Troeger v. Minn. Life Ins. Co.
| Decision Date | 09 August 2016 |
| Docket Number | Case No. 14-1083 |
| Citation | 200 F.Supp.3d 745 |
| Parties | Jamie TROEGER, Administrator of the Estate of Gayle Mitchell, Deceased, Plaintiff, v. MINNESOTA LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Central District of Illinois |
John P. Nicoara, Ryan Scott McCracken, Richard L Steagall, Nicoara & Steagall, Peoria, IL, for Plaintiff.
Jacqueline J. Herring, Smith Von Schleicher & Associates, Chicago, IL, for Defendant.
This matter is now before the Court on Defendant's Motion [15] for Summary Judgment. For the reasons set forth below, Defendant's Motion [15] is Denied.
The following facts are not in dispute. On July 20, 2002, Michael Mitchell fractured his neck after falling head-first into Kickapoo Creek. The fracture resulted in quadriplegia, or paralysis of all four extremities. In September 2005, Michael became a resident at Rose Garden Care Center ("Rose Garden"), a residential care facility in Peoria Heights, Illinois. He developed several medical conditions after his paralysis, including seizure disorder, depression, hypertension, obesity, dyslipidemia, bowl mobility disorder, gastroesophageal reflux disease ("GERD"), deep venous thrombosis, spasticity and chronic pain.
On at least four occasions between 2005 and 2006, Michael was found "non-responsive" by caretakers at Rose Garden. On June 24, 2006, Michael was admitted to the intensive care unit at Proctor Hospital for respiratory failure after he became unresponsive and stopped breathing during ambulance transport to the hospital. In August 2006, Michael was transferred to OSF Saint Francis Medical Center ("OSF") when he was found unresponsive and caretakers were unable to feel a pulse. Michael was again found unresponsive by Rose Garden caretakers and transferred to OSF in September 2006. On each occasion he was successfully resuscitated.
On July 28, 2007, Michael began "actively seizing" at Rose Garden. He was initially breathing on his own, but stopped breathing. Rose Garden called paramedics, and Advanced Medical Transport ("AMT") transferred Michael to OSF Hospital. AMT paramedics documented Michael's condition during transport, noting "no evidence of trauma" in any location and an "unremarkable" physical examination.1
ECF Doc. 16, ¶ 22. When paramedics attempted to intubate Michael, they suctioned his airway and aspirated foreign material. ECF Doc. 28, at 13. Michael could not be resuscitated and died at OSF Hospital. Dr. Richard C. Frederick was the emergency room physician who treated Michael at OSF on July 28, 2007. Dr. Frederick signed the medical records prepared by a resident which noted, under the heading of Initial Physical Exam , "General—no evidence of trauma ... Head /Neck—atraumatic ... Extremities—no signs of trauma." See ECF Doc. 16-10. Those records also indicated that Michael had vomit on his face. On October 18, 2007, a Coroner's Inquest into Michael's death was held by Peoria County Coroner Johnna Ingersoll. The jury found that Michael's death was "natural" from "seizure disorder."
Michael, as a former employee of the State of Illinois, obtained life insurance coverage under a group policy for state employees. The life insurance policy was issued by Minnesota Life Insurance Company ("Minnesota Life") and included Accidental Death and Dismemberment ("AD&D") coverage. Minnesota Life paid Michael's wife, Gayle Mitchell, $156,500 pursuant to the policy's Basic Life and Optional Life coverage. However, Minnesota Life declined to pay the additional $156,500 under the AD&D double indemnity provision. The AD&D provision of the policy states:
The policy also stated "injury must occur while your coverage under this supplement is in force" and "death or dismemberment must occur within 365 days after the date of the injury and while your coverage under this supplement is in force." Id. ; ECF Doc. 16-1, at 27. The AD&D policy further provided that "[i]n no event will [Minnesota Life] pay the accidental death or dismemberment benefit where your death or dismemberment results from or is caused directly by any of the following ... (3) bodily or mental infirmity, illness or disease; or (4) medical or surgical treatment ...." Id.
Under Rule 56 of the Federal Rules of Civil Procedure, summary judgment is proper "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed. R. Civ. P. 56 ; Celotex Corp. v. Catrett , 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Summary judgment is mandated "after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Id. at 322–23, 106 S.Ct. 2548. However, "[t]he burden on the non-movant is not onerous." Waldridge v. American Hoechst Corp. , 24 F.3d 918, 921 (7th Cir.1994). Rather, the non-movant "need only come forward with appropriate evidence demonstrating that there is a pending dispute of material fact" and "may rely on affidavits or any other materials of the kind identified in Rule 56(c)." Id.
"The interpretation of an insurance policy is a matter of state law." Westfield Ins. Co. v. Vandenberg , 796 F.3d 773, 777 (7th Cir.2015). In Illinois, "an insurance policy is a contract, and the general rules governing the interpretation of other types of contracts also govern the interpretation of insurance policies." Id. , citing Hobbs v. Hartford Ins. Co. of the Midwest , 214 Ill.2d 11, 17, 291 Ill.Dec. 269, 823 N.E.2d 561 (2005). When the language in an insurance policy is unambiguous, "the policy will be applied as written, unless it contravenes public policy." Hobbs , 214 Ill.2d at 17, 291 Ill.Dec. 269, 823 N.E.2d 561. However, when the language of an insurance policy is subject to more than one reasonable interpretation, the policy is ambiguous. Id. "Although policy terms that limit an insurer's liability will be liberally construed in favor of coverage, this rule of construction only comes into play when the policy is ambiguous." Id. When a policy is ambiguous, "and if, after considering the contract language in light of parol evidence and rules of construction, doubt still remains as to the meaning of the contract, then the question of interpretation must be left to the trier of fact." Bourke v. Dun & Bradstreet Corp. , 159 F.3d 1032, 1037 (7th Cir.1998) (citing Countryman v. Indus. Com'n , 292 Ill.App.3d 738, 741, 226 Ill.Dec. 712, 686 N.E.2d 61 (1997) ).
Minnesota Life asserts that summary judgment in its favor is appropriate for two reasons. First, Minnesota Life argues that "[t]he existence of an injury is a threshold requirement of the AD&D coverage," and "[t]he only injury shown by the evidence is Mitchell's broken neck." ECF Doc. 16, at 10. Thus, because Michael's death occurred five years after he injured his neck, his injury fell "squarely outside of the Group Policy's AD&D coverage," the terms of which require that death "occur within 365 days after the date of injury." Id.
Second, Minnesota Life argues that Plaintiff has failed "to establish any evidentiary link between a purported injury, choking, and a death that results independently of disease or bodily infirmity." Id. at 13. Minnesota Life further claims that "[i]f Mitchell's purported choking occurred while seizing, death did not result directly and independently of his seizure disorder." Thus, "Plaintiff's allegation of choking fails to establish any injury, and she lacks any evidence to demonstrate that the alleged choking resulted independently of (i) Mitchell's seizure disorder, and actively seizing at the time of his death; (ii) his compromised ability to move to protect his airway due to his bodily infirmity and tetraplegia ; (iii) his gastroesophageal reflux disease that significantly increases the risk of vomiting; or (iv) any of Mitchell's other numerous medical conditions." Id. at 13–14.
In response, Plaintiff asserts that "[t]here is a triable issue of fact on whether Mitchell accidentally aspirated food or vomit down his trachea which caused him to asphyxiate and have respiratory cardiac arrest as Dr. Frederick testified[,] which was an accidental injury that was sudden or unforeseen." ECF Doc. 24, at 13. Additionally, Plaintiff asserts that the policy's requirement that death result "directly and independently of disease or bodily infirmity" is not part of the definition of accidental death—on which Plaintiff bears the burden of establishing—but rather provides an exclusion to coverage that Minnesota Life must prove to defeat recovery.
At issue in this case is the cause of Michael's death on July 28, 2007. In Illinois, "[t]he insured has the burden of proving that his loss comes within the terms of his insurance policy." Roberts v. Allstate Life Ins. Co. , 243 Ill.App.3d 658, 660, 183 Ill.Dec. 846, 612 N.E.2d 103 (1993) ; Kolowski v. Metro. Life Ins. Co. , 35 F.Supp.2d 1059, 1061 (N.D.Ill.1998). The AD&D policy provides that "death or dismemberment results, directly and independently of disease or bodily infirmity, from an accidental injury which is unexpected and unforeseen." ECF Doc. 16-1, at 27. The parties first dispute whether Michael sustained an "accidental injury" as the term is used in the policy.
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