Tate v. Government Employees Ins. Co.
| Decision Date | 17 August 1993 |
| Docket Number | No. 92-6292,92-6292 |
| Citation | 997 F.2d 1433 |
| Parties | Martha G. TATE, individually and as Executrix of the estate of Lake E. Tate, Deceased, Plaintiff-Appellant, v. GOVERNMENT EMPLOYEES INSURANCE COMPANY, Defendant-Appellee. |
| Court | U.S. Court of Appeals — Eleventh Circuit |
Ralph E. Coleman, Sr., Coleman & Friday, Birmingham, AL, for plaintiff-appellant.
Ollie L. Blan, Jr., Spain, Gillon, Grooms, Blan & Nettles, Pamela Felkins Colbert, Birmingham, AL, for defendant-appellee.
Appeal from the United States District Court for the Northern District of Alabama.
Before KRAVITCH and HATCHETT, Circuit Judges, and ATKINS *, Senior District Judge.
Upon the death of Lake E. Tate (Tate), Martha G. Tate (appellant), the decedent's spouse, sued Government Employees Insurance Company (GEICO), the issuer of a group accidental death insurance policy (policy), to recover benefits under the policy for Tate's accidental death. Appellant appeals the district court's granting of GEICO's motion for a directed verdict. 1 Because we find genuine issues of fact and misapplication of state law, we vacate the judgment and remand the case to the district court.
On October 19, 1988, Tate entered the Veterans Administration Hospital in Birmingham, Alabama, for treatment of ear blockage and protruding ears. The treatment involved minor elective surgical procedures: bilateral myringotomy (for the ear blockage) and bilateral otoplasty (for protruding ears). A myringotomy involves making an incision in the eardrum and placing tubes to relieve pressure and to assist in hearing. Otoplasty is a correction of the deformity of the external ear which involves cutting and shaping the ears.
On October 19, 1988, prior to surgery, doctors at the hospital met with Tate, examined him, and performed diagnostic tests including a chest X-ray, routine blood screening, and an EKG. The doctors also advised Tate of the risks involved in the surgical procedures, including the risk of undergoing general anesthesia. Tate informed the doctors of his history of prostate cancer, but indicated to them that he did not have any problems. Based on the examinations and discussions with Tate prior to surgery, the doctors concluded that Tate was in good health and a proper candidate for surgery.
On October 20, 1988, Dr. Thomas Lee Eby performed the surgery. The surgery seemed a success with no complications, and Tate arrived at the recovery room appearing In 1985, GEICO issued the policy at issue to Tate in return for the payment of premiums. The policy provides benefits for injuries "caused by an accident," and sets forth a number of exclusions, including an exclusion for death resulting from "illness."
in satisfactory condition. Although a doctor reported that Tate was fine, alert, and responsive, he died later the same day after falling while walking in the hall outside his hospital room. The death certificate indicated the cause of death as pulmonary embolus due to prostatic carcinoma
On March 30, 1989, appellant filed a request for benefits under the accidental death provisions of the policy, listing as the cause of death an "accidental blood clot to the lungs." In its letter dated July 31, 1989, GEICO denied benefits stating that the death was not accidental and the "illness" exclusion in the policy precluded benefits.
On January 17, 1990, appellant filed this lawsuit in the Jefferson County, Alabama Circuit Court seeking benefits under the policy and punitive damages for GEICO's bad faith in refusing to pay benefits under the policy. GEICO removed the case to the United States District Court for the Northern District of Alabama, Southern Division, and on July 10, 1991, filed a motion to dismiss the action. On July 17, 1991, the district court denied GEICO's motion to dismiss.
On March 9, 1992, the district court granted partial summary judgment for GEICO on appellant's bad faith claim and denied GEICO's motion for summary judgment on appellant's claim for breach of the insurance policy.
On March 10, 1992, the case proceeded to trial. Immediately following appellant's presentation of her case, GEICO rested without presenting any evidence and moved the court for a directed verdict. On March 11, 1992, the district court granted GEICO's motion, treating it as a motion for judgment as a matter of law pursuant to Federal Rule of Civil Procedure 50.
The district court, in its order, concluded that, as a matter of law, appellant failed to establish a case. The district court expressed its concern that Alabama courts had not dealt with a factual situation such as this case presented, but concluded that the Alabama courts would apply the following rule to this situation: "if an operation is not necessitated by an injury resulting from an accident, death occurring during or following the operation can be considered 'accidental' only when it is the result of mishap or misadventure in operative procedure." (Citing Couch on Insurance, 2d (Rev. ed.) § 41:113 (1982)). The district court found similarity with the policy's definition of "injury" in this case and in Tate v. Insurance Company of North America, Case No. CV-90-P-0085, where the court granted summary judgment in favor of the insurer and against appellant, albeit involving a different insurance company and policy.
On March 18, 1992, the district court denied appellant's motion for a new trial.
The appellant contends that the district court erred in granting GEICO's motion for judgment as a matter of law, for she presented sufficient evidence for a jury to find that an accident caused Tate's death. GEICO contends that the district court properly granted judgment as a matter of law in its favor, because appellant failed to rebut the death certificate's cause of death as prostatic cancer, and no evidence exists for a finding that an accident caused Tate's death.
The issue in this case is whether the district court erred in granting judgment as a matter of law.
DISCUSSION
The policy at issue provides as follows:
If injury is the result of any other cause, [not the result of riding as a fair paying passenger or riding as a passenger in or operating a motor vehicle or being struck by any such vehicle while a pedestrian] we will pay Benefits for the appropriate loss in accordance with the Table of Benefits below.
It is undisputed that the table of benefits show benefits in the amount of $20,000 for injuries resulting in death. The policy defines "injury" as follows:
'Injury' means bodily injury which is caused by an accident. The accident must take place while coverage of the Covered Person is in force. The accident must cause a loss covered by the Policy.
It is undisputed that the policy was in force at the time Tate died. Thus, the controlling determination is whether Tate's death (the injury) was "caused by an accident." Although the policy does not define the term "accident," the Supreme Court of Alabama defines "accident" for insurance policy purposes. Under Alabama law, the "term 'accident' has been variously defined as something unforeseen, unexpected, or unusual." United States Fidelity & Guar. Co. v. Bonitz Insulation Co. of Alabama, 424 So.2d 569, 572 (Ala.1982). The GEICO policy in this case is an "accidental means" policy in that benefits are payable if injury "is caused by an accident." 2 In Hairston v. Liberty Nat'l Life Ins. Co., 584 So.2d 807 (Ala.1991), the Supreme Court of Alabama explicated its broad definition of what constitutes a death or injury by accidental means:
It is an accidental death or injury if the result is an accident whether or not due to accidental means; but it is caused by accidental means, although the means employed were voluntarily rendered, if, in the act preceding the injury, something unforeseen, unusual and unexpected occurs which produces the result.
Hairston, 584 So.2d at 808 (quoting Emergency Aid Ins. Co. v. Dobbs, 263 Ala. 594, 83 So.2d 335, 338 (1955)). GEICO asserts that the Alabama courts adequately define "accident," and in this case, GEICO stresses the limiting term "unforeseen" contained in the court's definition. "Provisions of insurance policies must be construed in light of the interpretation that ordinary men would place on the language used therein." Newman v. St. Paul Fire and Marine Ins. Co., 456 So.2d 40, 41 (Ala.1984). Webster's Third New International Dictionary 2496 (1976) defines "unforeseen" as "not foreseen: unexpected." It defines the term "foreseen" as:
to see (as a future occurrence or development) as certain or unavoidable; look forward to with assurance.
Webster's Third New International Dictionary 890. Thus, the appellant had to show that something unusual or unexpected caused Tate's death, in order to fit within the policy's definition of "injury." Moreover, because the policy contains an exclusion for injuries resulting from illness, appellant had to show that Tate did not die as a result of his prostate cancer.
GEICO contends that no evidence exists from which a jury could reasonably infer that an...
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