (N.D. Ill. 2005) (“Normally, when Congress uses different 

terms in this manner in the same statute, Congress’s choice to employ different terms 

(at least in the absence of contrary evidence) means that the two terms have different 

meanings.”); In re Mary Ann P., 781 N.E. 2d 237, 247 (Ill. Sup. Ct. 2002). 

Reliance argues that § 1405.40(g) must apply only to individual life insurance 

policies because it references a provision of 215 ILCS 5/224, the “standard provisions” 

for individual life insurance. The Court does not read the regulation this way. The 

second through fourth sentences of paragraph (g) explain what constitutes “due proof” 

of death for purposes of 215 ILCS 224(1)(j)’s requirement that settlement be made 

upon receipt of due proof of death. The fact that § 1405.40(g) cross-references a statute

that applies only to individual policies does not negate the regulation’s broad 

statement that “[t]here is no time limit for filing death claims if the claim is not 

conditioned upon other contingencies, i.e., prior disability or accident.” 50 Ill. Admin. 

Code 1405.40(g). Absent an indication in § 1405.40(g) that it is limited only to forms 

for individual life insurance, the Court will not read this limitation into the 

regulation.

Finally, Reliance argues that even if 50 Ill. Admin. Code 1405.40(g) applied to 

group policies, it would be preempted by ERISA because it “directly impacts the 

administration of the benefit plan at issue.” [Dkt. 24 at 8.] This argument is both 

undeveloped and unpersuasive. See Rock Hemp Corp. v. Dunn, 51 F.4th 693, 704 (7th 

Cir. 2022) (“perfunctory and undeveloped arguments, as well as arguments that are 

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unsupported by pertinent authority, are waived”). The Supreme Court has 

“repeatedly held that state laws mandating insurance contract terms are saved from 

preemption under § 1144(b)(2)(A).” UNUM Life Ins. Co. of America v. Ward, 526 U.S. 

358, 375 (1999) (citing Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 758, 

(1985); FMC Corp. v. Holliday, 498 U.S. 52, 64 (1990); see also Larson v United 

Healthcare Ins. Co., 723 F.3d 905, 911-13 (7th Cir. 2013). “Section 1144(b)(2)(A) is an 

exception to ERISA’s general preemption rule and provides that ‘nothing in this 

subchapter shall be construed to exempt or relieve any person from any law of any

State which regulates insurance.’” Larson, 723 F.3d at 912 (quoting Ward, 526 U.S. 

at 375). “Accordingly, when an employee-benefits plan includes an insurance policy, 

contract terms mandated by state insurance law become plan terms.” Id. (holding 

that Wisconsin’s equal-coverage mandate for chiropractic care is an ERISA plan term 

and may be enforced in a claim under § 1132(a)(1)(B)).

Thus, in Ward, for example, ERISA did not preempt California’s “noticeprejudice” rule, which requires an insurer to prove actual prejudice from an insured’s 

failure to provide timely notice in order to deny a claim on that basis. 526 U.S. at 367-

77. The Court reasoned that “[b]y allowing a longer period to file than the minimum 

filing terms mandated by federal law, the notice-prejudice rule complements rather 

than contradicts ERISA and the regulations.” Id. at 377. Likewise, in this case, 50 Ill. 

Admin. Code 1405.40(g) complements ERISA by extending the period to file certain 

death claims. Confusingly, Reliance argues that even if §1405.40(g) applies and is not 

preempted by ERISA, it was nonetheless entitled to deny the claim because the “proof 

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of loss” provision is contained in the Policy and in the Plan, “which is not and never 

will be subject to 50 Ill. Admin. Code §1405.40(g)(1).” [Dkt. 24 at 8; Dkt. 13 at 15.] 

Placing the time limitation in the Plan (in addition to the Policy) does not exempt the 

Plan from the requirements of Illinois law, since “contract terms mandated by state 

insurance law become plan terms.” Larson, 723 F.3d at 912; Ward, 526 U.S. at 375.

Reliance’s decision to deny the benefits claims based on a purported failure to 

timely comply with the “notice of loss” provision was arbitrary and capricious and an 

abuse of discretion. There is no support in the administrative record or applicable law 

for reading “legally incapable” as used in the notice of loss provision to exclude 

persons who lack legal capacity due to age. Even if there were, Illinois insurance law 

requirements are Plan requirements. They provide no time limit for filing death 

claims.

IV. Conclusion 

Plaintiffs’ motion for summary judgment [20] is granted and Defendant’s 

motion for summary judgment [12] is denied. Plaintiffs are entitled to payment of life 

insurance benefits in the amount of $130,000. Plaintiffs’ counsel is given until June 

29, 2023 to file a request for attorney fees and costs, and prejudgment interest.

Defendant shall respond by July 20, 2023, and the reply is due by August 3, 2023. 

Enter: 23-cv-3746

Date: June 1, 2023

__________________________________________ 

Lindsay C. Jenkins

United States District Judge

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