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Everett v. American General Life Insurance Co.

United States District Court, D. Idaho

July 31, 2015

DEANNA EVERETT aka Deanna Everett Whitley, Plaintiff,
v.
AMERICAN GENERAL LIFE INSURANCE COMPANY, formerly known as American General Assurance Company, an insurance company licensed to do business in the State of Idaho pursuant to Idaho Code, Title 41, Defendant.

MEMORANDUM DECISION AND ORDER

B. LYNN WINMILL, Chief District Judge.

INTRODUCTION

Before the Court is Defendant American General Life Insurance Company's Motion for Summary Judgment (Dkt. 18-1). The motion was argued on May 27, 2015, and taken under advisement. For the reasons explained below, the Court will grant Defendant's motion.

BACKGROUND

This case arises out of the passing of Mr. John Whitley, and his wife's efforts to collect under his accidental death insurance policy issued by Defendant, American General Life Insurance Company. The following facts and timeline of events are undisputed or, when disputed, taken in the light most favorable to Deanna Everett Whitley, the plaintiff and non-moving party. See Matsushita Elec. Indus. Co. v, Zenith Radio Corp., 475 U.S. 574, 587 (1986).

John Whitley was involved in an automobile accident on November 27, 2010 and broke his neck, sustaining a type II odontoid fracture. This injury was initially treated with a Miami neck brace and pain medications.

Prior to his car accident, Mr. Whitley had been scheduled to have cardiac surgery at the Mayo Clinic in Rochester, Minnesota. Mr. Whitley was approximately 76 years old at the time and had planned to undergo mitral valve replacement surgery in December 2010. However, it was determined that Mr. Whitley was not a good candidate, or did not need, the mitral valve replacement surgery.[1] But on February 25, 2011, the doctors at the Mayo Clinic elected to perform surgery for the neck injury sustained in the car accident which consisted of a posterior C 1-2 fusion with right iliac crest bone graft. Mr. Whitley stayed at Saint Mary's Hospital for approximately one week following his surgery.

While Mr. and Mrs. Whitley were flying home to Idaho on March 5, 2011, Mr. Whitley's heart decompressed, he fainted, and the plane was diverted to Pierre, South Dakota where Mr. Whitley was admitted to St. Mary's Healthcare Center. After spending the night at the hospital, Mr. and Mrs. Whitley returned home to Idaho, where Mr. Whitley was admitted to West Valley Medical Center in Caldwell, Idaho. Mr. Whitley was discharged 2 days later to home hospice care and died roughly one month later on April 6, 2011.

On April 29, 2011, Mrs. Whitley notified American General of her husband's death to begin the process of receiving benefits under the accidental death policy. The policy owned by Mr. Whitley had been in effect since July 15, 2005, and neither party disputes its authenticity. The policy provides that the amount of $100, 000 will be distributed to the beneficiary if "[a] covered person suffers loss solely as a result of an accidental bodily injury, " and "due proof of such loss [is] sent to American General." Complaint, Exhibit A, p. 3 (Accidental Death and Dismemberment Benefits). The policy further clarifies that "the accidental bodily injury must happen while the person is covered under the group policy and the loss must occur within 365 days after the date of the injury." Id. The policy provides several exclusions, most significantly an exclusion stating that "no benefits will be paid for any loss that results from or is caused directly, indirectly, wholly or partly by any of the following:... 3. A physical or mental sickness or treatment of that sickness;...." Id. at p. 6 (Accidental Death and Dismemberment Exclusions and Limitations).

American General responded to Mrs. Whitley's initial notice by asking for additional information, which Mrs. Whitley provided. Over the course of the following five months, information and documents were exchanged between the parties until October 11, 2011 when American General denied the claim. Mrs. Whitley then filed this lawsuit.

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 the 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.

The evidence must be viewed in the light most favorable to the non-moving party, and the Court must not make credibility findings. Id. at 255. Direct testimony of the non-movant must be believed, however implausible. Leslie v. Grupo ICA, 198 F.3d 1152, 1159 (9th Cir. 1999). On the other hand, the Court is not required to adopt unreasonable inferences from circumstantial evidence. McLaughlin v. Liu, 849 F.2d 1205, 1208 (9th Cir. 1988).

The moving party bears the initial burden of demonstrating the absence of a genuine dispute as to material fact. Devereaux v. Abbey, 263 F.3d 1070, 1076 (9th Cir. 2001)(en banc). To carry this burden, the moving party need not introduce any affirmative evidence (such as affidavits or deposition excerpts) but may simply point out the absence of evidence to support the ...


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