Seay v. Southern Life & Health Insurance

660 F. Supp. 1076, 1986 U.S. Dist. LEXIS 22786
CourtDistrict Court, S.D. Mississippi
DecidedJuly 15, 1986
DocketCiv. A. No. S85-0037 (NG)
StatusPublished

This text of 660 F. Supp. 1076 (Seay v. Southern Life & Health Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Seay v. Southern Life & Health Insurance, 660 F. Supp. 1076, 1986 U.S. Dist. LEXIS 22786 (S.D. Miss. 1986).

Opinion

MEMORANDUM OPINION

GEX, District Judge.

The Complaint filed in the above captioned action alleges the Defendant insurer (“Southern Life”) has failed to pay benefits to Plaintiff in response to her claim submitted under the accident insurance policy (No. Q-19250) the insured maintained with Defendant. Plaintiff further alleges that Defendant “has completely failed to properly investigate or consider the claim”, “has acted in complete bad faith with an obvious intent to avoid a contractural (sic) obligation”, and that Defendant has so acted “intentionally and maliciously” with “no justifiable or arguable reasons”. Plaintiff’s prayer for relief includes, inter alia, a demand for “all benefits due the Plaintiff under said policy”, damages for “intentional mental distress” (sic) and punitive damages.

Defendant’s Amended Answer denies the material allegations advanced in the Complaint although it acknowledged that the subject policy was in full force and effect in June of 1984, the date of the events at issue in this cause. Specifically, Defendant avers that the daily income benefits due under the subject policy have been paid. Defendant has also pled that Plaintiff’s claim for accidental death benefits was properly denied in view of medical proof which demonstrated that the cause of the [1078]*1078insured’s death was due to natural causes which pre-existed the accident in question.

This cause is presently before the Court on Defendant’s “Motion for Partial Summary Judgment As To Punitive and Other Extracontract Damages”. For the reasons stated below, the Court is of the Opinion that the Motion should be granted.

I. STATEMENT OF FACTS

In February of 1984, Samuel R. Seay submitted a completed application1 and initial premium for insurance to Defendant with his wife, the Plaintiff, listed as beneficiary. Defendant issued an accident policy to Mr. Seay with an effective date of May 1, 1984. The policy provided for: (1) the payment of $20,000 upon receipt of due proof by Southern Life that the insured died of an accidental injury to the extent provided in the policy and (2) an $80 daily income benefit during hospital confinement resulting from accidental injury as provided in the policy. The policy did not cover death or hospital confinement resulting from infirmity, illness or disease of any kind.2

On June 11,1984, the 27-year-old insured broke his left leg when he is said to have fallen from a swimming pool diving board. Mr. Seay was taken forthwith to the Gulf-port Memorial Hospital where the admitting physician, Dr. E.N. Throop, performed surgery and set the fracture; the procedure was well tolerated and the insured’s immediate postoperative recovery proceeded without complication. In the early morning hours of June 16, 1984, however, Mr. Seay was found to be in cardiac arrest in his hospital bed. Efforts at resuscitation were unsuccessful, and he was pronounced dead shortly thereafter. The report of the autopsy performed that day by the hospital’s pathologist, Dr. John S. Basone, contains the following entry:

PROVISIONAL ANATOMICAL DIAGNOSIS
I. ACCUTE PULMONARY EMBOLUS, RIGHT PULMONARY ARTERY.
II. RECENT FRACTURE WITH OPEN REDUCTION OF LEFT LOWER TIBIA AND FIBULA BONES.
III. SEVERE BILATERAL PULMONARY EDEMA.
IV. EXTENSIVE RIGHT PLEURAL ADHESIONS.
V. FATTY METAMORPHOSIS OF LIVER.
VI. ACUTE SPLENITIS.

Dr. Basone’s findings may thus be characterized as suggesting a causal connection between the accident in which the decedent was involved on June 11, 1984, and his subsequent death five days later. At the request of the decedent’s father, John Seay, Harrison County Coroner Steve Delahousey secured the services of Dr. Paul McGarry of the New Orleans Coroner’s Office to perform a second autopsy. Dr. McGarry performed an autopsy on the decedent on June 18, 1984, and rendered an autopsy protocol dated June 19, 1984, and his microscopic findings are dated November 27, 1984. Dr. McGarry attributed the cause of death “to be related to extensive liver disease with fatty change and cardiomyopathy of unknown cause resulting in sudden cardiac arrest, probably proceeded by arrhythmia”. Dr. McGarry’s letter to Mr. Delahousey dated October 26, 1984, discloses his opinion that “factors other than the leg injury, principally advanced liver disease and abnormalities in the heart muscle predating the injury, are accounta[1079]*1079ble for death rather than the injury itself or complications of the injury”.3

Plaintiffs father notified Defendant’s district office in Biloxi, Mississippi, of the decedent’s death in the latter part of June, 1984, and Plaintiff was furnished with claim forms for benefits shortly thereafter, i.e., two to three weeks. Although the claimant’s statement reflects a notarized signature date of July 26, 1984, the “completed”4 forms were not forwarded by Plaintiff’s counsel to Defendant’s district office until August 10, 1984. By letter dated August 20, 1984, one of Defendant’s agents, John Hough, advised Plaintiff’s counsel that it was necessary to receive additional information “[i]n order to expedite the handling of this claim”. Hough referred specifically to the need for a certified death certificate, an autopsy report, and an itemized copy of the deceased’s hospital bill. The claims were retained in Defendant’s district office pending receipt of such information. By letter5 dated October 9, 1984, Plaintiff’s counsel sent Hough (1) the death certificate which indicated the cause of death was pending while the case was under investigation, (2) the hospital death summary, (3) the operation record, and (4) the preliminary autopsy reports of Dr. Basone and Dr. McGarry. No itemized copy of the hospital bill was sent. Defendant’s district office transmitted these documents to the claims department of the home office in Birmingham, Alabama, which received them on October 15, 1984.

By letter dated October 18, 1984, Defendant’s home office informed its district office that settlement of the daily income benefits claim would be delayed because of the need for the “[hjospital statement of charges (itemized or summary billing)”; Plaintiff was sent a copy of this letter. By separate letter of the same date from the home office claims department to Plaintiff,6 Plaintiff was informed as follows:

This will acknowledge the claim that you recently submitted on the above policy-
It will be necessary for us to obtain additional information on this claim, and we anticipate that there will be a delay in settlement. This additional information may consist of medical records, accident reports or similar records.
Please be assured that every effort will be made to conclude this investigation as soon as possible. Should you have any questions, please feel free to discuss them with your agent or the district office to which your premium payments are made.

By letter dated October 18,1984, Defendant’s home office requested from the hospital its “transcript” compiled on the decedent from the date of his admission to the date of his death.

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Cite This Page — Counsel Stack

Bluebook (online)
660 F. Supp. 1076, 1986 U.S. Dist. LEXIS 22786, Counsel Stack Legal Research, https://law.counselstack.com/opinion/seay-v-southern-life-health-insurance-mssd-1986.