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Stapley v. Minnesota Life Insurance Co.

United States District Court, D. Utah

May 8, 2019

KELLY STAPLEY, Plaintiff,
v.
MINNESOTA LIFE INSURANCE CO., Defendant.

          MEMORANDUM DECISION AND ORDER ORDER DENYING IN PART AND GRANTING IN PART MOTION FOR SUMMARY JUDGMENT

          Clark Waddoups Judge.

         Before the court is Defendant Minnesota Life Insurance Co.’s Motion for Summary Judgment (ECF No. 33). The motion has been fully briefed, and the court heard argument on the same on April 17, 2019. Having reviewed the pleadings and materials submitted and considered the arguments of counsel, the court now enters this order DENYING IN PART AND GRANTING IN PART Defendant’s motion.

         BACKGROUND

         Plaintiff is the daughter of the late Conrad Jahries. (ECF No. 2, at ¶ 1, Compl.) Mr. Jahries died in his home on October 17, 2015, at the age of 84. Id. at ¶ 5. His body was found by his hospice nurse, Penny Johnson, who is now deceased. Nurse Johnson reported that she found Mr. Jahries “in the doorway to his bathroom . . . with his head against the door jam [sic]” and with “copious amounts of dried blood coming from his mouth and nose.” (ECF No. 32-3.) No. one witnessed Mr. Jahries’s death, and an autopsy was not performed on his body. On Mr. Jahries’s death certificate, his cause of death was attributed to a stroke. (ECF No. 33-7.)

         Mr. Jahries was the owner of an accidental death and dismemberment insurance policy (the “Policy), which Defendant sold to him. (ECF No. 2, at ¶ 6, Compl.) Plaintiff is the beneficiary of the Policy. The Policy states that Defendant will only provide benefits “when the insured’s loss results directly-and independently-from all other causes, from an accidental bodily injury which was unintended, unexpected and unforeseen.” (ECF No. 33-2, at p. 4.) The Policy further states that “[t]he bodily injury must be evidenced by a visible contusion or wound” and that it “must be the sole cause of the insured’s loss.” Id. The Policy excludes payment “where the insured’s loss or injury is caused directly or indirectly by, results from, or there is contribution from . . . bodily or mental infirmity, illness or disease . . . .” Id. at p. 5.

         Plaintiff made a claim under the Policy. By letter dated May 25, 2016, Defendant denied Plaintiff’s claim because Mr. Jahries’s death was “caused directly or indirectly by, resulted from or there was contribution from bodily or mental infirmity, illness or disease.” (ECF No. 33-10, at p. 2.) Defendant’s denial letter further stated that it had not been provided any information to support the conclusion that Mr. Jahries’s death resulted from an accidental bodily injury. Id. On March 17, 2017, Plaintiff, through her counsel, sent Defendant a letter appealing its denial and offering evidence to support her assertion that Mr. Jahries’s death was the result of an accidental bodily injury. (ECF No. 33-12.) Enclosed with this letter were: 1) a statement prepared by Nurse Johnson, stating that she found Mr. Jahries “in the doorway to his bathroom . . . with his head against the door jam [sic]” and with “copious amounts of dried blood coming from his mouth and nose” and a letter written by Dr. Rothfeder, stating that it was his “medical opinion in this matter is that Mr. Jahries suffered a slip and fall ambulating to the bathroom, blunt cranial trauma, and a fatal traumatic brain injury” and that he “found no evidence that any of Mr. Jahries’ [sic] chronic medical conditions contributed in any way to his sudden death.” Id.

         Defendant received and reviewed Mr. Jahries’s medical records and referred the file to its own doctor, Dr. Dennis Lee. Dr. Lee opined that the available records were both “consistent and supportive” of the cause of death listed on the death certificate (a stroke) and “supportive of a medical event that cause[d] Mr. Jahries to collapse and be later found deceased.” (ECF No. 33-16, at p. 2–3.) Defendant therefore upheld its denial of Plaintiff’s claim.

         Plaintiff thereafter initiated this action, seeking payment of benefits and asserting that Defendant breached the Policy and acted in bad faith in handling and denying its claim. The parties have conducted discovery, including the depositions of Dr. Rothfeder, Dr. Lee, and Dr. Joseph, who was the hospice physician who signed Mr. Jahries’s death certificate. Plaintiff also disclosed a report prepared by Dr. Rothfeder stating that his “medical opinion in this matter is that Mr. Jahries suffered a slip and fall ambulating to the bathroom, blunt cranial trauma, and a fatal traumatic brain injury” and that he “found no evidence that any of Mr. Jahries’ [sic] chronic medical conditions contributed in any way to his sudden death.” (ECF No. 32-1, at p. 3.)

         ANALYSIS

         Summary judgment is proper when the moving party demonstrates that there is no genuine issue of material fact and that it is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). A material fact is one that may affect the outcome of the litigation. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). The moving party bears the initial burden of showing an absence of evidence to support the nonmoving party’s case. Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986). “Once the moving party meets this burden, the burden shifts to the nonmoving party to demonstrate a genuine issue for trial on a material matter.” Id. The court must “view the evidence and draw reasonable inferences therefrom in a light most favorable to the nonmoving party.” Commercial Union Ins. Co. v. Sea Harvest Seafood Co., 251 F.3d 1294, 1298 (10th Cir. 2001).

         Defendant argues that it is entitled to summary judgment on Plaintiff’s claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Much of Defendant’s motion relies on its contemporaneously-filed motion to exclude testimony of Dr. Rothfeder (ECF No. 32) being granted, but the court recently denied that motion in part, allowing Dr. Rothfeder to offer testimony that Mr. Jahries fell and died as the exclusive result of that fall. (ECF No. 49.) Such testimony, if believed by the jury, “may affect the outcome of the litigation” and therefore creates genuine issues of material fact that preclude Defendant from being granted summary judgment. See Anderson, 477 U.S. at 248.

         A. Defendant is not entitled to summary judgment on Plaintiff’s claim for breach of contract.

         Defendant argues that it is entitled to summary judgment on Plaintiff’s claim for breach of contract because, as a matter of law, Plaintiff cannot establish the elements of a covered loss under the Policy and because Mr. Jahries’s death is explicitly excluded under the Policy.

         Defendant asserts, and for purposes of this motion Plaintiff does not contest, that Plaintiff must prove four elements in order to prevail on her breach of contract claim and recover under the Policy: 1) Mr. Jahries died directly from a blunt cranial trauma suffered in a slip-and-fall; 2) Mr. Jahries died from a blunt cranial trauma independently from all other causes; 3) the blunt cranial trauma was evidenced by a visible contusion or wound; and 4) the blunt cranial trauma was the sole cause of ...


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