Holley v. Mutual of Omaha Insurance Company

CourtDistrict Court, N.D. Texas
DecidedJuly 13, 2021
Docket3:20-cv-02542
StatusUnknown

This text of Holley v. Mutual of Omaha Insurance Company (Holley v. Mutual of Omaha Insurance Company) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Holley v. Mutual of Omaha Insurance Company, (N.D. Tex. 2021).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF TEXAS DALLAS DIVISION DAMON STEWART, ET AL., ) ) Plaintiffs, ) ) CIVIL ACTION NO. VS. ) ) 3:20-CV-2542-G MUTUAL OF OMAHA INSURANCE ) COMPANY, ) ) Defendant. ) MEMORANDUM OPINION AND ORDER Before the court is the defendant Mutual of Omaha Insurance Company (“Mutual of Omaha”)’s motion for summary judgment. Defendant’s Motion for Summary Judgment (docket entry 14) (“motion for summary judgment”). For the reasons set forth below, the motion for summary judgment is GRANTED. I. BACKGROUND A. Factual Background This suit arises out of a dispute between Damon Stewart, Dekeitric Holley, and Charles Stewart (collectively, “the plaintiffs”) and Mutual of Omaha regarding an accidental death insurance policy covering Burtis Holley, Jr. (“the Insured”).1

1 The plaintiffs are heirs of the original plaintiff, Johnette Stewart Holley (“Ms. Stewart Holley”), who passed away during the pendency of this suit. Second Amended Complaint (“SAC”) ¶¶ 14-16. On March 26, 2021, the court granted (docket entry 26) the plaintiffs’ Motion to Substitute Parties and Amend Pleadings Defendant’s Brief in Support of Its Motion for Summary Judgment (docket entry 15) (“Brief in Support”) ¶ 1. In December 2016, the Insured applied for, and Mutual of

Omaha issued, Accidental Death Policy No. 784200-92 (“the Policy”). Id. ¶¶ 4-5. The Policy provided coverage of $250,000 and designated the Insured’s wife, Ms. Stewart Holley, as the beneficiary. Id. ¶ 4; Appendix in Support of Defendant’s Motion for Summary Judgment (“APP.”) (docket entry 16) at 1. Under the Policy, Mutual of Omaha agreed to a payout “[i]f, while insured

under this policy, an insured person sustains an injury which results in death within 365 days following the date of the injury . . . .” APP. at 7 (emphasis in original). The Policy defines an “Injury” as “bodily harm which (a) is the direct result of an accident or trauma that occurs while [the] policy is in force; and (b) results in loss

independently of sickness and all other causes (except for sickness caused by the injury).” Id. The Policy also specifically excludes from coverage “death resulting directly or indirectly from disease or bodily infirmity.” Id. at 10. The former is known as a “sole cause” clause; the latter as an “exclusionary” clause.

On September 9, 2019, while the Policy was still in effect, the Insured was alone in the bathroom of a hotel room in which he and Ms. Stewart Holley were staying. APP. at 30, 34. Ms. Stewart Holley “heard a loud thud” come from the

(docket entry 24), allowing Ms. Stewart Holley’s heirs to continue the suit in her stead. - 2 - bathroom and went in to find the Insured unresponsive on the floor. Id. Ms. Stewart Holley called paramedics, who determined that the Insured had no pulse and

subsequently performed chest compressions. Id. at 34. The Insured was pronounced dead at the scene. Id. at 41. The plaintiffs allege that the Insured “accidentally fell and hit his head resulting in his death.” SAC ¶ 10; APP. at 25 (a claim statement filed by Ms. Holley Stewart stating that her “spouse fell in the restroom while going to take a shower and

passed away” and noting “[b]ruising on [the right side of the Insured’s] forehead”). The plaintiffs attached two photographs of the Insured taken by one of the plaintiffs showing an injury on the right forehead. Brief in Support of Plaintiffs’ Response to Defendant’s Motion for Summary Judgement (“Response”) (docket entry 32) at 3,

Exhibit D. However, the Certificate of Death for the Insured issued by the State of New Mexico states that the “cause of death” was “[a]therosclerotic and hypertensive cardiovascular disease.” APP. at 17. The Certificate of Death also noted “[m]orbid obesity” as an other “significant condition[] contributing to death.” Id. The

Certificate of Death made no mention of head trauma as a contributing cause of death. No autopsy was performed. Response at 3. On October 29, 2019, Ms. Stewart Holley submitted an “Accidental Death Claim Statement for Beneficiaries” seeking the full amount of coverage provided by the Policy. APP. at 25. “After receiving the Claim, Mutual of Omaha commenced a

- 3 - routine investigation.” Brief in Support ¶ 14. Mutual of Omaha obtained a police “Incident Report,” APP. at 29-31, a medical investigator report, id. at 32-34, an

emergency response report completed by emergency response personnel, id. at 36-39, and a physician review, id. at 40-42. Neither the police report, the medical investigator report, nor the emergency response report note any head trauma suffered by the Insured or that such trauma was the cause of death. Dr. Cline-Parhamovich, the medical investigator, identified the cause of death as “[a]therosclerotic and

hypertensive cardiovascular disease” with “[m]orbid obesity” as a “significant contributory condition,” and that the Insured’s death was “[n]atural.” Id. at 35. Dr. Stuart Schlanger, the reviewing physician, concluded the Insured, “with a very high probability[,] suffered an out of hospital cardiac arrest” and “almost certainly fell

after the cardiac arrest.” Id. at 41. Dr. Schlanger also concluded that “there was no accidental bodily injury which caused or contributed to the insurer’s [sic] demise.” Id. Rather, the Insured’s “underlying atherosclerotic vascular disease” and “morbid obesity” “directly contributed to [the Insured’s] out of hospital cardiac arrest.” Id.

On April 11, 2020, Mutual of Omaha notified Ms. Stewart Holley (“the Decision Letter”) that her claim for the Policy’s death benefit payment had been denied. Brief in Support ¶ 20; APP. at 43-44. The Decision Letter noted that the Insured’s death was caused by “atherosclerotic and hypertensive cardiovascular disease,” factors which fall outside the scope of “injury” as defined in the Policy. Id.

- 4 - at 47. B. Procedural History

Ms. Stewart Holley filed her Plaintiff’s Original Petition in state court on August 3, 2020. (docket entry 1-1, Exhibit A). Mutual of Omaha filed its Notice of Removal on August 27, 2020. (docket entry 1). Mutual of Omaha filed its motion for summary judgment on January 27, 2021. After Ms. Stewart Holley passed away, the court granted the plaintiffs’ Motion to Substitute Party and Amend Complaint

on March 26, 2021. On the same day, the plaintiffs filed their Second Amended Complaint, which omitted several of the claims brought in Ms. Stewart Holley’s previous complaints. Mutual of Omaha also filed its answer on March 26, 2021. Defendant’s Answer and Affirmative Defenses to Plaintiffs’ Second Amended

Complaint (docket entry 28) (“Answer”).2 The plaintiffs filed their response to Mutual of Omaha’s motion for summary judgment on April 7, 2021. Brief in Support of Plaintiffs’ Response to Defendant’s Motion for Summary Judgement (docket entry 32) (“Response”). Mutual of Omaha filed its reply on April 8, 2021.

2 Rather than file a second motion for summary judgment corresponding to the plaintiffs’ Second Amended Complaint, Mutual of Omaha filed a Supplement to Defendant’s Motion for Summary Judgment (docket entry 29) wherein it argued that “[t]he arguments and issues raised in the [motion for summary judgment] are not mooted by the Second Amended Complaint, and the [motion for summary judgment] does not require amendment or supplementation beyond the references to the recent procedural developments articulated herein.” Id. ¶ 8. Mutual of Omaha urges the court to ignore the portions of its motion for summary judgment relating to claims that were omitted in the Second Amended Complaint. Id. ¶ 7. - 5 - Defendant’s Reply in Support of its Motion for Summary Judgment (docket entry 33) (“Reply”). Accordingly, Mutual of Omaha’s motion for summary judgment is

ripe for decision. II. ANALYSIS A.

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Holley v. Mutual of Omaha Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holley-v-mutual-of-omaha-insurance-company-txnd-2021.