United States District Court, W.D. Oklahoma
DEBORAH DAVIS, Individually and as Personal Representative of the Estate of Barbara Mosley; TOMMY DAVIS; GERALD DAVIS; JOEL DAVIS; and DALE MOSLEY, Plaintiffs,
FEDERAL INSURANCE COMPANY, Defendant.
L. RUSSELL UNITED STATES DISTRICT JUDGE
this Court is Defendant Federal Insurance Company's
Motion for Summary Judgment (Doc. 18). The matter is fully
briefed and at issue. See Docs. 18, 21-22. For the
reasons stated herein, the Court GRANTS Defendant's
Court views the factual record and all reasonable inferences
drawn from it in the light most favorable to Plaintiff, the
non-movant. See Banner Bank v. First Am. Title Ins.
Co., 916 F.3d 1323, 1326 (10th Cir. 2019).
case concerns an Accidental Death and Dismemberment Insurance
Policy (“Policy”) issued to Barbara Mosley on
April 6, 2016, by Defendant, Federal Insurance Company.
See Doc. 18, at 6; Doc. 21, at 6. Ms. Mosley
suffered from leukemia, among other ailments, and she was
receiving treatment for this disease at the time of her
death. See Doc. 18, at 5-7; Doc. 21, at 4-5; see
also Doc. 18-3. On May 10, 2017, Ms. Mosley fell from
her wheelchair; nineteen days later-on May 29, 2017-she
passed away. See Doc. 18, at 6-7; Doc. 21, at 4,
Ms. Mosley's death was investigated by Cheryl Niblo,
D.O., from Oklahoma's Office of the Chief Medical
Examiner. See Doc. 18-3; Doc. 21-2. Dr. Niblo
concluded that the “probable cause of death” was
sepsis “due to [b]acteremia from [an] infected
port.” Id. Within the investigation report,
Dr. Niblo listed the following “[o]ther significant
conditions contributing to death (but not resulting in the
underlying cause given)”: “Acute myelogenous
leukemia, ” “Acute on chronic right subdural
hematoma, ” “Hypertensive cardiovascular disease,
” and “Diabetes mellitus.” Id. Dr.
Niblo also certified Ms. Mosley's Certificate of Death,
which lists “Sepsis” as the “Immediate
Cause” of death and “bacteremia from infected
port” as the condition “leading to the
cause.” Doc. 18-2; Doc. 21-1. On both the Certificate
of Death and investigation report, the “manner of
death” is listed as “Accident.” Docs. 18-2,
18-3, 21-1, 21-2.
January 16, 2018, Defendant denied coverage for Ms.
Mosley's death in a letter addressed to Ms. Mosley's
daughter, Deborah Davis. Doc. 18, at 8. The letter stated, in
We [Defendant] have reviewed all of the information you [Ms.
Davis] provided and the coverage available under the above
referenced policy. Based on our review of the received claim
documentation, we must regretfully decline to pay for your
loss. Our reasons for this declination of coverage are
explained below, followed by pertinent provisions of the
policy. In order to recover for an Accidental Death Benefit
under this Policy, we must be able to demonstrate that an
Accident occurred which resulted in a loss, and that loss
must not be otherwise excluded under the Policy.
Per the received medical records from St. John Medical
Center, Ms. Mosley was admitted on May 10, 2017 due to a fall
where she suffered a forehead contusion and right knee
contusion. A CT scan of her brain was clear and she was
discharged the next day, May 11, 2017. The medical records
further revealed Ms. Mosley's sepsis was caused by the
infected port related to her ongoing treatment with
chemotherapy. The Medical Examiner report and Death
Certificate confirmed Ms. Mosley's cause of death was
sepsis due to bacteremia from infected port.
We have been unable to verify that an accident or accidental
bodily injury directly resulted in Ms. Mosley's demise
and the Disease or Illness exclusion would apply. It is for
the above referenced reasons, we must respectfully deny your
Doc. 18-6, at 2 (emphasis omitted).
issue is whether the Policy covers Ms. Mosley's death.
Under “Accidental Loss of Life and Dismemberment
Benefit, ” the Policy states: “If an Accidental
Bodily Injury causes the Covered Person's Loss of Life .
. . [Defendant] will pay the applicable percentage of the
Loss of Life Benefit Amount shown in the Declarations.”
Doc. 18-1, at 9; Doc. 21-3, at 8 (emphasis
omitted). The Policy defines “Accidental
Bodily Injury” as a “bodily injury” that
(1) is “Accidental, ” (2) is “the direct
cause of a loss, ” and (3) “occurs while a
Covered Person is insured” under the Policy. Doc. 21-3,
at 11 (emphasis omitted). The Policy also defines
“Accident”/“Accidental” as “a
sudden, unforeseen, and unexpected event which happens by
chance, is independent of illness, disease or other bodily
malfunction and is the direct cause of loss.”
Id. at 17 (emphasis omitted). Neither “direct
cause” nor “bodily injury” are defined in
Policy also includes an exclusion concerning diseases and
illnesses, which reads in full:
This insurance does not apply to any Accident, Accidental
Bodily Injury or loss caused by or resulting from, directly
or indirectly, a Covered Person's emotional trauma,
mental or physical illness, disease, normal pregnancy,
childbirth or miscarriage, bacterial or viral infection,
bodily malfunctions, or medical, surgical or diagnostic
This exclusion does not apply to loss resulting from the
Covered Person's Accidental bacterial infection or from
consumption of a ...