Harrison v. Monumental Life Ins. Co.

• Decision Date: 24 June 2003
• Docket Number: No. 01-1345.,01-1345.
• Citation: 333 F.3d 717
• Parties: Warren K. HARRISON, Plaintiff-Appellee, v. MONUMENTAL LIFE INSURANCE COMPANY, Defendant-Appellant.
• Court: U.S. Court of Appeals — Sixth Circuit

333 F.3d 717

Warren K. HARRISON, Plaintiff-Appellee, v. MONUMENTAL LIFE INSURANCE COMPANY, Defendant-Appellant.

No. 01-1345.

United States Court of Appeals, Sixth Circuit.

Argued January 29, 2003.

Decided and Filed June 24, 2003.

Benjamin Whitfield, Jr. (argued and briefed), Cynthia J. Gaither, Whitfield & Associates, Detroit, MI, for Appellee.

Elaine A. Parson (argued and briefed), Raymond & Prokop, Southfield, MI, John W. Schmieding, Doepken, Keevican & Weiss, Southfield, MI, for Appellant.

Before GUY and MOORE, Circuit Judges; BECKWITH, District Judge.^*

OPINION

BECKWITH, District Judge.

Defendant-Appellant Monumental Life Insurance Company appeals from the judgment of the district court finding that Plaintiff-Appellee Warren K. Harrison was entitled to accidental death benefits under a group life insurance policy covering the life of Wayne Harrison. Because we conclude that the evidence presented by Plaintiff at trial was sufficient to find that an exclusionary clause precluding coverage was not applicable, the judgment of the district court is AFFIRMED.

I.

On June 15, 1997, Defendant-Appellant Monumental Life Insurance Company ("Monumental") issued a certificate of insurance under a group life insurance policy covering the life of Plaintiff Warren K. Harrison's decedent, Wayne Harrison. The policy paid $50,000 to the beneficiary if, and only if, bodily injury was the cause of death of the insured: "The injury must be the direct cause of [death] and must be independent of all other causes. The injury must not be caused by or contributed to by Sickness." See Policy, J.A. at 101. In addition, the policy contained the following specific exclusion of coverage: "We will not pay a benefit for a loss which is caused by, results from, or contributed to by [s]ickness or its medical or surgical treatment, including diagnosis[.]" Id. at 102.

Wayne Harrison was age 60 at the time he obtained coverage under the policy but by then he had already experienced an extensive medical history. In 1990, Mr. Harrison was diagnosed with squamous cell carcinoma of the soft palate, which was treated with radiation and chemotherapy. J.A. at 355. In 1992, Mr. Harrison was admitted to the hospital for treatment of an intracranial hemorrhage after he was found lying in his basement. Id. at 426. In 1993 and 1994, Mr. Harrison received treatment for seizures. Id. at 419, 471. In 1995, Mr. Harrison was treated at the emergency room after being assaulted and struck in the head with a baseball bat. Id. at 1310. In 1996, Mr. Harrison was treated in the emergency room after being struck in the head by a metal plate at work. Id. at 289. Also in 1996, Mr. Harrison had a colonoscopy to remove a polyp. Id. at 504. In 1997, Mr. Harrison was again admitted to the hospital for a fractured vertebrae after being pushed down a flight of stairs. Id. at 646. In addition to these discrete incidents requiring medical attention, the record reflects that Mr. Harrison had a history of hypertension and alcoholism. Finally, either as part of his treatment for throat cancer or during a seizure, Mr. Harrison lost part of his tongue. This caused food to aspirate into his lungs, resulting in chronic aspiration pneumonitis, or aspiration pneumonia.

On January 12, 1998, Mr. Harrison was struck by a truck while crossing a street in Detroit. He was admitted to St. John's Hospital with multiple fractures of the pelvis, a fracture of the pubic bone, and comminuted fractures of the proximal ends of the right tibia and fibula. J.A. at 154. On January 13, 1998, Mr. Harrison was transferred to Henry Ford Hospital. While at Henry Ford, Mr. Harrison developed bilateral bronchial pneumonia and died on January 30, 1998. Dr. Suwait Kanluen, the chief medical examiner for Wayne County, Michigan, performed an autopsy on Mr. Harrison which concluded that death was caused by the fractures sustained in the collision. Dr. Kanluen listed bilateral bronchial pneumonia as a complicating factor in Mr. Harrison's death. Id. at 157.

Following Mr. Harrison's death, Plaintiff filed a claim for benefits under the policy. Monumental, however, denied Plaintiff's claim on the grounds that the medical records demonstrated that the accident itself was not sufficient to cause Mr. Harrison's death and that his numerous preexisting conditions were a contributing cause of death. Thus, according to Monumental, Plaintiff's claim fell under the exclusionary clause which required bodily injury to be the sole cause of death.

Plaintiff originally filed suit against Monumental for breach of the policy in the Wayne County Circuit Court, but Monumental removed the case to the United States District Court for the Eastern District of Michigan on February 17, 1999. The basis for the district court's subject matter jurisdiction was diversity jurisdiction pursuant to 28 U.S.C. § 1332.¹

The case proceeded to a trial before the bench on January 2 and January 3, 2001. Not surprisingly, given the nature of Mr. Harrison's medical history, the trial came down to the opinions of each side's medical expert. Dr. Kanluen, the Wayne County medical examiner, testified on behalf of Plaintiff. According to Dr. Kanluen:

After autopsy, it was my opinion that Mr. Harrison died of multiple injuries. That means, fracture of the pelvis, pelvis bone, fracture of the right leg bone, and he also has complications, bilateral pneumonia, and cause of death was multiple injuries complicated by pneumonia.

J.A. at 254. Dr. Kanluen further testified that knowing Mr. Harrison's medical history did not change his opinion that the accident was the cause of death. Id. at 260-61; 263-64. Dr. Kanluen admitted that he observed both acute and chronic pneumonia in Mr. Harrison's lung tissue. See id. at 262-63; 268-69.² Dr. Kanluen testified, however, that acute pneumonia, and not chronic pneumonia, was the contributing cause of death:

What I observed was acute pneumonia. Not talking about chronic. That pneumonia was because he was in the hospital for treatment, and the people who was in the hospital, of course, body resistance is low. That's why infection was very easy. That's why in my opinion bronchopneumonia is the complication of the injury, because he was hit by truck and in the hospital. His body was low, and that's why he got the pneumonia, and that was the complication of the injury that brought him there. If not for the truck or in the hospital, he doesn't have acute bronchopneumonia. That's my opinion.

Id. at 262-63. Dr. Kanluen further stated that Mr. Harrison could have lived with chronic pneumonia for "a long, long time." Id. at 269. Dr. Kanluen's testimony obviously created an important distinction because if chronic, i.e. preexisting, pneumonia contributed to Mr. Harrison's death, there would be no coverage under the policy.

Monumental's expert, Dr. Werner Spitz, of course testified differently:

Q.Have you made a determination of the injuries Mr. Harrison sustained when struck by a vehicle at a crosswalk where [sic] the sole cause of his death meaning, did he die as a direct and independent result of injuries without the contribution of any sickness or disease?

A.No he did not. Let me please say in a full sentence, it is not my opinion that Mr. Harrison died solely of the injury. The injury in and of itself was not a fatal condition.

J.A. at 1608. Dr. Spitz testified that his examination of Mr. Harrison's lung tissue showed no signs of acute bronchopneumonia and that he saw only evidence of long-standing lung disease. Id. at 1610. Later, in attempting to apportion the cause of death, Dr. Spitz testified that the accident played only a two percent role in Mr. Harrison's death and that the remainder was attributable to his preexisting conditions. Id. at 1625.

On January 5, 2001, the district court issued a short written order making findings of fact and conclusions of law and containing its verdict. After reviewing some of the background facts and testimony, the district court stated:

The Court finds Dr. Kanluen's testimony credible. Wayne Harrison's injury and resulting death were not "contributed to" by preexisting sickness. Wayne Harrison died because he sustained severe injuries from being struck by a vehicle on January 12, 1998. Wayne Harrison died of injuries accidentally-sustained, which the insurance policy covers. Plaintiff, the beneficiary, is entitled to the benefits of that policy, in the amount of $50,000. The Court does not find credible the testimony of the defense expert, Dr. Werner Spitz. Dr. Spitz opined that a chronic infection was the 97% or 98% cause of Mr. Harrison's death-a man who was living on his own and walking across the street when he struck by a truck that inflicted multiple severe injuries that cause his death. The Court finds this testimony not credible.

J.A. at 227. The district court then entered judgment in favor of the Plaintiff and awarded damages of $50,000.

Monumental now appeals from the judgment of the district court finding that Plaintiff was entitled to recover accidental death benefits under the circumstances of Mr. Harrison's death. Specifically, Monumental argues that the district court's finding that the accident was the sole cause of Mr. Harrison's death was clearly erroneous and/or lacked evidentiary support in the record and that the district court erroneously applied Michigan law relating to exclusionary clauses in accidental death policies.

II.

Rule 52(a) of the Federal Rules of Civil Procedure describes the deference to be afforded a district court's findings of fact upon the conclusion of a bench trial: "Findings of fact, whether based on oral or documentary evidence, shall not be set aside unless clearly erroneous, and due regard shall be given to the opportunity of the trial court to judge of the credibility of the witnesses." The U.S. Supreme Court further explained this standard:

If the district court's account of the evidence is plausible in light...