Davis v. Fed. Ins. Co.

• Decision Date: 08 April 2019
• Docket Number: Case No. CIV-18-667-R
• Citation: 382 F.Supp.3d 1189
• Parties: Deborah DAVIS, Individually and as Personal Representative of the Estate of Barbara Mosley ; Tommy Davis; Gerald Davis; Joel Davis; and Dale Mosley, Plaintiffs, v. FEDERAL INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Western District of Oklahoma

382 F.Supp.3d 1189

Deborah DAVIS, Individually and as Personal Representative of the Estate of Barbara Mosley ; Tommy Davis; Gerald Davis; Joel Davis; and Dale Mosley, Plaintiffs,

v.FEDERAL INSURANCE COMPANY, Defendant.

Case No. CIV-18-667-R

United States District Court, W.D. Oklahoma.

Signed April 8, 2019

Gregory W. Milstead, Rex K. Travis, Travis Law Office, Oklahoma City, OK, for Plaintiffs.

Mack J. Morgan, III, Andrew E. Henry, Crowe & Dunlevy, Oklahoma City, OK, for Defendant.

ORDER

DAVID L. RUSSELL, UNITED STATES DISTRICT JUDGE

Before this Court is Defendant Federal Insurance Company's Motion for Summary Judgment (Doc. 18). The matter is fully briefed and at issue. See Docs. 18, 21–22. For the reasons stated herein, the Court GRANTS Defendant's Motion.

I. Background

The Court views the factual record and all reasonable inferences drawn from it in the light most favorable to Plaintiff, the non-movant. See Banner Bank v. First Am. Title Ins. Co. , 916 F.3d 1323, 1326 (10th Cir. 2019).

This case concerns an Accidental Death and Dismemberment Insurance Policy ("Policy") issued to Barbara Mosley on April 6, 2016, by Defendant, Federal Insurance Company. See Doc. 18, at 6; Doc. 21, at 6.¹ Ms. Mosley suffered from leukemia, among other ailments, and she was receiving treatment for this disease at the time of her death. See Doc. 18, at 5–7; Doc. 21, at 4–5; see also Doc. 18-3. On May 10, 2017, Ms. Mosley fell from her wheelchair; nineteen days later—on May 29, 2017—she passed away. See Doc. 18, at 6–7; Doc. 21, at 4, 6.² Ms. Mosley's death was investigated by Cheryl Niblo, D.O., from Oklahoma's Office of the Chief Medical Examiner. See Doc. 18-3; Doc. 21-2. Dr. Niblo concluded that the "probable cause of death" was sepsis "due to[ ] [b]acteremia from [an] infected port." Id. Within the investigation report, Dr. Niblo listed the following "[o]ther significant conditions contributing to death (but not resulting in the underlying cause given)": "Acute myelogenous leukemia," "Acute on chronic right subdural hematoma," "Hypertensive cardiovascular disease," and "Diabetes mellitus." Id. Dr. Niblo also certified Ms. Mosley's Certificate of Death, which lists "Sepsis" as the "Immediate Cause" of death and "bacteremia from infected port" as the condition "leading to the cause." Doc. 18-2; Doc. 21-1. On both the Certificate of Death and investigation report, the "manner of death" is listed as "Accident." Docs. 18-2, 18-3, 21-1, 21-2.

On January 16, 2018, Defendant denied coverage for Ms. Mosley's death in a letter addressed to Ms. Mosley's daughter, Deborah Davis. Doc. 18, at 8. The letter stated, in part:

We [Defendant] have reviewed all of the information you [Ms. Davis] provided and the coverage available under the above referenced policy. Based on our review of the received claim documentation, we must regretfully decline to pay for your loss. Our reasons for this declination of coverage are explained below, followed by pertinent provisions of the policy. In order to recover for an Accidental Death Benefit under this Policy, we must be able to demonstrate that an Accident occurred which resulted in a loss, and that loss must not be otherwise excluded under the Policy.

Per the received medical records from St. John Medical Center, Ms. Mosley was admitted on May 10, 2017 due to a fall where she suffered a forehead contusion and right knee contusion. A CT scan of her brain was clear and she was discharged the next day, May 11, 2017. The medical records further revealed Ms. Mosley's sepsis was caused by the infected port related to her ongoing treatment with chemotherapy. The Medical Examiner report and Death Certificate confirmed Ms. Mosley's cause of death was sepsis due to bacteremia from infected port.

We have been unable to verify that an accident or accidental bodily injury directly resulted in Ms. Mosley's demise and the Disease or Illness exclusion would apply. It is for the above referenced reasons, we must respectfully deny your claim.

Doc. 18-6, at 2 (emphasis omitted).

At issue is whether the Policy covers Ms. Mosley's death. Under "Accidental Loss of Life and Dismemberment Benefit," the Policy states: "If an Accidental Bodily Injury causes the Covered Person's Loss of Life ... [Defendant] will pay the applicable percentage of the Loss of Life Benefit Amount shown in the Declarations." Doc. 18-1, at 9; Doc. 21-3, at 8 (emphasis omitted).³ The Policy defines "Accidental Bodily Injury" as a "bodily injury" that (1) is "Accidental," (2) is "the direct cause of a loss," and (3) "occurs while a Covered Person is insured" under the Policy. Doc. 21-3, at 11 (emphasis omitted).⁴ The Policy also defines "Accident"/"Accidental" as "a sudden, unforeseen, and unexpected event which happens by chance, is independent of illness, disease or other bodily malfunction and is the direct cause of loss." Id. at 17 (emphasis omitted). Neither "direct cause" nor "bodily injury" are defined in the Policy.

The Policy also includes an exclusion concerning diseases and illnesses, which reads in full:

This insurance does not apply to any Accident, Accidental Bodily Injury or loss caused by or resulting from, directly or indirectly, a Covered Person's emotional trauma, mental or physical illness, disease, normal pregnancy, childbirth or miscarriage, bacterial or viral infection, bodily malfunctions, or medical, surgical or diagnostic treatment thereof.

This exclusion does not apply to loss resulting from the Covered Person's Accidental bacterial infection or from consumption of a substance contaminated by bacteria.

Id. at 10 (emphasis omitted). Defendant maintains that this exclusion applies to Ms. Mosley's death, while Plaintiffs disagree. Compare Doc. 18, at 16–17 with Doc. 21, at 12–15.

II. Motion for Summary Judgment Standard

"The court shall grant summary judgment if 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). "An issue is ‘genuine’ if there is sufficient evidence on each side so that a rational trier of fact could resolve the issue either way.... An issue of fact is ‘material’ if under the substantive law it is essential to the proper disposition of the claim." Adler v. Wal-Mart Stores, Inc. , 144 F.3d 664, 670 (10th Cir. 1998) (quoting Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) ). "The movant bears the initial burden of making a prima facie demonstration of the absence of a genuine issue of material fact and entitlement to judgment as a matter of law." Id. at 670–71 (citing Celotex Corp. v. Catrett , 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986) ). "If the movant carries this initial burden, the nonmovant that would bear the burden of persuasion at trial may not simply rest upon its pleadings; the burden shifts to the nonmovant to go beyond the pleadings and ‘set forth specific facts’ that would be admissible in evidence in the event of trial from which a rational trier of fact could find for the nonmovant." Id. at 671 (citing Fed. R. Civ. P. 56(e) ). In short, the Court must inquire "whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law." Liberty Lobby , 477 U.S. at 251–52, 106 S.Ct. 2505.

While the Court construes all facts and reasonable inferences in the light most favorable to the non-moving party, Macon v. United Parcel Serv., Inc. , 743 F.3d 708, 712–13 (10th Cir. 2014), "[t]he mere existence of a scintilla of evidence in support of the plaintiff's position will be insufficient; there must be evidence on which the [trier of fact] could reasonably find for the plaintiff." Liberty Lobby , 477 U.S. at 252, 106 S.Ct. 2505. At the summary judgment stage, the Court's role is "not ... to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial." Id. at 249, 106 S.Ct. 2505.

III. Discussion

The Court applies Oklahoma substantive law to this dispute. See Evanston Ins. Co. v. Law Office of Michael P. Medved, P.C. , 890 F.3d 1195, 1198 (10th Cir. 2018) ; see also State Farm Fire & Cas. Co. v. Pettigrew , 180 F.Supp.3d 925, 931 (N.D. Okla. 2016) ("The interpretation of an insurance contract is governed by state law and, sitting in diversity, we look to the law of the forum state." (internal quotation marks and citation omitted)). Under Oklahoma law,

[a]n insurance policy is a contract. The rules of construction and analysis applicable to contracts govern equally insurance policies. The primary goal of contract interpretation is to determine and give effect to the intention of the parties at the time the contract was made. In arriving at the parties' intent, the terms of the instrument are to be given their plain and ordinary meaning. Where the language of a contract is clear and unambiguous on its face, that which stands expressed within its four corners must be given effect. A contract should receive a construction that makes it reasonable, lawful, definite and capable of being carried into effect if it can be done without violating the intent of the parties.

May v. Mid-Century Ins. Co. , 2006 OK 100, ¶ 22, 151 P.3d 132, 140. Where the insurance policy is ambiguous, however, it is strictly construed against the insurer and in favor of the insured because insurance policies are contracts of adhesion. Spears v. Shelter Mut. Ins. Co. , 2003 OK 66, ¶ 5, 73 P.3d 865, 868.⁵

Plaintiffs argue that Ms. Mosley's death is covered by the Policy. See generally Doc. 21. Specifically, Plaintiffs assert that Ms. Mosley's fall on May 10, 2017, is somehow related to the agreed-upon cause of her death: sepsis stemming from a bacterial infection in Ms. Mosley's port. See Doc. 21, at 4 ("But for the accidental fall that caused the fatal infection and resulting sepsis, [Ms. Mosley] undoubtedly would have lived longer."). But even...