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John Ramsey v. Hartford Life Insurance Company

April 17, 2013

JOHN RAMSEY, PLAINTIFF,
v.
HARTFORD LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: B. Lynn Winmill Chief Judge United States District Court

MEMORANDUM DECISION AND ORDER

INTRODUCTION

The Court has before it cross-motions for summary judgment on Plaintiff John Ramsey's breach of an insurance contract claim against Defendant Hartford Life Insurance Company. Ramsey claims that he is entitled to recover death benefits arising from the accidental death of his ex-wife, Margie Ramsey. Hartford responds that Margie Ramsey's death was not covered under the policy. On April 1, 2013, the Court heard oral argument and took the matter under advisement.

Having considered oral argument and the record, the Court concludes that the policy covers Ms. Ramsey's accidental death, but finds no evidence that Hartford denied coverage in bad faith. In addition, the Court finds that Ms. Ramsey purchased a voluntary plan benefit of $100,000 and not $150,000. Hartford, however, shall refund the excess premiums Ms. Ramsey paid for the family benefit.

BACKGROUND

Plaintiff John Ramsey's ex-wife, Margie Ramsey, died on July 19, 2011. At the time of her death, Ms. Ramsey was insured under an accidental death and dismemberment policy issued by Hartford. Ms. Ramsey obtained the policy through her credit union, Advantage Plus Federal Credit Union. The policy provided for a Basic Plan benefit for Ms. Ramsey in the amount of $1,000.00 and a Voluntary Plan benefit in the amount of either $100,000.00 or $150,000.00. Id. Ms. Ramsey named Ramsey as the sole beneficiary under the policy.

Prior to her death, Ms. Ramsey was taking several different kinds of medications prescribed by her physician. Those medications included Amitriptyline for bipolar affective disorder, Propranolol and Maxalt for headaches, and cyclobenzaprine (brand name Flexeril) for flank plain and headaches. Ms. Ramsey also was legally blind and used a service dog.

Between May 13 and June 16, 2011, Ms. Ramsey visited her physician on various occasions to obtain counseling regarding her medications. That counseling included arranging pharmacotherapy treatment, eliminating duplicate medications, limiting "as needed" medications, addressing issues she had related to taking medications while blind, suggesting that she discuss those issues with her pharmacist, changing the delivery system of her Flexeril (cyclobenzaprine) to a blister pack because she was blind, discussing side effects and indications of her medications, and arranging for a nurse to conduct an in-home medication reconciliation.

Despite taking these precautions, Ms. Ramsey stopped breathing on the night of July 16, 2011. She was transported by ambulance to Portneuf Medical Center's Emergency Room. There it was reported that she had not been feeling well the day before she was transported to the ER, and shortly before she was transported, she had been snoring in an unusual way during her sleep and began breathing abnormally before her breathing stopped altogether. The ER staff placed her on a ventilation system. Lab results showed a critically high tricyclic level of 963. On July 19, 2011, Ms. Ramsey showed no evidence of responsiveness, which established a diagnosis of brain death. She died that same day.

For purposes of summary judgment, the parties have stipulated that Ms. Ramsey "died as a result of poisoning through the prescription use of cyclobenzaprine and tricyclic antidepressant; or a toxic cross-reaction between those two prescription medications; or poisoning from those two prescription medications due to the alteration of the manner in which the delivery of her medication was facilitated and the fact that she received an overdose of those medications."

No one contends that Ms. Ramsey was suicidal. Her death certificate identified the cause of death as "an accidental overdose of a tricyclic medication." Ms. Ramsey took her medications as prescribed. And there is no evidence that she had ingested any non-prescribed medications or illegal drugs.

After Ms. Ramsey's death, Ramsey applied for death benefits under the life insurance policy. Hartford denied Ramsey's claim on the grounds that Ms. Ramsey's death was not the result of an "Injury" as defined in the policy. Specifically, in the "Definitions" section of the Certificate of Insurance, the policy defines "Injury" as .. bodily injury resulting directly from accident and independently of all other causes which occurs while the Covered Person is covered under the policy. Loss resulting from: a) a sickness of disease, except a pus-forming infection which occurs through an accidental wound; or b) medical or surgical treatment of a sickness or disease; is not considered as resulting from injury.

Policy at 5, Dkt. 11-3. ." Id.

Hartford concluded that, to the extent Ms. Ramsey's fatal overdose resulted from taking cyclobenzaprine and tricyclic antidepressant, the medicines prescribed to treat her chronic headaches and bipolar affective disorder, such loss was a result of "medical or surgical treatment of a sickness or disease," and thus did not meet the definition of Injury required for covered losses under the Policy.

Because Hartford concluded that Ms. Ramsey's fatal overdose did not qualify as an "Injury," Hartford never addressed the separate "Exclusions" section. This section expressly excludes from coverage losses resulting from (1) intentionally self-inflicted injury or suicide, (2) war, (3) Injury sustained while in the full-time armed forces of any country or international authority, (4) Injury sustained while riding an aircraft, except a Civil or Public Aircraft or a Military Transport Aircraft, (5) Injury sustained while riding on any aircraft as a pilot, crewmember, flight instructor or examiner, (6) Injury sustained while voluntarily taking illegal or non-prescribed drugs, unless the drug is taken as prescribed or administered by a licensed physician, (7) Injury sustained in the course of a felony, (8) Injury sustained while legally intoxicated from alcohol. Policy, "Exclusions" at 5. Most important to this case is the sixth exclusion, or the drug exclusion, which excludes from coverage any "Injury sustained while voluntarily taking drugs which federal law prohibits dispensing without a prescription, unless the drug is taken as prescribed or administered by a licensed physician." Id. (Emphasis added).

After Hartford denied Ramsey's written requests to pay him the policy's benefits, he filed this action for breach of contract and bad faith.

LEGAL STANDARD

Summary judgment is appropriate where a party can show that, as to any claim or defense, "there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). One of the principal purposes of summary judgment "is to isolate and dispose of factually unsupported claims ...." Celotex Corp. v. Catrett, 477 U.S. 317, 323--24 (1986). It is "not a disfavored procedural shortcut," but is instead the "principal tool[ ] by which factually insufficient claims or defenses [can] be isolated and prevented from going to trial with the attendant unwarranted consumption of public and private resources." Id. at 327. "[T]he mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247--48 (1986). There must be a genuine dispute as to any material fact-a fact "that may affect the outcome of the case." Id. at 248.

When cross-motions for summary judgment are filed, the Court must independently search the record for factual disputes. Fair Housing Council of Riverside County, Inc. v. Riverside Two, 249 F.3d 1132, 1136 (9th Cir. 2001). The filing of cross-motions for summary judgment -- where both parties argue there are no material factual disputes -- does not vitiate ...


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