Siguel v. Allstate

48 F.3d 1211, 1995 WL 98240
CourtCourt of Appeals for the First Circuit
DecidedMarch 10, 1995
Docket94-1392
StatusUnpublished
Cited by3 cases

This text of 48 F.3d 1211 (Siguel v. Allstate) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Siguel v. Allstate, 48 F.3d 1211, 1995 WL 98240 (1st Cir. 1995).

Opinion

48 F.3d 1211
NOTICE: First Circuit Local Rule 36.2(b)6 states unpublished opinions may be cited only in related cases.

Berta Maidanik SIGUEL and Edward N. Siguel, Plaintiffs, Appellants,
v.
ALLSTATE LIFE INSURANCE COMPANY, Defendant, Appellee.

No. 94-1392.

United States Court of Appeals,
First Circuit.

Mar. 10, 1995.

Appeal from the United States District Court for the District of Massachusetts [Hon. Robert E. Keeton, U.S. District Judge ]

Edward N. Siguel on brief pro se.

Craig Browne, Daniel H. Conroy and Goldstein & Manello, P.C. on brief for appellee.

D.Mass.

AFFIRMED.

Before TORRUELLA, Chief Judge, SELYA and BOUDIN, Circuit Judges.

PER CURIAM.

This appeal concerns an attempt by appellant Edward Siguel to collect benefits under an accidental death and dismemberment insurance policy issued by appellee Allstate Life Insurance Co. to Siguel's father. The district court entered judgment for Allstate under Fed. R. Civ. P. 52(c) after Siguel presented his evidence at a non-jury trial.1

I.

In 1986 Siguel obtained the insurance policy from Allstate; he listed his father, Isidoro Siguel, as the insured and his mother, Berta Siguel, as the beneficiary. According to Siguel the insured, while in Argentina, sustained an injury to his left forearm from a blow he received while getting off a public bus. This accident occurred sometime in January 1988. On February 10, 1988, the insured went to a hospital out- patient clinic where a physician, Dr. Pattin, drained an abscess on the insured's left forearm. Later that same day, the insured died.

Siguel filed a claim in June 1988 on behalf of his mother for benefits under the policy. As proof of loss, Siguel submitted a death certificate which listed the cause of death as cardiorespiratory arrest; he also submitted two reports prepared by Dr. Pattin which stated that the insured's death was accidental. Allstate denied the claim on December 27, 1989. It had conducted an investigation and concluded that the cause of death was not the result of an accident as defined in the insurance policy. On March 28, 1991, Siguel filed an action in federal district court on behalf of his mother as the beneficiary.2

The parties engaged in discovery and the case was tried in January 1994. The district court first heard Siguel's evidence and argument that his father's death was accidental. It then made Rule 52(c) findings concerning the cause of death. The court initially determined that an accident had occurred on the bus. However, the court found that Siguel had not demonstrated by a preponderance of the evidence that the accident had resulted in the insured's death. Specifically, the court concluded there were no causal connections, first, between the accident on the bus and the abscess and, second, between the abscess and the death. The court further stated that the existence of the link was not a matter that could be proved without the aid of expert testimony.

The court then rejected Siguel's theory that the medical treatment of the abscess itself was faulty, thereby constituting an accident which caused the death. The court stated that there was insufficient evidence from which it could find that the draining of the abscess was an accident. Again, the court opined that it required expert testimony to establish that there was something wrong with the treatment and that this error was responsible for the insured's death. The court also rejected Siguel's argument that because his father did not expect to die, his death was accidental; the court described this legal theory as incorrect and without any support in the caselaw.

II.

On appeal, Siguel claims that the district court erred by (A) ruling on the merits in favor of Allstate; (B) denying Siguel's motion for a new trial; (C) permitting Allstate to file late responses to Siguel's request for admissions; (D) disqualifying Siguel from representing his mother; (E) denying Siguel (who the court allowed to appear pro se after his mother assigned her claims to him) the right to have a lawyer assist him at trial; and (F) refusing to assess costs or sanctions against Allstate.

A. The Merits.

As with any case involving questions of insurance coverage, we start with the language of the policy. It provides benefits if the person insured is injured in an accident. Injury or injured is defined as meaning

bodily injury caused by an accident occurring while the insurance is in force and which injury results within 365 days after the date of the accident, directly and independently of all other causes, in death or any other "Loss" covered by the Policy. (emphasis § added).

If an individual is injured while a passenger on a public conveyance the benefit is $200,000. In other cases the benefit is $60,000.

Siguel first argues that the district court should have used the "accidental results" approach to interpreting this kind of insurance contract and that it instead erroneously used an "accidental means" test.3 Under the latter test, "the means which produced death or injury must have been unintentional." Wickman v. Northwestern Nat'l Ins. Co., 908 F.2d 1077, 1085 (1st Cir.) (emphasis added), cert. denied, 498 U.S. 1013 (1990). A results approach focusses on the unexpected nature of the injury or death itself; thus, "where the death is not designed and not anticipated by the deceased, though it is in consequence of some act voluntarily done by him, it is accidental death." 10 Couch on Insurance 2d Sec. 41:29, at 44 (rev. ed. 1982).

Under both approaches, however, an accident must be the proximate cause of the harm or loss.

Irrespective of whether or not it is required that the means, as well as the result, be accidental in origin, it has been held that in determining whether or not a recovery will be allowed ... a court may require that the accident be a proximate cause of the injury or death, regardless of the fact that the policy may not set up this requirement.

1A Appleman, Insurance Law and Practice Sec. 362, at 482 (rev. ed. 1981) (footnotes omitted); Couch on Insurance Sec. 41:12, at 16 ("In order to bring the harm sustained within the coverage of an accident policy, it is necessary that the accident be the proximate cause of the harm sustained.") (footnote omitted).

We first note that the insurance policy in this case in fact requires that death be "caused by an accident." Second, the courts of both Illinois and Massachusetts have held that to obtain benefits under this kind of insurance, an accident must be the proximate cause of death or injury. See Carlson v. New York Life Ins. Co., 76 Ill. App. 2d 187, 196, 222 N.E.2d 363

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Cite This Page — Counsel Stack

Bluebook (online)
48 F.3d 1211, 1995 WL 98240, Counsel Stack Legal Research, https://law.counselstack.com/opinion/siguel-v-allstate-ca1-1995.