Wei-Ni Chen and Jimmy Po-Chen Lee, Individually, and as Next Friend for Helen Ay-Luen Lee, a Minor v. Metropolitan Insurance and Annuity Company

907 F.2d 566, 1990 U.S. App. LEXIS 13209, 1990 WL 100704
CourtCourt of Appeals for the Fifth Circuit
DecidedAugust 6, 1990
Docket89-2805
StatusPublished
Cited by13 cases

This text of 907 F.2d 566 (Wei-Ni Chen and Jimmy Po-Chen Lee, Individually, and as Next Friend for Helen Ay-Luen Lee, a Minor v. Metropolitan Insurance and Annuity Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wei-Ni Chen and Jimmy Po-Chen Lee, Individually, and as Next Friend for Helen Ay-Luen Lee, a Minor v. Metropolitan Insurance and Annuity Company, 907 F.2d 566, 1990 U.S. App. LEXIS 13209, 1990 WL 100704 (5th Cir. 1990).

Opinion

JOHN R. BROWN, Circuit Judge:

Facts and Procedure Below

On September 18,1986, while celebrating a Chinese festival, Ching Sing Lee (Lee) died as a result of drinking too much brandy. A life insurance policy (Policy) issued to Lee by Metropolitan Insurance and Annuity Company (Metropolitan) provided for the payment of $100,000.00 to Lee’s wife and children (the Beneficiaries) in the event of his death. Metropolitan has paid this amount. The Policy also included an accidental death rider in the amount of $100,-000.00, to be paid if “the insured died, directly and independently of all other causes, as the result of an accident.” However, the accidental death benefit would not be allowed “if the death: 5. Is caused or contributed to, directly or indirectly, by the use of any drug, unless on the advice of a licensed medical practitioner.” Neither “accident” nor “drug” were defined in the Policy. Metropolitan denied the claim for accidental death benefits on the ground that Lee’s death was not an accident under the insurance contract. 1

Thereafter, the Beneficiaries sued Metropolitan, seeking the accidental death benefits, penalties and attorney’s fees. Following discovery by the Beneficiaries, Metropolitan filed a motion for summary judgment arguing that there were no genuine issues of material fact as to whether Lee’s death was indeed an “accident.” The Beneficiaries did not timely oppose Metropolitan’s motion for summary judgment, and the trial court granted it.

The Beneficiaries moved for reconsideration of the district court’s decision and submitted a late response to Metropolitan’s motion for summary judgment. Citing “the interest of justice,” the court below granted the motion to reconsider and reviewed the entire record but adhered to its original decision in favor of Metropolitan. The trial judge gave two reasons for his decision. First, stating that “the Texas Supreme Court has taken. judicial notice that the consequences of alcohol consumption are ‘common knowledge,’ ” the trial judge — agreeing with Metropolitan’s argument — ruled that Lee’s death was not accidental. Second, the court below took judicial notice that “alcohol is a drug,” and since deaths caused by drugs are not covered by the accidental death rider, the court in effect held that there could be no recovery for use of that drug, whether accidental or otherwise. This second, independent ground for granting the summary judgment was not raised in Metropolitan’s summary judgment motion.

(i) Was Lee’s Death an “Accident”?

When the Beneficiaries received Metropolitan’s motion for summary judgment, they bore the onus of establishing that some fact issue existed showing that the insured’s death was accidental. Anderson v. Liberty Lobby Inc., 477 U.S. 242, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986), and Matsushita Electric Industrial v. Zenith Radio Corp., 475 U.S. 574, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The Beneficiaries were entitled to the trial court’s indulging in their favor all reasonable inferences proceeding from the facts before it. Matsushita, 475 U.S. at 587, 106 S.Ct. at 1356, 89 L.Ed.2d at 552, citing United States v. Diebold, Inc., 369 U.S. 654, 655, 82 S.Ct. 993, 994, 8 L.Ed.2d 176, 177 (1962). If a fair minded jury, on the facts presented in the motion, could have returned a verdict for the Beneficiaries, then the judge is required to deny the motion for summary judgment. Anderson, 477 U.S. at 252, 106 S.Ct. at 2512, 91 L.Ed.2d at 214. The motion for summary judgment involves two competing interests: the Beneficiaries, asserting that their claim is adequately based *568 in fact; and the insurer’s defense that the beneficiaries’ claim has no basis in fact. The trial court’s obligation is to give due regard to both interests, Celotex Corp. v. Catrett, 477 U.S. 317, 327, 106 S.Ct. 2548, 2555, 91 L.Ed.2d 265, 276 (1986), and the trial judge is not to determine whether in his opinion the contradictory evidence favors one side or the other. Anderson, 477 U.S. at 252, 106 S.Ct. at 2512, 91 L.Ed.2d at 214.

Texas: The Source and End of It All

Texas law is determinative of this Texas diversity case. See Sekel v. Aetna Life Ins. Co., 704 F.2d 1335, 1337 (5th Cir.1983). The leading Texas case on the construction of accidental death provisions in insurance policies is Republic Nat. Life Ins. Co. v. Heyward, 536 S.W.2d 549 (Tex.1976). Bennie Heyward was covered under an accidental death rider. An assailant intentionally shot and killed him. The insurance company denied the claim for accidental death benefits on the ground that the death was caused by the intentional act of the assailant. The Supreme Court of Texas rejected the insurer’s position, holding that the focus should be on the reasonable anticipation of the insured, viewed from his/her standpoint: “[the death is accidental] if, from the viewpoint of the insured, the injuries are not the natural and probable consequence of the action or consequence which produced the injury; or, in other words, if the injury could not reasonably be anticipated by insured, or would not ordinarily follow from the action or occurrence which caused the injury.” 536 S.W.2d at 557. Because Mr. Heyward from his conduct could not reasonably anticipate that he would be the victim of a shooting, the Supreme Court of Texas affirmed the judgment in favor of the beneficiary. See also Crumpton v. Confederation Life Ins. Co., 672 F.2d 1248, 1254 (5th Cir.1982).

The insurer argues that it is common knowledge that large doses of alcohol may cause death. In Pemberton v. American Distilled Spirits Co., 664 S.W.2d 690 (Tenn.1984), which concerned quite a different problem — the duty to warn — the father of a minor child sued an alcohol retailer, wholesaler and manufacturer for failing to warn consumers of the dangers of alcohol consumption. The child died from drinking too much alcohol. The Supreme Court of Tennessee held there was no duty to warn because the dangers of alcohol consumption are generally known and recognized:

The law requires manufacturers to warn of the hidden and unknown dangers in their product; however, as to some risks, manufacturers are entitled to rely upon the common sense and good judgment of consumers. Clearly, death or serious injuries resulting from either excessive or prolonged consumption of alcohol are within the latter type of risks.

664 S.W.2d at 693.

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