Interiano v. Colonial Life & Accident Ins. Co.

• Decision Date: 18 May 2020
• Docket Number: 2:19-cv-01834-VAP-FFMx
• Citation: 460 F.Supp.3d 945
• Parties: Gladys INTERIANO, Plaintiff, v. COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY, Defendant
• Court: U.S. District Court — Central District of California

460 F.Supp.3d 945

Gladys INTERIANO, Plaintiff,

v.COLONIAL LIFE AND ACCIDENT INSURANCE COMPANY, Defendant

2:19-cv-01834-VAP-FFMx

United States District Court, C.D. California.

Signed May 18, 2020

James T. Hudson, Law Offices of James T. Hudson, Los Angeles, CA, for Plaintiff.

Nicole Y. Blohm, Tatiana Semerjian Nunneri, Merserve Mumper and Hughes LLP, Los Angeles, CA, for Defendant.

Order GRANTING IN PART and DENYING IN PART Defendant Colonial Life and Accident Insurance Company's Motion for Summary Judgment (Dkt. 28) and GRANTING Plaintiff's Cross Motion for Partial Summary Judgment (Dkt. 25)

Virginia A. Phillips, Chief United States District Judge

Before the Court are Defendant Colonial Life and Accident Insurance Company's Motion for Summary Judgment (Dkt. 28) and Plaintiff Gladys Interiano's Cross Motion for Partial Summary Judgment (Dkt. 25), both filed January 27, 2020. The parties each opposed the other's motion on February 3, 2020, (Dkts. 30, 31), and replied on February 10, 2020 (Dkts. 32, 33).

After considering all papers filed in support of, and in opposition to, the motions, the Court GRANTS Plaintiff's Cross Motion for Partial Summary Judgment and GRANTS IN PART and DENIES IN PART Defendant Colonial Life and Accident Insurance Company's Motion for Summary Judgment.

I. BACKGROUND

This case arises from the death of Hazel Burgos and Defendant Colonial Life and Accident Insurance Company's ("Colonial Life") denial of accident insurance benefits to Plaintiff Gladys Pena (aka Interiano), Ms. Burgos' mother and plan beneficiary. Plaintiff commenced this action in Los Angeles Superior Court on January 16, 2019, raising claims for breach of insurance contract, insurance bad faith, and financial elder abuse. Plaintiff seeks damages for failure to provide benefits, general damages for mental and emotional distress, consequential economic damages, and punitive and exemplary damages. Defendants removed the case to the Central District of California on March 13, 2019. (Dkt. 1).

II. LEGAL STANDARD

A motion for summary judgment or partial summary judgment shall be granted when there is no genuine issue as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a) ; Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 247-48, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).

"[W]hen parties submit cross-motions for summary judgment, each motion must be considered on its own merits." Fair Hous. Council of Riverside Cty., Inc. v. Riverside Two , 249 F.3d 1132, 1136 (9th Cir. 2001) (internal quotations and citation omitted). Thus, "[t]he court must rule on each party's motion on an individual and separate basis, determining, for each side, whether a judgment may be entered in accordance with the Rule 56 standard." Id. (quoting Wright, et al., Federal Practice and Procedure § 2720, at 335–36 (3d ed. 1998) ). If, however, the cross-motions are before the court at the same time, the court must consider the evidence proffered by both sets of motions before ruling on either one. Riverside Two , 249 F.3d at 1135–36.

Generally, the burden is on the moving party to demonstrate that it is entitled to summary judgment. Margolis v. Ryan , 140 F.3d 850, 852 (9th Cir. 1998). "The moving party may produce evidence negating an essential element of the nonmoving party's case, or ... show that the nonmoving party does not have enough evidence of an essential element of its claim or defense to carry its ultimate burden of persuasion at trial." Nissan Fire & Marine Ins. Co. v. Fritz Companies, Inc. , 210 F.3d 1099, 1106 (9th Cir. 2000). The nonmoving party must then "do more than simply show that there is some metaphysical doubt as to the material facts" but must show specific facts which raise a genuine issue for trial. Matsushita Elec. Indus. Co. v. Zenith Radio Corp. , 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). A genuine issue of material fact will exist "if the evidence is such that a reasonable jury could return a verdict for the non-moving party." Anderson , 477 U.S. at 248, 106 S.Ct. 2505.

In ruling on a motion for summary judgment, a court construes the evidence in the light most favorable to the non-moving party. Barlow v. Ground , 943 F.2d 1132, 1135 (9th Cir. 1991). "[T]he judge's function is not [ ] to weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial." Anderson , 477 U.S. at 249, 106 S.Ct. 2505.

At the summary judgment stage, a district court should "focus on the admissibility of the [evidence's] contents" and not the form in which the evidence is presented—it is sufficient that a party will be able to produce evidence in its admissible form at trial. See Fraser v. Goodale , 342 F.3d 1032, 1036 (9th Cir. 2003) ; Block v. City of Los Angeles , 253 F.3d 410, 418-19 (9th Cir. 2001). Moreover, "objections to evidence on the ground that it is irrelevant, speculative, and/or argumentative, or that it constitutes an improper legal conclusion are all duplicative of the summary judgment standard itself" and thus need not be considered on a motion for summary judgment. Burch v. Regents of Univ. of Cal. , 433 F. Supp. 2d 1110, 1120 (E.D. Cal. 2006).

III. UNDISPUTED FACTS

The parties have filed a joint statement of facts, the most relevant of which are included below:

Underlying Events

• On July 16, 2013, Hazel Burgos submitted an application for accidental coverage policy to Colonial Life and Accident Insurance Company ("Colonial Life"), designating her mother, Gladys Pena (aka Interiano), as the primary beneficiary for 100% of the policy benefit. (Dkt. 28-3, "Goss Decl.," ¶ 5; Goss Decl. Ex. 1).

• On August 1, 2013, Colonial Life issued Accident Only Policy No. 4437737185 (Dkt. 28-2, "Policy") to Ms. Burgos. (Goss Decl. ¶ 6; Goss Decl. Ex. 2). The policy provides for a $100,000 benefit for Accidental Death-Common Carrier. (Dkt. 28-20, "Joint Stipulation of Facts" or "JSF," ¶ 3).

• On May 26, 2018, Colonial Life received Plaintiff's claim for accidental death benefits under the Policy. On the claim form, Plaintiff reported that Ms. Burgos died on March 13, 2018 at 7:52 a.m. after developing a pulmonary embolism on a flight from LAX to Taiwan. She died approximately one hour after landing in Taipei. (JSF ¶ 4).

• The majority of the medical evidence provided is listed on Ms. Burgos' death certificate:

• Ms. Burgos' death certificate lists her "cause of death (final disease or condition resulting in death" as an "acute massive pulmonary embolism" specifying further that there was "no evidence of infection disease." (Dkt. 28-5).

• Her "manner of death" is described as "natural death," which is defined as "due solely or nearly totally to disease and/or the aging process." (Dkt. 28-5).

• There are no "other significant conditions" listed on the death certificate. (Dkt. 28-5).

• Colonial Life denied accidental death benefits on June 12, 2018, stating that the information provided with Plaintiff's claim did not support a finding that Ms. Burgos' death was the result of an accidental injury. (JSF ¶ 5).

• Plaintiff unsuccessfully appealed Colonial Life's claim denial on October 25, 2018, and the parties continued to contest the denial of coverage in a series of letters for the next several months (JSF ¶ 6-12). No new medical evidence was provided during this time. (Id.).

Policy Terms

• The Policy defines "accident" as "an unintended or unforeseen bodily injury sustained by a covered person, wholly independent of disease, bodily infirmity, illness, infection, or any other abnormal physical condition." A "covered accident" is one which "occurs on or after the effective date of [the] policy," "occurs while [the] policy is in force," "is of the Accident Type listed on the Policy Schedule page; and is not excluded by specific description in [the] policy." (Dkt. 30 ¶ 6).

• "Injury" is defined in the Policy as "physical harm or damage to the body." (JSF ¶ 3).

• The Policy excludes from coverage losses caused by sickness, defined broadly to mean "[h]aving any sickness or declining process caused by a sickness, including physical or mental infirmity." (Dkt. 30 ¶ 8; Policy at 21). The term "sickness" is defined as "any illness, infection, disease or any other abnormal physical condition which is not caused by an injury." (Policy at 21).

• The "Accidental Death – Common Carrier" is "payable if, as the result of a covered accident, a covered person is injured while a fare-paying passenger on a common carrier and the injury causes the covered person to die within 90 days after the accident." (Policy, COLONIAL-Interiano-00031). A "common carrier" is defined to include "commercial airplanes." (Id.).

IV. DISCUSSION

This Court is sitting in diversity jurisdiction and therefore applies California substantive law.

Erie Railroad Co. v. Tompkins , 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188 (1938).

A. Breach of Contract

Both parties have moved for summary judgment on the first claim, breach of contract. The parties dispute whether the Policy is an "accidental means" or "accidental death" policy, whether Ms. Burgos' death was the result of an "accident" for the purposes of the Policy, and whether the "sickness" exclusion applies. The Court considers each issue in turn below.

1. Accidental Death Policy

The California Supreme Court has distinguished between accidental death and accidental life policies, and has refused to eliminate the distinction even when expressly invited to do so.¹ See Weil v. Fed. Kemper Life Assurance Co. , 7 Cal. 4th 125, 129–30, 27 Cal.Rptr.2d 316, 866 P.2d 774 (1994) ("[T]he distinction in policy language between ‘accidental means’ and ‘accidental results,’ recognized in our prior decisions, should be preserved[.]"); accord Bilezikjian v. Unum Life Ins. Co. of Am. , 692 F. Supp. 2d 1203, 1212 (C.D. Cal. 2010), aff'd , 443 F. App'x 231 (9th Cir. 2011) (noting preservation of distinction).

This distinction is "critical," as "policies requiring only that there...