Scanlon v. Life Insurance Co. of North America

670 F. Supp. 2d 1181, 2009 U.S. Dist. LEXIS 106198, 2009 WL 3832619
CourtDistrict Court, W.D. Washington
DecidedNovember 13, 2009
DocketC08-0256-JCC
StatusPublished
Cited by4 cases

This text of 670 F. Supp. 2d 1181 (Scanlon v. Life Insurance Co. of North America) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Scanlon v. Life Insurance Co. of North America, 670 F. Supp. 2d 1181, 2009 U.S. Dist. LEXIS 106198, 2009 WL 3832619 (W.D. Wash. 2009).

Opinion

ORDER

JOHN C. COUGHENOUR, District Judge.

This matter comes before the Court on Defendant’s motion for summary judgment (Dkt. No. 54), and Plaintiffs motion for partial summary judgment. (Dkt. No. 65). The Court has considered Plaintiffs response to Defendant’s motion (Dkt. No. 58), Defendant’s reply (Dkt No. 67), and Plaintiffs surreply. (Dkt. No. 70). The Court has also considered Defendant’s response to Plaintiffs motion (Dkt. No. 75), Plaintiffs reply (Dkt. No. 83), and Defendant’s surreply. (Dkt. No. 87). Finally, the Court has considered the parties’ various declarations and exhibits, and concluded that oral argument is unnecessary.

For the reasons explained below, the Court hereby GRANTS Plaintiffs motion with respect to her contract and bad-faith breach claims. The Court GRANTS Defendant’s motion with respect to Plaintiffs claims sounding in the Washington Consumer Protection Act.

I. BACKGROUND

This case stems from an insurance dispute. In October 2003, Plaintiff Jody Lynn Scanlon purchased a $500,000 accidental-death-and-dismemberment policy made available to her as part of her employment with King County for her husband Michael Scanlon. Mr. Scanlon died on November 2, 2006. Defendant Life Insurance Company of North America (LINA) refused to pay Plaintiffs claim for benefits, having concluded that Mr. Scanlon’s death was not attributable to an accident. In relevant part, the policy language reads:

We agree to pay benefits for loss from bodily injuries:
(a) caused by an accident which happens while an insured is covered by this policy; and
(b) which, directly and from no other causes, results in a covered loss.
We will not pay benefits if the loss was caused by:
(a) sickness, disease, or bodily infirmity; or
*1185 (b) any of the exclusions listed in the policy.

(Policy 1 (Dkt. No. 55-2 at 2)). The only relevant exclusion listed in the policy contains language mirroring clause (b), stating that Defendant will refuse to pay benefits “for loss resulting from ... sickness, disease, bodily or mental infirmity[J” (Id. 3).

Mr. Scanlon suffered from heart problems and multiple sclerosis, which made it difficult for him to walk and rendered him prone to falls. Because of these and other health problems, he had been living at the Park Place assisted-living facility since December 2005. Mr. Scanlon’s health was in long-term decline, but he was still somewhat independent at the time of his death. Approximately one week before he passed away, Park Place staff completed an assessment which described him as able to ambulate with the aid of a walker and leg brace, able to dress and undress himself, and able to attend to his general hygiene, including showering. (Annual Report (Dkt. No. 58-2 at 4-9)).

Park Place staff discovered Mr. Scanlon lying unresponsive on the bathroom floor of his suite on the evening of November 1, 2006. He was taken to the hospital, where doctors pronounced him brain-dead. Mr. Scanlon was removed him from life support, and he passed away early the next morning. (PI. Opp’n 4 (Dkt. No. 58)). In the days after her husband’s death, Plaintiff Jody Scanlon learned that Park Place workers had found him on a hard, tiled area of flooring near the shower. (Scanlon Decl. 2 (Dkt. No. 58-1)). Hospital physicians concluded that Mr. Scanlon died from a subdural hematoma, a type of brain injury. (Hospital Report (Dkt. No. 79 at 77)). Dr. Aldo Fusaro, an associate medical examiner for King County, performed an autopsy. Dr. Fusaro agreed with the hospital doctors’ diagnosis, attributing Mr. Scanlon’s death to a large subdural brain hemorrhage. Dr. Fusaro presumed that the injury had been caused by blunt force trauma to the head. The autopsy concluded: “The manner of death is accident.” (Autopsy 1 (Dkt. No. 55-3 at 4)). While both Dr. Fusaro and hospital physicians noted that Mr. Scanlon suffered from heart problems, none of them attributed his death to a heart attack.

Plaintiff submitted an insurance claim on November 8, 2006. In response to a question asking how the accident occurred, Plaintiff wrote, “He fell while alone in his room at his assisted-care facility, striking his head, causing a fatal cerebral hematoma.” (Claim (Dkt. No. 55-3 at 14)). Ms. Sheri Leister, an accident-claims specialist, reviewed Plaintiffs claim for Defendant LINA. As part of her review, Ms. Leister requested the opinion of Dr. Norton Hall, who worked as a physician-adviser for Defendant. (Letter to Dr. Hall (Dkt. No. 55-3 at 33)). Dr. Hall prepared a handwritten, two-sentence memorandum report which concluded that Mr. Scanlon had died from a heart attack, and that he fell only after having lost consciousness. Dr. Hall also concluded that certain anticoagulant heart medication Mr. Scanlon was taking had contributed to his death. (Hall Report (Dkt. No. 55-3 at 35)). Two days after receiving Dr. Hall’s report, Ms. Leister sent Plaintiff a letter informing her that Defendant was denying her claim for benefits. The letter stated: “The medical evidence and our physician adviser’s review has established that Michael Scanlon’s fall was the result of an acute myocardial infarction and accelerated by anticoagulant therapy.” (Denial Letter 3 (Dkt. No. 55-3 at 39)).

Plaintiff secured the representation of attorney Michael Nelson, who continues to represent her in this matter. After meeting with LINA representatives, Mr. Nelson wrote a lengthy letter documenting Plaintiffs potential claims for relief, and *1186 offering to settle the case for $650,000. Mr. Nelson strongly criticized Defendant’s claims investigation, especially Dr. Hall’s report, which the letter described as a “two-sentence scribble”:

[T]his doctor somehow argues that the myocardial infarction leads to unconsciousness, then to a subsequent fall, and then, out of the fall, evolves the subdural hematoma, which is then accelerated by the anticoagulant therapy. What is he relying on? The doctor concludes with the statement: “Of note is the absence of external trauma to scalp, face or head.” This sounds like two arguments at once: the subsequent fall produced a subdural hematoma, but then possibly he didn’t fall because there was an absence of external trauma to the head or scalp. Which is it? The “doctor” appears to argue both.

(Nelson Letter 5-6 (Dkt. No. 55-4 at 7-8)) (some emphases removed or modified). Mr. Nelson included with the letter a report prepared by Dr. Bennet Omalu, a board-certified clinical pathologist who is the chief medical examiner of San Joaquin County in California. Dr. Omalu was unsparing in his criticisms of Defendant’s investigation and conclusions, describing “[t]he grounds, basis and justifications for the denial of Mr. Scanlon’s death benefits” as “scientifically invalid” and “grossly outside the established and generally accepted guidelines and principles in clinical and forensic medicine.” (Omalu Report 5 (Dkt. No. 55-4 at 26)). Relying on postmortem blood tests and autopsy information, Dr. Omalu specifically rejected the possibility of a heart attack. He concluded that Mr.

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Cite This Page — Counsel Stack

Bluebook (online)
670 F. Supp. 2d 1181, 2009 U.S. Dist. LEXIS 106198, 2009 WL 3832619, Counsel Stack Legal Research, https://law.counselstack.com/opinion/scanlon-v-life-insurance-co-of-north-america-wawd-2009.