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Parsons v. Unum Life Insurance Co. of America

United States District Court, N.D. Mississippi, Oxford Division

October 16, 2019

SUSAN Y. PARSONS PLAINTIFF
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, UNUM GROUP and JOHN DOES 1-50 DEFENDANTS

          ORDER

          MICHAEL P. MILLS UNITED STATES DISTRICT JUDGE

         This cause comes before the court on the motion of defendants UNUM Life Insurance Company of America (“UNUM”), et al, for summary judgment, pursuant to Fed.R.Civ.P. 56. Plaintiff Susan Parsons has responded in opposition to the motion, and the court, having considered the memoranda and submissions of the parties, concludes that the motion is well taken and should be granted.

         This ERISA insurance case presents the issue of whether a decedent's death was accidental so as to entitle his widow to recover $50, 000 in accidental death benefits from the UNUM life insurance policy she purchased from her employer. The decedent in this case is Mr. William Parsons, and his widow, Susan Y. Parsons, is the plaintiff in this action. This case arises from a April 27, 2017 incident in which Parsons was killed after he lost consciousness at the wheel of his tractor, fell off, and was then run over by it. The Incident Report produced by the Marshall County Sheriff's Department (“the Sheriff”) summarizes the circumstances of Parsons' death as follows:

On Saturday, April 29, 2017, at 16:02 hours, I, Deputy Mark Kaply, responded to an E-911 dispatched radio call of a male possibly not breathing at 4572 Highway 178 East. MedStat and a Potts Camp Firefighter were on the scene when I arrived performing CPR. * * * MedStat advised that Mr. William Parsons was found unresponsive on a tractor in the yard of the residence by his daughter, Mrs. Scarlett Hart. He showed no cardiac activity before, during or after CPR, etc. ME-1 was notified and arrived on the scene. Mrs. Hart said that her father was on the tractor cutting the grass with a bush hog attachment. When she went outside to check on him at about 3:50 PM today, he was sitting on the seat of the tractor in the yard near the green boat. He was slumped over the steering wheel and was unresponsive. The tractor was running. She said that when she raised him up and called to him to try to get him to respond to her he fell from the tractor. The tractor then moved forward hitting her left leg and running over Mr. Parsons causing some cuts to his arm and head. The tractor continued down a hill and stopped in some brush. She said that Mr. Parsons' head and upper chest was blue and that he did not appear to be breathing when she raised him up on the seat of the tractor before he fell to the ground.

[Doc. 18-3 at 46-47].

         Following her husband's death, plaintiff sought $50, 000 in accidental death benefits from UNUM. In concluding that such benefits were unavailable, defendant applied a policy exclusion for deaths in which a non-accidental medical event was a contributing factor. Defendant determined that, in light of evidence that Parsons was already non-responsive at the wheel of the tractor before he fell off it, he had, in fact, sustained a medical event which contributed to his death. Defendant accordingly denied the $50, 000 in accidental death benefits sought by Susan, and, feeling aggrieved, she filed the instant lawsuit in this court. Defendant has presently moved for summary judgment, arguing that no genuine issue of fact exists regarding its liability in this case and that it is entitled to judgment as a matter of law.

         While this case comes before this court in the context of a motion for summary judgment, it seems clear that the procedural posture here is quite different from the typical such motion. Indeed, as an appeal of defendant's decision to deny accidental death benefits, this court is limited to the record which was before the ERISA administrator in this case. See Vega v. National Life Ins. Co., 188 F.3d 287, 299 (5th Cir. 1999)(en banc)(“[a] long line of Fifth Circuit cases stands for the proposition that, when assessing factual questions, the district court is constrained to the evidence before the plan administrator.”)[1] That being the case, even though this court believes that the factual record here is rather limited in some respects, it is simply not an option to deny summary judgment based upon the prospect that new evidence might be developed at trial.[2] This court is essentially acting as an appellate court in this case, and the proof which is presently in the record is all the proof which will ever exist in this action.

         In light of the foregoing, this court must simply assess that proof and determine, under a de novo review of the facts, whether defendant correctly determined that accidental death benefits were unavailable in this case. Although some aspects of the proof in this case are not as clear as this court might prefer, it does seem clear that the relevant UNUM policy provisions and Fifth Circuit precedent interpreting similar provisions are strongly in favor of defendant. This is, ultimately, the deciding factor in this case. In its summary judgment brief, defendant emphasizes that its policy defines “accidental bodily injury” as “bodily injury that is the direct result of an accident and not related to any other cause.” Moreover, the policy contains an exclusion which provides that:

Your plan does not cover any accidental losses caused by, contributed to by, or resulting from disease of the body or diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders.

[Doc. 18-1 at 61]. This policy language strikes this court as being quite favorable to UNUM's position in this case, and defendant correctly argues that there is a considerable amount of Fifth Circuit precedent which supports its decision not to award plaintiff accidental death benefits.

         In Sekel v. Aetna Life Ins. Co., 704 F.2d 1335, 1337 (5th Cir. 1983), for example, the Fifth Circuit considered a case which, like this one, involved a death which appeared to have elements of both a natural and accidental death. In Sekel, the insured fell to the floor at his home, sustaining a severe blow to his head, which resulted in his death approximately an hour later. Sekel, 704 F.2d at 1336. An autopsy revealed that severe atherosclerotic and hypertensive cardiovascular disease had probably caused his fall. Id. The district court awarded benefits to the plaintiff under his accidental death policy, finding that the mere fact that the insured's hypertension may have caused him to pass out did not mean that the medical condition caused his death. Id.

         The Fifth Circuit in Sekel reversed, noting that the decedent's policy had an exclusion which denied “coverage for accidental death benefits respecting ‘any loss resulting from any injury caused or contributed to by, or as a consequence of, any of the ... excluded risks, even though the proximate or precipitating cause of loss is accidental bodily injury.'” Id. at 1337. Similar to the accidental death provision in this case, one of the excluded risks in Sekel was “disease.” Id. Based on these facts, the Fifth Circuit concluded that the district court erred in awarding the plaintiff benefits, writing that:

We now examine the words of the Aetna policy to determine how these principles apply. The exclusion clause in this policy denies coverage for accidental death benefits respecting “any loss resulting from any injury caused or contributed to by, or as a consequence of, any of the ... excluded risks, even though the proximate or precipitating cause of loss is accidental bodily injury.” This language contemplates a situation where “the proximate or precipitating cause of loss” is accidental bodily injury, and makes clear that, “even though” the accidental injury is the proximate or precipitating cause, if disease or bodily infirmity is also a contributing factor or cause, there is no coverage. Since the exclusion clause by its terms is applicable when the proximate or precipitating cause of loss is an accidental injury, necessarily implicit in its meaning is that other contributing factors or causes which the policy excludes (e.g., “bodily or mental infirmity” or “disease”) need not be concurrent proximate or as immediately precipitating causes for the exclusion to have effect.

Id. at 1337-38. Sekel is hardly an outlier in the Fifth Circuit's jurisprudence; defendant notes that there are several decisions reaching similar results. See, e.g. Southern Farm Bureau Life Ins. Co. v. Moore,993 F.2d 98, 103-04 (5th Cir. 1993); Hagen v. ...


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