Edwards v. Monumental Life Ins. Co.
| Decision Date | 23 August 2011 |
| Docket Number | Case No. 10–2299–WEB. |
| Citation | 812 F.Supp.2d 1263 |
| Court | U.S. District Court — District of Kansas |
| Parties | Malachi EDWARDS and Malcolm Edwards, Plaintiffs, v. MONUMENTAL LIFE INSURANCE COMPANY, Defendant. |
OPINION TEXT STARTS HERE
Kala A. Spigarelli, Sarah A. Mills, Spigarelli, Spigarelli & Hayes, Pittsburg, KS, for Plaintiffs.
Mark A. Samsel, Curtis L. Tideman, Rebecca McMahon, Lathrop & Gage LLP, Overland Park, KS, for Defendant.
Plaintiffs filed the above entitled case against Monumental Life Insurance Company, alleging breach of an insurance contract in failing to pay insurance benefits. Plaintiffs request judgment for the amount of the life insurance contract, interest, and attorney fees. The parties have filed cross motions for summary judgment.
1. Monumental issued a policy of accidental death insurance, Policy No. 14A9150558 (hereinafter the “Policy”) to Patricia M. Smith. (Pretrial Order Stipulation, Doc. 27).
2. The Policy was in effect beginning November 8, 2006 and was in effect on June 2–June 4, 2008. (Pretrial Order Stipulation, Doc. 27).
3. The beneficiaries under the Policy are Malachi Edwards and Malcolm Edwards. (Pretrial Order Stipulation, Doc. 27).
4. Patricia Smith was last seen alive on June 2, 2008. (Police Report, Doc. 29–2).
5. Patricia M. Smith died sometime between June 2, 2008 and June 4, 2008. (Pretrial Order Stipulation, Doc. 27).
6. Prior to her death, Smith was treated and prescribed Oxycodone for severe chronic back pain, severe chronic neck pain, as well as hip pain and knee pain from arthritis. (Accidental Death Benefit Claim, Doc. 29–6).
7. The cause of death was listed as “oxycodone toxicity.” (Report of Death, Doc. 29–2; Certificate of Death, Doc. 29–3).
8. The Certificate of Death also specified that the manner of death was an “accident.” (Certificate of Death, Doc. 29–3).
9. Dr. Donald Pojman, Medical Coronor, stated in the autopsy report, (Autopsy Report, Doc. 29–4).
10. Dr. Pojman testified that at least 17 oxycodone pills were unaccounted for at the time of her death. (Doc. 29–5, Pojman Depo., p. 3).
11. Dr. Wimbish testified that the concentration of oxycodone found in Smith's blood was 2.5 times the expected blood concentration, a value much higher than expected from the dosage she was taking. .
12. Dr. Wimbish opined that Smith did not take the medication as prescribed. .
Jurisdiction is not in dispute and is properly before the court pursuant to 28 U.S.C. § 1332.
Summary judgment is appropriate when “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; Thomas v. Metropolitan Life Ins. Co., 631 F.3d 1153, 1160 (10th Cir.2011). A fact is “material” if under the substantive law it is essential to the proper disposition of the claim. Wright ex rel. Trust Co. of Kansas v. Abbott Laboratories, Inc., 259 F.3d 1226, 1231–1232 (10th Cir.2001), quoting Adler v. Wal–Mart Stores, 144 F.3d 664, 670 (10th Cir.1998). “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.” Adler, 144 F.3d at 670. The court must “view the evidence and draw all reasonable inferences therefrom in the light most favorable to the party opposing summary judgment.” Atl. Richfield Co. v. Farm Credit Bank of Wichita, 226 F.3d 1138, 1148 (10th Cir.2000). The burden of showing that no genuine issue of material fact exists is borne by the moving party. E.E.O.C. v. Horizon/CMS Healthcare Corp., 220 F.3d 1184, 1190 (10th Cir.2000). Once the moving party meets the burden, the nonmoving party must demonstrate a genuine issue for trial on a material matter. Concrete Works of Colorado, Inc. v. City & County of Denver, 36 F.3d 1513, 1517 (10th Cir.1994).
Defendant Monumental Life Insurance Company (Monumental) requests summary judgment, arguing that plaintiffs cannot establish, as a matter of law, that the death of Patricia Smith was the result of a loss for which the Policy provides coverage. Monumental argues that the Policy excludes coverage when death results from medical treatment, including the taking of medication. Monumental also argues that since 17 pills were missing, and plaintiff cannot establish whether the overdose was accidental or intentional, plaintiffs cannot show the death of Smith comes under the Policy's accidental death language.
Plaintiffs allege that there is no evidence that Smith intentionally overdosed, she was taking the medication under the care of a doctor, and the cause of death was an accidental overdose. Plaintiffs allege that Smith suffered a loss of life as a result of injury, and they are entitled to death benefits of $150,000.00, including interest and attorney fees.
The language of an insurance policy should be construed to give effect to the intention of the parties. Catholic Diocese of Dodge City v. Raymer, 251 Kan. 689, 693, 840 P.2d 456 (1992). A policy of insurance should be considered as a whole. Farm Bureau Mut. Ins. Co. v. Horinek, 233 Kan. 175, 180, 660 P.2d 1374 (1983). Insurance policy language should be clear and unambiguous, otherwise the policy will be liberally construed in favor of the insured. Catholic Diocese, 251 Kan. at 693, 840 P.2d 456. To be ambiguous, Id. The test in determining whether an insurance contract is ambiguous is not what the insurer intends the language to mean, but what a reasonably prudent insured would understand the language to mean. First Financial Ins. Co. v. Bugg, 265 Kan. 690, 694, 962 P.2d 515 (1998).
The Policy at issue in the case was effective on November 8, 2006, and remained in effect at the time of Smith's death. The Policy contained the following provisions:
INJURY means bodily injury caused by an accident. The accident must occur while the Covered Person's insurance is in force under this Policy. The Injury must be the direct cause of the Loss and must be independent of all other causes. The Injury must not be caused by or contributed to by Sickness.
LOSS means your death or any physical impairment, incurred expense, or other benefit covered under the terms of this Policy and any attached Riders.
SICKNESS means an illness or disease which results in a covered Loss while insurance for the Covered Person is in force under this Policy.
We will not pay a benefit for a Loss which is caused by, results from, or contributed to by:
suicide, attempted suicide or intentionally self-inflicted injury, while sane or insane.
sickness or its medical or surgical treatment, including diagnosis. taking of any drug, medication, narcotic, or hallucinogen, unless as prescribed by a Physician. (Doc. 30–3).
The Policy did not define the term “accident.” The State of Kansas has defined “accident” as an “occurrence or event which is undesigned, sudden and unexpected, usually of an affective or unfortunate character and often, but not necessarily, accompanied by a manifestation of force.” Bohanan v. Schlozman Ford, Inc., 188 Kan. 795, 798, 366 P.2d 28 (1961).
The first issue is whether Smith's death is a result of sickness. The policy contained an exclusion for loss which results from sickness. Smith was treated for severe chronic back pain, severe chronic neck pain, as well as hip pain and knee pain from arthritis. Smith's doctor prescribed pain medication, specifically oxycodone, to treat the pain. Smith died from toxicity of the medications.
In Kellogg v. Metropolitan Life Ins. Co., 549 F.3d 818 (10th Cir.2008), the Court found that the insured's death was caused by a skull fracture resulting from a car accident, not by the seizure that caused the car accident. Id. at 832. The Court stated, “[T]he Plan does not contain an exclusion for losses due to accidents that were caused by physical illness, but rather excludes only losses caused by physical illness.” Id. The court concluded, Id. The court held that since the insured's death resulted from a skull fracture as a result of the car accident, and not the underlying sickness, the policy exclusion did not apply. Id.
Just like in Kellogg, Smith's underlying sickness was not the cause of her death. The physical illness Smith was treated for was severe chronic back pain, severe chronic neck pain, as well as hip pain and knee pain from arthritis. Smith was prescribed pain killers for a disease, but the sole cause of death was toxicity, not the disease for which she was taking the medicine. Smith's sickness was independent of the cause of death. A reasonable policy holder would understand the exclusion in the policy to refer to causes contributing to the death, not to an accident. Since the loss in this case was not caused or contributed to by a physical illness, Smith's death cannot be excluded under the plan for sickness. Smith's death was a direct result of the medication she was prescribed, not her sickness.
The next issue is whether Smith's death was the result of an accident or suicide....
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