United States District Court, D. Utah
MEMORANDUM DECISION AND ORDER ORDER DENYING IN PART
AND GRANTING IN PART MOTION FOR SUMMARY JUDGMENT
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.
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.)
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.
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.
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
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.)
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).
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.
Defendant is not entitled to summary judgment on
Plaintiff’s claim for breach of contract.
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.
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 ...