Perez v. Sears Life Insurance

968 F. Supp. 2d 1192, 2013 WL 4780064, 2013 U.S. Dist. LEXIS 128739
CourtDistrict Court, S.D. Florida
DecidedAugust 9, 2013
DocketCase No. 12-23535-CIV
StatusPublished

This text of 968 F. Supp. 2d 1192 (Perez v. Sears Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Perez v. Sears Life Insurance, 968 F. Supp. 2d 1192, 2013 WL 4780064, 2013 U.S. Dist. LEXIS 128739 (S.D. Fla. 2013).

Opinion

[1194]*1194 ORDER

CECILIA M. ALTONAGA, District Judge.

THIS CAUSE came before the Court on Defendant, Sears Life Insurance Company’s (“SLICf’s]”) Motion for Summary Judgment (“Motion”) [ECF No. 49] filed on May 24, 2013, together with its Statement of Undisputed Facts (“Defendant’s SMF”).1 Plaintiff, Estrella Perez (“Perez”), filed a Memorandum of Law in Opposition to Defendant’s Motion (“Response”) [ECF No. 66], and a Statement of Material Facts in Response to Defendant’s Motion (“Plaintiffs SMF”) [ECF No. 65] on June 24, 2013. SLIC replied (“Reply”) [ECF No. 75] on July 3, 2013. The Court has carefully reviewed the parties’ written submissions, the record, and applicable law.

I. BACKGROUND

This case involves an insured’s entitlement to benefits for the death of her husband under a Certificate of Accidental Death Insurance (“Insurance Certificate”) [ECF Nos. 49-1, 65-1] pursuant to a Group Accidental Death Insurance Policy, master policy number 64497113. (See Ins. Certificate 1). SLIC, the insurer, is a Texas corporation registered to do business in Florida. (See Am. Compl. ¶ 3 [ECF No. 24]; Am. Answer ¶ 3 [ECF No. 40]). Perez, the insured, is a Florida resident. (See Am. Compl. ¶ 2; Am. Answer ¶ 2). Perez purchased insurance coverage provided by SLIC and received the Insurance Certificate on January 24, 2007.2 (See Ins. Certificate 1; Pl.’s SMF ¶ 1). Perez subsequently upgraded the coverage for the Insurance Certificate, to be effective June 2007, and her monthly premium increased. (See Def.’s SMF ¶ 1; PL’s SMF ¶ 2).3

The Insurance Certificate covers and defines “Accidental Death” as “[d]eath resulting directly from bodily injury or injuries. The injury or injuries must be sustained by the Insured as a result of an accident and be the direct cause of the loss.” (Ins. Certificate 3; see also Def.’s SMF ¶ 3; PL’s SMF ¶ 4). The loss covered by the Insurance Certificate includes Accidental Death. (See id.). The Insurance Certificate further provides “[it] does not cover Loss caused directly by: ... 4. disease, or bodily or mental infirmity.” (Ins. Certificate 5; see also Def.’s SMF ¶ 4; PL’s SMF ¶ 5). Additionally, the Insurance Certificate states “[b]enefits payable under the Policy will be paid when we receive the necessary proof of loss.” (Ins. Certificate 7; see also Def.’s SMF ¶ 12; PL’s SMF ¶ 13). The Master Policy [ECF Nos. 50-2, 65-3] contains a provision which states, “[The] terms [of this Master Policy] shall be construed in accordance [1195]*1195with the laws of the State of Illinois.” (Master Policy 1).

On the evening of August 26, 2007, Perez’s husband, Roberto Morales (“Morales”), drove Perez to the Miccosukee Casino (“Casino”) in west Miami-Dade County and returned to the home (“Home”) he shared with Perez. {See Def.’s SMF ¶ 9; PL’s SMF ¶ 10). In the early morning hours of August 27, 2007, Perez’s tenant, Maritza Llopiz (“Llopiz”), heard Morales’s voice through the connected wall of the efficiency she rented from Perez and Morales. {See Llopiz Dep. 21:11-22:23 [ECF No. 51-2]; see also Def.’s SMF ¶9; Pl.’s SMF ¶10). Morales placed a phone call to his children in Cuba in the early hours of that morning. {See Def.’s SMF ¶ 9; PL’s SMF ¶10).

Later that morning, Perez called Morales to have him pick her up from the Casino where she had spent the night, but she was unable to reach him. {See Perez Dep. 17:17-25 [ECF No. 51-1]; see also Def.’s SMF ¶ 10; PL’s SMF ¶ 11). Because Perez could not reach Morales, she called Juan de la Cruz (“de la Cruz”), Llopiz’s husband, to check on Morales. {See Perez Dep. 18:2-4). When de la Cruz reached the Home, the front door was open; and he found Morales dead on the floor inside, lying face up, naked with only his shoes on and bruises on his chest, abdomen, arms, and chin. {See de la Cruz Aff. ¶¶ 16-18 [ECF No. 61-1]4; de la Cruz Dep. 12:3-22:19 [ECF No. 51-2]; see also Def.’s SMF ¶ 10; PL’s SMF ¶ 11). Llopiz was able to confirm the bruises, as she saw Morales’s body lying on the floor of the Home. {See Llopiz Aff. ¶¶ 13-18 [ECF No. 59-1]; Llopiz Dep. 16:13-17:9). The autopsy photographs (“Autopsy Photographs”) [ECF No. 54] of Morales from the Miami-Dade County Medical Examiner’s Department (“Medical Examiner”) show bruising or abrasions on Morales’s body. {See PL’s SMF ¶ 9).

Aida Delgado (“Delgado”), Perez’s daughter, testified that on the day of Morales’s death she watched a video recording taken the night before from the Home’s surveillance system. {See Delgado Dep. 24:18-25:3 [ECF No. 51-1]; see also Def.’s SMF ¶ 11; PL’s SMF ¶ 12). The video showed Morales arriving at the Home after dropping Perez off at the Casino, followed by twenty to thirty minutes of inactivity, and then the video “cut off,” meaning the video inexplicably went blank. (Delgado Dep. 25:42-26:22).

The Medical Examiner performed an autopsy (“Autopsy Report”) [ECF No. 49-2], listing Morales’s cause of death as coronary artery atherosclerosis (“Coronary Disease”) (see Autopsy Report 1), and the Death Certificate (“Death Certificate”) [ECF No. 49-3] stated the manner of death was natural, which is not covered under the Insurance Certificate. {See also Def.’s SMF ¶¶ 5-6; PL’s SMF ¶¶6-7). Both parties agree no medical records exist from the years preceding Morales’s death. {See Def.’s SMF ¶ 7; PL’s SMF ¶ 8).

SLIC received Perez’s Claim for Benefits (“Claim”) on December 7, 2007, which consisted of Morales’s Death Certificate, a claim form, and an incident report. {See Def.’s SMF ¶ 13; PL’s SMF ¶¶ 13-14). SLIC sent a denial letter to Perez after it received her Claim. {See Def.’s SMF ¶ 14; PL’s SMF ¶ 15). Perez filed an Amended Complaint (“Amended Complaint”) [ECF No. 24] on December 17, 2012, claiming [1196]*1196breach of contract and seeking payment of benefits under the Insurance Certificate and other damages. (See generally Am. Compl.). SLIC presently moves for summary judgment in its favor. (See Mot. 2).

II. LEGAL STANDARD

Summary judgment shall be rendered if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(a, c). “[T]he court must view all evidence and make all reasonable inferences in favor of the party opposing summary judgment.” Chapman v. AI Transp., 229 F.3d 1012, 1023 (11th Cir.2000) (en banc) (quoting Haves v. City of Miami 52 F.3d 918, 921 (11th Cir.1995) (internal quotation marks omitted)). “An issue of fact is material if it is a legal element of the claim under the applicable substantive law which might affect the outcome of the case.” Burgos v. Chertoff, 274 Fed.Appx. 839, 841 (11th Cir.2008) (quoting Allen v. Tyson Foods Inc., 121 F.3d 642, 646 (11th Cir.1997) (internal quotation marks omitted)). “A factual dispute is genuine if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Channa Imps., Inc. v.

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968 F. Supp. 2d 1192, 2013 WL 4780064, 2013 U.S. Dist. LEXIS 128739, Counsel Stack Legal Research, https://law.counselstack.com/opinion/perez-v-sears-life-insurance-flsd-2013.