Gloria Wells v. Minnesota Life Insurance Co.

885 F.3d 885
CourtCourt of Appeals for the Fifth Circuit
DecidedMarch 22, 2018
Docket16-20831
StatusPublished
Cited by46 cases

This text of 885 F.3d 885 (Gloria Wells v. Minnesota Life Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gloria Wells v. Minnesota Life Insurance Co., 885 F.3d 885 (5th Cir. 2018).

Opinions

E. GRADY JOLLY, Circuit Judge:

This appeal addresses coverage for a mosquito bite under an accidental-death insurance policy. Melton Dean Wells was bitten by a mosquito carrying West Nile Virus. Following complications, he died. Melton's wife claimed accidental-death benefits under a policy with Minnesota Life Insurance Company, but Minnesota Life denied her claim. The district court dismissed her suit on summary judgment. On appeal, the parties dispute the insuring clause, i.e. whether Melton's death was accidental, and an exclusion under the policy, i.e. other causes of Melton's death. Because we hold that there are genuine disputes of material fact as to both, we reverse and remand for a factfinder to decide determinative facts of the breach-of-contract claim. We affirm the district court's dismissal of the bad-faith tort claim.

I.

Melton Dean Wells, age 68, went to the hospital on August 21, 2013, with a history of obesity, diabetes, and hypertension.1 He was suffering from a fever, headache, and altered mental status, and the doctors ultimately *888diagnosed him with West Nile Encephalitis ("WNE"). West Nile Virus ("WNV"), carried and transmitted to humans by the Culex mosquito, causes WNE. Over the next three weeks, Melton's condition deteriorated as he developed respiratory failure, multi system organ failure, and septic shock. He died on September 17. The certified death certificate ("CDC") reads:

IMMEDIATE CAUSE (final disease or condition a. WESTNILE ENCEPHALITIS resulting in death) [C]onditions ... leading to the cause listed on line a. b. ACUTE RESPIRATORY FAILURE Enter the UNDERLYING CAUSE (disease or injury c. SEPTIC SHOCK that initiated the events resulting in death) LAST d. MULTI SYSTEM FAILURE

The certifying physician marked Melton's death as "natural", in contrast to an "accident," on the CDC.

At all times relevant to this appeal, Melton had a Decreasing Term Accidental Death Insurance Policy ("the policy") from Minnesota Life Insurance Company ("Minnesota Life"), which provides coverage

only when your death results, directly and independently from all other causes, from an accidental bodily injury which was unintended, unexpected and unforeseen. The bodily injury must be evidenced by a visible contusion or wound.... The bodily injury must be the sole cause of your death.... Your death must occur within 90 days after the date of the accidental injury.

But even if a death falls within that insuring clause, coverage may still be excluded. Important here, Exclusion Four reads:

In no event will we pay the accidental death benefit where your death is caused directly or indirectly by, results from, or there is contribution from ... bodily or mental infirmity, illness or disease....

The terms "accidental bodily injury," "contusion," "wound," "infirmity," "illness," and "disease" are not defined in the policy.

Following Melton's death, his wife, Gloria Wells, submitted a claim under the policy for payment of accidental-death benefits. Over the phone, she explained to a Minnesota Life representative that a mosquito bite caused Melton's death. Nevertheless, Minnesota Life denied her claim, explaining:

We have received no information to support that [Melton's] death resulted directly and independently from any accidental bodily injury sustained. Rather it appears the severe [WNE] was exacerbated by his diabetes, morbid obesity and his age.
The claim is not payable as an accidental bodily injury did not cause [Melton's] death, directly and independently from all other causes. Rather, his death was due or there were contributions from bodily or mental infirmity, illness or disease and this is specifically excluded under the terms of the policy.

II.

Unhappy with the denial of her insurance claim, Gloria filed this diversity suit against Minnesota Life in Texas federal court, claiming breach of contract, breach of good faith and fair dealing, violation of the Texas Insurance Code, and violation of the Texas Deceptive Trade Practices Act.

*889In her complaint, she alleges that her insurance claim falls within the insuring clause of the policy because Melton's mosquito bite, a visible contusion/wound, was an unintended, unexpected, and unforeseen accidental bodily injury that resulted in the WNE that was a "substantial factor in bringing about [Melton's] death."

Minnesota Life moved for summary judgment on all claims, and the district court granted its motion. The district court held that Gloria's insurance claim did not fall under the insuring clause for three reasons. First, the court held that Gloria did not satisfy the "sole cause" requirement because septic shock, acute respiratory failure, and multi system failure all contributed to Melton's death, in addition to the WNE. Second, the court held that Gloria failed to introduce evidence showing that a mosquito bite is or should be considered "accidental" under the policy. And finally, the court held that Gloria offered no evidence of a visible wound or contusion in the form of a mosquito bite.

Then, turning to the policy exclusion, the district court held that, even if Gloria's insurance claim did fall under the insuring clause, benefits should not be paid because her claim also fell under Exclusion Four of the policy. The court noted Melton's "bodily infirmities"-obesity, diabetes, and hypertension-and his "conditions"-acute respiratory failure, septic shock, and multi-system failure-then held Gloria's claim excluded because she "did not rebut evidence of multiple contributing causes" to Melton's death. It is unclear whether the court was referring to Melton's infirmities, conditions, or both.

Following the district court's judgment in favor of Minnesota Life, Gloria moved for a new trial or, alternatively, to amend the judgment. The district court denied that motion, and Gloria timely appealed. Specifically, she now appeals the dismissal of her breach-of-contract and bad-faith claims and the denial of her post-judgment motion.

III.

We review a district court's grant of summary judgment de novo. Crose v. Humana Ins. Co. , 823 F.3d 344, 347 (5th Cir. 2016). Summary judgment is appropriate only where "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). "Unsubstantiated assertions, improbable inferences, and unsupported speculation are not sufficient to defeat a motion for summary judgment." Brown v. City of Houston , 337 F.3d 539, 541 (5th Cir. 2003). "We resolve factual controversies in favor of the nonmoving party, but only when ... both parties have submitted evidence of contradictory facts." Little v. Liquid Air Corp. ,

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Bluebook (online)
885 F.3d 885, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gloria-wells-v-minnesota-life-insurance-co-ca5-2018.