Westbrook v. Safeco Life Ins. Co.

• Citation: 908 F.2d 927
• Decision Date: 13 August 1990
• Docket Number: No. 89-8245,89-8245
• Parties: Judie Fay WESTBROOK, Plaintiff-Appellant, v. SAFECO LIFE INSURANCE COMPANY, Defendant-Appellee.
• Court: United States Courts of Appeals. United States Court of Appeals (11th Circuit)

Page 927

908 F.2d 927

Judie Fay WESTBROOK, Plaintiff-Appellant, v. SAFECO LIFE INSURANCE COMPANY, Defendant-Appellee.

No. 89-8245.

United States Court of Appeals, Eleventh Circuit.

Aug. 13, 1990.

Adele Grubbs, Lynn M. Stevens, Marietta, Ga., for plaintiff-appellant.

Christina A. Craddock, John V. Burch, Bovic, Kyle and Burch, Atlanta, Ga., for defendant-appellee.

Appeal from the United States District Court for the Northern District of Georgia.

Before TJOFLAT, Chief Judge, TUTTLE and RONEY ^*, Senior Circuit Judges.

PER CURIAM:

Judie Fay Westbrook, executrix for Ernest Westbrook's (the decedent's) estate, brought this suit against Safeco Life Insurance Company (Safeco) to recover disability benefits under an accident insurance policy held by Lockheed Corporation, the decedent's employer. Westbrook also alleged that coverage had been denied by Safeco in bad faith and therefore sought statutory and punitive damages. The district court directed verdicts on both the bad faith claim and the coverage claim. Westbrook now appeals from the district court's judgment entered on those directed verdicts. We affirm. ¹

I.

The following facts are not disputed. On November 18, 1985, the decedent was working the night shift at a Lockheed facility. While walking up a flight of steps, the decedent tripped and fell. He continued working but suffered pain in his left foot for the next two days. On November 20, he sought medical attention. An X-ray taken that day revealed that blood clots had lodged in the decedent's left leg and foot. Dr. Oliver King, the decedent's treating physician, determined from the X-ray that the pain resulted from a loss of circulation to the area due to the blood clots. Although Dr. King was able to remove most of the clots surgically, some remained in the left foot, causing gangrene to set in. On November 29, 1985, the decedent's left foot was amputated. The decedent's problem with blood clotting continued, forcing the amputation of his left leg above the knee. After Dr. King's initial treatment of the decedent, he determined that a blood clot that had been lodged in the pelvic area was dislodged by the fall on November 18 and that the clot traveled to the left leg and foot, where it lodged again, causing circulation in the leg and foot to decrease significantly and eventually leading to the gangrenous condition. In August of 1986, blood clots began to lodge in the decedent's right leg, causing gangrene to develop in that leg as well. Apparently, these clots also originated in the pelvic area but were not dislodged by the accident of November 18. The decedent died from this condition shortly thereafter.

On the date of the decedent's accident, November 18, 1985, Lockheed maintained for its employees an accident insurance policy with Safeco. That policy covered losses "resulting directly and independently of all other causes from bodily injuries caused by accident." The policy excluded from coverage any loss "caused by or resulting from ... [i]llness, disease, bodily infirmity or any bacterial infection other than bacterial infection occurring in consequence of an accidental cut or wound."

The decedent filed a proof of loss on December 4, 1985, in which he claimed that the amputation of his left foot and leg had resulted from an injury covered by the Safeco accident policy. The proof of loss included a physician's statement sent by Dr. King, indicating that the injury was "sustained due solely to the ... accident." A Safeco representative sent a letter to Dr. King on March 12, 1986, asking Dr. King to elaborate on his earlier statement that the decedent's left foot and leg were amputated "due solely to the ... accident." Dr. King responded on March 21 by explaining that the blood clot had been lodged in the decedent's pelvis for some time prior to the accident but that the accident caused part of the clot to dislodge and travel to the left leg and foot. Safeco then denied coverage.

Westbrook brought this suit in state court. She alleged that the decedent's loss of his left foot and leg resulted solely from his fall on November 18, 1985, and that his loss was covered under the Safeco accident policy. She also asserted that Safeco had, in bad faith, failed to make timely payment on the claim in violation of Ga.Code Ann. Sec. 33-34-6 (1982). ² Safeco removed the case to the district court, and the case eventually went to trial before a jury. At the close of Westbrook's case, Safeco moved for a directed verdict on both the coverage and bad faith issues, see Fed.R.Civ.P. 50(a); the court granted the motion with regard to the bad faith issue. At the close of all of the evidence, the court directed a verdict for Safeco on the coverage issue as well. The court entered judgment on those directed verdicts, and Westbrook now appeals.

II.

When reviewing a district court's entry of a directed verdict, we consider all of the evidence in the light most favorable to the nonmoving party and then ask whether any reasonable person viewing the evidence in that light could have reached a different conclusion. See FDIC v. Marina, 892 F.2d 1522, 1528-29 (11th Cir.1990); see also Brady v. Southern Ry., 320 U.S. 476, 479-80, 64 S.Ct. 232, 234, 88 L.Ed. 239 (1943) (court must ask whether, "without weighing the credibility of the witnesses, there can be but one reasonable conclusion as to the verdict"). Westbrook argues that the evidence presented on the coverage and bad faith issues did not warrant directed verdicts in Safeco's favor. We disagree.

The policy in question clearly stated that it covered only those losses "resulting directly and independently of all other causes from bodily injuries caused by accident." (Emphasis added.) The policy excluded losses resulting from "[i]llness, disease, [and] bodily infirmity." Dr. King testified at trial that the decedent's diseased pancreas had created the blood clots and that this pancreatic "disease was not caused by the fall"; rather, it "preceded the fall." According to Dr. King, the decedent "fell and dislodged a blood clot that caused his loss of leg. That blood clot was there because of [his pre-existing] disease, not because of the fall.... Well, without the disease, there would have been no loss...." This testimony was never contradicted.

Georgia courts, ³ interpreting identical policy language in nearly identical circumstances, have consistently held that " '[w]here a diseased condition aggravates the result of the injury or is, itself, aggravated thereby, there can be no recovery, where the combined result is to cause the ... disability.' " Life Ins. Co. v. McDaniel, 141 Ga.App. 746, 234 S.E.2d 379, 382 (1977) (emphasis added) (quoting Interstate Life & Accident Ins. Co. v. Upshaw, 134 Ga.App. 394, 214 S.E.2d 675, 677 (1975)); see Prudential Ins. Co. v. Kellar, 213 Ga. 453, 99 S.E.2d 823, 827 (1957). In McDaniel, for example, the decedent suffered from a condition known as thrombophlebitis, which simply meant that any trauma could result in the formation of blood clots in his legs. When the decedent fell from his motorcycle, either a blood clot was formed in his leg and then dislodged, or a pre-existing blood clot in his leg was dislodged. The clot eventually traveled to the decedent's lungs, which caused his death five days after the accident. The treating physician testified that the decedent's pre-existing disposition to the formation of blood clots contributed to his eventual death.

The Georgia Court of Appeals, interpreting an accidental death policy with virtually identical language to that of the policy at issue here, held that the decedent's "pre-existing diseased condition aggravated or was aggravated by his injury and the ensuing surgery" and therefore ordered the trial court to direct a verdict in the insurer's favor. See McDaniel, 234 S.E.2d at 382. We can find no basis for distinguishing McDaniel from the case at hand. Dr. King's uncontradicted testimony clearly indicates that the decedent suffered from a pre-existing condition that was aggravated by his fall on November 18, 1985. If the blood clot had not already formed in the decedent's pelvis, no significant injury would have occurred from the fall. Given McDaniel and the many other similar Georgia cases, we must conclude that, even viewing the evidence in the light most favorable to Westbrook, the decedent's loss of his leg did not result from an accident "independently of all other causes." ⁴

Westbrook argues that the phrase "independently of all other causes" is not as easily applied as Safeco would have us believe. Westbrook directs our attention to cases in which similar policies have been interpreted more liberally in favor of the insured. All of those cases, however, were decided under the laws of different states. Certainly, "if the policy or contract of insurance is fairly susceptible of more than one construction, the...