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Davis v. Federal Insurance Co.

United States District Court, W.D. Oklahoma

April 8, 2019

DEBORAH DAVIS, Individually and as Personal Representative of the Estate of Barbara Mosley; TOMMY DAVIS; GERALD DAVIS; JOEL DAVIS; and DALE MOSLEY, Plaintiffs,



         Before 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 Motion.

         I. Background

         The 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).

         This 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.[1] 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, 6.[2] 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.

         On 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 part:

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 claim.

Doc. 18-6, at 2 (emphasis omitted).

         At 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).[3] 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).[4] 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 the Policy.

         The 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 treatment thereof.
This exclusion does not apply to loss resulting from the Covered Person's Accidental bacterial infection or from consumption of a ...

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