Svensson v. Securian Life Ins. Co.

• Decision Date: 31 March 2010
• Docket Number: Case No. 08-CV-10148 (KMK).
• Citation: 706 F.Supp.2d 521
• Parties: Paul E. SVENSSON, Plaintiff,v.SECURIAN LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Southern District of New York

706 F.Supp.2d 521

Paul E. SVENSSON, Plaintiff,v.SECURIAN LIFE INSURANCE COMPANY, Defendant.

Case No. 08-CV-10148 (KMK).

United States District Court,

S.D. New York.

March 31, 2010.

COPYRIGHT MATERIAL OMITTED

Stephen H. Slater, Esq., Hodges, Walsh & Slater LLP, White Plains, NY, for Plaintiff.

James P. Evans, Esq., Hiscock & Barclay, LLP, Syracuse, NY, for Defendant.

OPINION AND ORDER

KENNETH M. KARAS, District Judge:

What is an accident? “More precisely, when is death accidental under insurance policies specifically written for such events? For a century and a half, courts and underwriters have struggled to answer what has been described as ‘one of the more philosophically complex simple questions.’ ” Adam F. Scales Man, God and the Serbonian Bog: The Evolution of Accidental Death Insurance, 86 Iowa L. Rev. 173, 175 (2000) (quoting Fegan v. State Mut. Life Assurance Co. of Am., 945 F.Supp. 396, 399 (D.N.H.1996)).

Plaintiff Paul Svensson, Esq. (“Plaintiff” or “Mr. Svensson”), brings this suit against Securian Life Insurance Company (“Defendant” or “Securian”). Plaintiff's wife, at the time of her death, was insured by Defendant under a $200,000 policy covering “death by accidental injury.” She died of a respiratory illness which she developed after inhaling a community-spread bacterial pathogen. As the policy's beneficiary, Plaintiff alleges that Defendant owes him $200,000. Defendant has moved to dismiss or, in the alternative, for summary judgment. Plaintiff, in turn, has cross-moved for summary judgment. For the reasons stated herein, Defendant's Motion to Dismiss is granted.

I. Background

A. Facts

The Court assumes the following facts, as alleged in the Complaint, to be true for the purposes of the Motion to Dismiss. Plaintiff's late wife, Providencia R. Svensson (“Decedent,” or “Mrs. Svensson”), was insured under a policy owned by Defendant covering “death by accidental injury” (“the Policy”).¹ (Compl. ¶¶ 12, 13; Decl. of James P. Evans, Ex. A (“Def.'s Ex. A”).) Mr. Svenson was the designated beneficiary. (Compl. ¶ 16.) The Policy is styled as an “accidental death benefit” and contains a bold disclaimer stating that it “PROVIDES ACCIDENT ONLY INSURANCE AND DOES NOT PAY BENEFITS FOR LOSS FROM SICKNESS.” (Def.'s Ex. A.) The Policy defines “death by accidental injury” as a death that “results directly and independently of all other causes from an accidental drowning or from an accidental injury which was unintended, unexpected, and unforeseen.” ( Id.) The Policy further states that “[i]n no event will we pay the accidental death benefit if your death results from or is caused directly or indirectly by any of the following: ... bodily or mental infirmity, illness, or disease,” or “infection, other than infection occurring simultaneously with, and as a result of, the accidental injury.” ( Id.)

According to the Complaint, on March 10, 2008, Decedent “sustained an accidental injury from the unintended, unexpected, and unforeseen community-spread transmission of a Group A streptococcus bacterial pathogen on March 10, 2008 that resulted directly and simultaneously in an infection.” ( Id. ¶ 21.) Further, “the unforeseen inhalation of Group A streptococcus bacteria resulted in the simultaneous infection of [Decedent's] lungs leading to her death from bronchopneumonia” on March 18, 2008. ( Id. ¶¶ 24-25.)

B. Procedural History

Plaintiff filed the instant action on November 21, 2008, claiming both breach of contract and breach of fiduciary duty. (Dkt. No. 1.) ² On April 17, 2009, Defendant moved to dismiss this case or, in the alternative, for summary judgment. (Dkt. No. 17.) Plaintiff opposed these motions, and cross-moved for summary judgment. (Dkt. No. 19.)

II. Discussion

A. Standard of Review

“On a Rule 12(b)(6) motion to dismiss a complaint, the court must accept a plaintiff's factual allegations as true and draw all reasonable inferences in [the plaintiff's] favor.” Gonzalez v. Caballero, 572 F.Supp.2d 463, 466 (S.D.N.Y.2008); see also Ruotolo v. City of New York, 514 F.3d 184, 188 (2d Cir.2008) (“We review de novo a district court's dismissal of a complaint pursuant to Rule 12(b)(6), accepting all factual allegations in the complaint and drawing all reasonable inferences in the plaintiff's favor”) (internal quotation marks omitted). The Supreme Court has held that “[w]hile a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the ‘grounds' of his ‘entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.’ ” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (internal citations omitted) (second alteration in Twombly ). “Factual allegations must be enough to raise a right to relief above the speculative level,” id., and “once a claim has been stated adequately, it may be supported by showing any set of facts consistent with the allegations in the complaint,” id. at 563, 127 S.Ct. 1955.

Simply put, Plaintiff must allege “enough facts to state a claim to relief that is plausible on its face.” Id. at 570, 127 S.Ct. 1955. If Plaintiff “ha[s] not nudged [his] claims across the line from conceivable to plausible, [his] complaint must be dismissed.” Id.; see also Ashcroft v. Iqbal, --- U.S. ----, 129 S.Ct. 1937, 1950, 173 L.Ed.2d 868 (2009) ( “Determining whether a complaint states a plausible claim for relief will ... be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense. But where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not ‘show[n]’-‘that the pleader is entitled to relief’ ” (internal citation omitted) (quoting Fed.R.Civ.P. 8(a)(2)) (alteration in original)).

Finally, in adjudicating a Rule 12(b)(6) motion, a court may consider “facts stated in the complaint or documents attached to the complaint as exhibits or incorporated by reference,” or facts of which the Court may take judicial notice. Nechis v. Oxford Health Plans, Inc., 421 F.3d 96, 100 (2d Cir.2005); see also Leonard F. v. Isr. Disc. Bank of N.Y., 199 F.3d 99, 107 (2d Cir.1999). The Court also may consider documents that are referenced in and integral to the Complaint. See Blakeman v. Walt Disney Co., 613 F.Supp.2d 288, 297 (E.D.N.Y.2009). Here, although Plaintiff did not attach the Policy, the Court properly may consider it without converting Defendant's motion to one for summary judgment, as the Complaint explicitly refers to, and relies on, the Policy. See Jurupa Valley Spectrum, LLC v. Nat'l Indem. Co., No. 06-CV-4023, 2007 WL 1862162, at *5-*6 (S.D.N.Y. June 29, 2007) aff'd, 555 F.3d 87 (2d Cir.2009).

B. Analysis

1. Did Decedent Suffer From an Accidental Injury?

Plaintiff's claim derives solely from the Policy, which provides that “the accidental death benefit” will be paid if that the decedent “died as the result of an accidental injury.” The Policy explains that “death by accidental injury” means that death “results directly and independently of all other causes from an accidental drowning or from an accidental injury which was unintended, unexpected, and unforeseen.” ³ However, the Policy also provides that “in no event” will it pay benefits if death “results from” seven circumstances, including of relevance here, “bodily or mental infirmity, illness, or disease,” and “infection, other than infection occurring simultaneously with, and as a result of, the accidental injury.”

Plaintiff claims that he is entitled to benefits under this Policy because his wife died from an accidental injury. In particular, he claims that his wife sustained an accidental injury from the unintended, unexpected and unforeseen, community-spread transmission of a Group A streptococcus bacterial pathogen, and that as a direct result of this, she passed away from bronchopneumonia.

The first question, then, is whether Decedent's fatality was the result of an “accidental injury.” This initially requires the Court to consider what the Policy means by “accidental injury.” Under New York law, “the initial interpretation of a contract ‘is a matter of law for the court to decide.’ ” K. Bell & Assocs. v. Lloyd's Underwriters, 97 F.3d 632, 637 (2d Cir.1996) (quoting Readco, Inc. v. Marine Midland Bank, 81 F.3d 295, 299 (2d Cir.1996)). “The cardinal principle for the construction and interpretation of insurance contracts-as with all contracts-is that the intentions of the parties should control.” Newmont Mines Ltd. v. Hanover Ins. Co., 784 F.2d 127, 135 (2d Cir.1986).⁴ The inquiry at this initial interpretation stage is whether the insurance policy is unambiguous with respect to the question disputed by the parties. Unambiguous terms are to be given their plain and ordinary meaning New York v. Blank, 27 F.3d 783, 792 (2d Cir.1994), as it has long been the rule in New York that, “[i]n an insurance policy the words are to be judged in the light of the understanding of the average [person] who procures such a policy,” Berkowitz v. N.Y. Life Ins. Co., 256 A.D. 324, 10 N.Y.S.2d 106, 109 (1939). When the policy's provisions are unambiguous and intelligible, courts should enforce them as drafted. See Parks Real Estate Purchasing Group v. St. Paul Fire & Marine Ins. Co., 472 F.3d 33, 42 (2d Cir.2006). However, an ambiguity exists where “the terms of an insurance contract could suggest ‘more than one meaning when viewed objectively by a reasonably intelligent person who has examined the context of the entire integrated agreement and who is cognizant of the customs, practices, usages and terminology as generally understood in the particular trade or business.’ ” Morgan Stanley Group Inc. v. New Eng. Ins. Co., 225 F.3d 270, 275 (2d Cir.2000) (quoting Lightfoot v. Union Carbide Corp., 110 F.3d 898, 906 (2d Cir.1997)). It is...