Phan v. Metropolitan Life Insurance Company
Filing
44
Judge Douglas P. Woodlock: MEMORANDUM AND ORDER entered granting 25 Motion for Summary Judgment (Woodlock, Douglas)
UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
KIM PHAN,
Plaintiff,
v.
METROPOLITAN LIFE INSURANCE, CO.,
Defendant.
)
)
)
)
)
)
)
)
)
CIVIL ACTION NO.
12-11490-DPW
MEMORANDUM & ORDER
February 18, 2014
The Defendant, Metropolitan Life Insurance, Co., issued a
life insurance policy to Tuc Phan.
That policy provided a basic
“death benefit” and included a rider providing for payment of an
additional amount in the case of “accidental death.”
The policy
also included an exclusion that the accidental death benefit
would not be available if death was in “any way” the result of
physical illness.
After Mr. Phan died on August 10, 2011, MetLife paid the
amount of the basic death benefit to his surviving spouse and
insurance beneficiary, Kim Phan--the plaintiff.
Mrs. Phan made a
claim for payment of the additional insurance amount provided
under the Accidental Death Rider.
When MetLife denied that claim, contending that the
circumstances and cause of Mr. Phan’s death fell outside of the
scope of the rider’s coverage, Mrs. Phan brought this lawsuit,
asserting claims of breach of contract, breach of the covenant of
-1-
good faith and fair dealing, and violation of Massachusetts
General Law, Chapter 93A.
MetLife has now moved for summary
judgment on all of Mrs. Phan’s claims.
I. BACKGROUND
A.
The Life Insurance Policy
The decedent, Tuc Phan, was an insured individual and
covered person under a life insurance policy issued by MetLife to
Connecticut National Bank, N.A.
In addition to a general “death
benefit” payable upon the death of a covered person regardless of
cause, the insurance policy contains a rider providing an
“Accidental Death Benefit” in the amount of $50,000.
The
Accidental Death Rider explains that “[i]f a Covered Person dies
in an accident, [MetLife] will pay Accidental Death Benefits . .
. if that accident is the sole cause of death.”
The “Exclusions”
section of the rider provides that MetLife “will not pay for a
loss of life if it in any way results from, or is caused or
contributed to:
by . . . physical or mental illness, diagnosis
of or treatment for the illness.”1
1
In her opposition briefing, Mrs. Phan contends that
MetLife has failed to produce certain sections of the life
insurance contract, including specifically Connecticut National
Bank, N.A.’s application for group coverage. Despite the close
of discovery, Mrs. Phan never raised this issue before she filed
her opposition briefing. Consequently, I consider this issue
waived. Further, my own review of the life insurance policy in
the record indicates it is complete. The allegedly missing
application is located at Page 17 of Exhibit 1 to MetLife’s
memorandum in support of its motion for summary judgment.
-2-
B.
Tuc Phan’s Death
On August 10, 2011, Trooper George Katsarakes of the
Massachusetts State Police was alerted to an unidentified
individual heading the wrong way on the northbound lane of
Interstate 95 in Boxford, Massachusetts.
A fair reading of
Trooper Katsarakes’ report indicates that, while proceeding to
the area, he observed one vehicle pulled over in the North bound
breakdown lane of Interstate 95 and what appeared to be the tail
lights of another vehicle in the brush lined border of the woods.
It is unclear from the narrative report whether either of these
vehicles had been the car reported going the wrong way on
Interstate 95.
A chart attached to the report suggests that Mr.
Phan’s car crossed the median strip and the northbound lane
heading south before coming to rest at the border of the woods.2
Trooper Katsarakes reported that he approached a man
(presumably in the car in the breakdown lane) who indicated that
there was a male driver (later identified as Mr. Phan) slumped
over the front seat (presumably of the car in the brush bordering
the road) with his seatbelt still secured.
Trooper Katsarakes
reported that the airbag had not deployed and the damage to the
vehicle was less than $1,000.
The trooper found Mr. Phan without
2
Because the circumstances of the incident in the end prove
immaterial to the outcome of the motion before me, I need not
strain to fill in the evidentiary blanks in the record regarding
the incident and whether it may be characterized as an accident.
-3-
a pulse or signs of breathing, removed him from his vehicle, and
began to administer CPR on-scene until the arrival of emergency
medical services.
EMS performed acute cardiovascular life
support (“ACLS”); despite these efforts and the administration of
five doses of epinephrine, Mr. Phan remained asystolic--meaning
that he had no cardiac activity.
EMS transported Mr. Phan to Beverly Hospital where ACLS
protocol was continued.
Upon arrival at the hospital, Mr. Phan
was found pulseless and asystolic with his pupils fixed and
dilated, but without obvious signs of trauma or open wounds.
Mr.
Phan was administered calcium and bicarbonate without any change
in his condition.
At 10:48 pm, given that the patient was
asystolic for more than 40 minutes prior to arrival at the
hospital and that this condition persisted after arrival in the
emergency department, Mr. Phan was pronounced dead by the
treating physician.
On August 12, 2011, an autopsy was performed by Dr. Henry
Nields, Chief Medical Examiner for the Commonwealth of
Massachusetts.
In his autopsy report, Dr. Nields listed the
“Cause of Death” as:
I.
II.
Hypertensive and Atherosclerotic Cardiovascular Disease
Blunt Trauma to Chest
Dr. Nields reported the manner of death as: “Accident (Driver of
Motor Vehicle Drove Off Highway Into a Wooded Area.)”
Under “Injuries, external and internal,” Dr. Nields stated
-4-
that “[t]here is an approximately 1 inch laceration to the portal
area of the liver.
There are approximately 250 cc of blood in
the abdominal cavity.”
Under “Cardiovascular System,” Dr. Nields observed that:
There is mild atherosclerosis of the aorta and iliac
arteries. The vena cava and pulmonary arteries are
without thrombus or embolus. The heart weighs 530 g
and has a normal distribution of right predominant
coronary arteries with 85-90% stenosis of the proximal
left anterior descending coronary artery and 10%
stenosis of the left circumflex and right coronary
arteries. The myocardium is uniform, firm and reddishbrown. The left ventricular wall measures 1.3 cm in
thickness. The endocardial surfaces and four cardiac
valves are unremarkable.
A medical examiners’ certificate of death was issued on
August 16, 2011 by the Commonwealth of Massachusetts.
That
certificate listed the “Immediate Cause” of death as
“Hypertensive and Atherosclerotic Cardiovascular Disease.”
It
listed “Blunt Trauma to Torso” as an “other significant condition
contributing to death.”
C.
Mrs. Phan’s Claim
On or about August 31, 2011, Mrs. Phan submitted a life
insurance claim form to MetLife.
MetLife paid the amount of the
basic death benefit to Mrs. Phan on September 13, 2011 and
requested that Mrs. Phan provide a copy of the autopsy report and
accident report.
After receiving these materials, MetLife
informed Mrs. Phan by letter dated February 24, 2012 that they
were denying her claim for the “Accidental Death Benefit.”
-5-
MetLife explained that, under the terms of the Accidental Death
Rider “even if there was an accidental component to the death,
the accident was not the ‘sole cause of death’ as the medical
examiner’s findings [was] that cardiovascular disease was the
immediate cause of death . . . [T]he physical exclusion applies
for the same reason.
The death resulted from, or was caused or
contributed to by the decedent’s heart disease.”
D.
MetLife’s Expert Declaration
In support of its motion for summary judgment, MetLife has
submitted an affidavit from Dr. Bruce Goldman, a physician
specializing in autopsy pathology and cardiovascular pathology.
[Dkt. 26-14, ¶ 1].
Dr. Goldman opined that:
the cause of death in this case is hypertensive and
atherosclerotic cardiovascular disease. Mr. Phan’s
cardiac hypertrophy is demonstrated by the finding of
severe cardiomegaly, i.e. that his heart weighed 530
grams (a normal adult heart typically weighs less than
400 grams). The ‘severe single vessel coronary artery
sclerosis’ is demonstrated by the finding of an ‘85-90%
stenosis of [Mr. Phan’s] proximal left anterior
descending coronary artery.’
Dr. Goldman also opined that:
[T]he liver injury and hemoperitoneum found at autopsy
were the result of resuscitative efforts. The location
of the laceration of the liver on the portal (deep
undersurface) of the liver is most consistent with
injury related to ‘aggressive’ chest compression during
CPR . . . If this injury had occurred because of the
automobile crash, then one would expect evidence of
other trauma, e.g., to the body wall, chest, and/or
anterior surface of the liver, none of which was
evident at autopsy . . . Finally, it cannot be
postulated that Mr. Phan died as a result of the liver
injury, since the amount of blood found in the abdomen
-6-
is not sufficient to cause death from hypovolemic
shock, which typically requires loss of at least a
quarter of blood volume (i.e. approximately 1.5 L or
more).
E.
The Plaintiff’s Expert Declaration
As part of her opposition to MetLife’s motion for summary
judgment, Mrs. Phan submitted an expert declaration from Dr.
Robert Belliveau, M.D.
In that declaration, Dr. Belliveau opined
that:
Mr. Phan died accidentally due to blunt trauma causing
a sudden and unexpected cardiac event in reaction to
his vehicle leaving the road. Mr. Phan did not die of
medical disease of any kind, including renal disease or
arteriosclerotic cardiovascular disease . . . There is
no evidence in the medical examiner’s report or in any
other document that I reviewed stating that a
thrombosis totally cut-off the blood supply to Mr.
Phan’s heart causing a sudden cardiac arrest . . . The
medical examiner’s report states that Mr. Phan had an
85% to 90% stenosis of the proximal left anterior
descending coronary artery. I have never observed a
sudden cardiac death from the proximal left anterior
descending coronary artery without a thrombosis. For
this reason . . . a thrombosis or occlusion to the
proximal left anterior descending coronary artery did
not cause a sudden cardiac arrest.
II. STANDARD OF REVIEW
Federal Rule of Civil Procedure 56 “mandates the entry of
summary judgment, after adequate time for discovery and upon
motion, against a party who fails to make a showing sufficient to
establish the existence of an element essential to that party’s
case, and on which that party will bear the burden of proof at
trial.”
Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986).
question is whether, viewing the facts in the light most
-7-
The
favorable to the nonmoving party, there is a “genuine dispute as
to any material fact.”
Fed. R. Civ. P. 56(a); Casas Office
Machines, Inc. v. Mita Copystar Am., Inc., 42 F.3d 668, 684 (1st
Cir. 1994).
III. ANALYSIS
In her complaint, Mrs. Phan asserts three causes of action:
(1) Breach of Contract; (2) Breach of the Covenant of Good Faith
and Fair Dealing; and (3) Violation of Massachusetts General Law,
Chapter 93A, Section 9.
At the outset, however, I must determine
the applicable source for the rules of decision.
A.
Choice of Law
Mrs. Phan has come to argue that MetLife improperly relies
upon Massachusetts law in support of its motion for summary
judgment and that Rhode Island law applies instead.3
The reason
Defendant has chosen Massachusetts law is understandable; Mrs.
Phan asserted her claims and has litigated this case under
Massachusetts law.
Plaintiff’s counsel set forth the basis for
Mrs. Phan’s claims in a Chapter 93A letter sent to MetLife.
That
letter, which provides the predicate for Count II of her
complaint under Massachusetts statutory law, cites almost
3
Mrs. Phan’s position is that the life insurance policy was
delivered in Rhode Island, that the original policy holder was
Connecticut National Bank, N.A., DBA Shawmut Bank of Rhode
Island, Trustee, an entity which was doing business in Rhode
Island, and that these facts require the application of Rhode
Island law.
-8-
exclusively to Massachusetts case-law and statutes, and makes no
reference to Rhode Island law.
In Count II of her complaint,
Plaintiff is even more explicit about the applicability of
Massachusetts common law, alleging that: “Metlife breached the
covenant of good faith and fair dealing implied in the terms of
the Life Policy under the law of the Commonwealth of
Massachusetts by failing to pay benefits due as reasonably
expected by an insured under that Life Policy.”
added.)
(Emphasis
Despite the belated assertion of Rhode Island law in the
summary judgment briefing, no effort has ever been made by the
Plaintiff to amend her complaint to allege Rhode Island as the
source of law.
I need not determine whether to indulge the plaintiff’s
effort to execute a previously unannounced about-face regarding
the applicable law.
“It is axiomatic that ‘[t]he first step in
performing a choice of law analysis is to determine whether there
is a conflict between the substantive laws of the interested
jurisdictions.’”
O’Connell v. Federal Ins. Co., 484 F. Supp. 2d
223, 225 n.3, (D. Mass. 2007) (citing Millipore Corp. v.
Travelers Indemnity Co., 115 F.3d 21, 29 (1st Cir. 1997)).
As
will be seen below, I discern no distinction between the law of
Rhode Island and Massachusetts that makes any difference in this
case as pled and so I need not address the dispute between the
-9-
parties on this point.4
See Lambert v. Kysar, 983 F.2d 1110,
1114 (1st Cir. 1993) (“We need not resolve the issue [of which
state law applies], however, as the outcome is the same under the
substantive law of either jurisdiction.”).
B.
Breach of Contract and of the Covenant of Good Faith
1.
Interpretation of the Contract
“[T]he rules governing the interpretation of insurance
contracts are the same as those governing the interpretation of
any other contract.”
Sullivan v. Southland Life Ins. Co., 854
N.E.2d 138, 141 (Mass. App. Ct. 2006) (internal citation and
quotation marks omitted).5
In a coverage dispute, the “insured bears the initial burden
of proving that the claimed loss falls within the coverage of the
insurance policy.”
Boazova v. Safety Ins. Co., 968 N.E.2d 385,
390 (Mass. 2012).6
If an insured carries this initial burden,
4
Rhode Island law does provide for a common law bad faith
claim which is distinct from a claim for breach of the implied
covenant of good faith and fair dealing. See Zarrella v.
Minnesota Mut. Life Ins. Co., 824 A.2d 1249, 1261 (R.I. 2003).
Mrs. Phan, however, has not pled any such claim. In any event,
as will become clear in this Memorandum, even if this claim had
been pled, it would not survive summary judgment. See Note 16,
infra.
5
Accord Gregelevich v. Progressive Northwestern Insurance
Co., 882 A.2d 594, 595 (R.I. 2005) (Rhode Island courts construe
the terms of an insurance policy “according to the same rules of
construction governing contracts.”).
6
Accord General Accident Insurance Company of America v.
American National Fireproofing, Inc., 716 A.2d 751, 757 (R.I.
1998) (“[T]he insured seeking to establish coverage bears the
-10-
“the burden then shifts to the insurer to show that a separate
exclusion to coverage is applicable to the particular
circumstances of the case.”
Id. at 390.7
Here, the relevant coverage provision requires Mrs. Phan to
show that Mr. Phan died “in an accident” and that “that accident
is the sole cause of death” and excludes coverage if MetLife is
able to demonstrate that the loss of life is “caused or
contributed to by . . . physical . . . illness.”
Mrs. Phan contends that this clause is ambiguous because the
terms “accident” and “in an accident” are not defined within the
life insurance policy and that this ambiguity precludes entry of
summary judgment.
While it is true that the precise contours of
the meaning of the term “accident” are not well defined, see
Wickman v. Northwestern Nat. Ins. Co., 908 F.2d 1077, 1086-87
(1st Cir. 1990) (“Probably the best definition is [Justice]
Cardozo’s tautology that an accident is what the public calls an
accident.”),8 I need not mark with precision the outer bounds of
burden of proving a prima facie case, including . . . the
existence . . . of a policy.”).
7
Accord General Accident Insurance, 716 A.2d at 757 (“The
insurer then bears the burden of proving the applicability of
policy exclusions and limitations in order to avoid an adverse
judgment.”).
8
Drawing language from a Pennsylvania Supreme Court case,
the Wickman court asked: “What is an accident? Everyone knows
what an accident is until the word comes up in court. Then it
becomes a mysterious phenomenon, and, in order to resolve the
enigma, witnesses are summoned, experts testify, lawyers argue,
-11-
what may be termed an accident to resolve this dispute.
Rather
it is sufficient to recognize that death from disease is not an
“accidental” death.
This is a proposition that is well-
established in the law and does not appear to be disputed by
either party.
See, e.g., Vickers v. Boston Mut. Life Ins. Co.,
135 F.3d 179, 180 (1st Cir. 1998) (explaining that death may be
“held to be the result of accident rather than of disease”)
(citations omitted); Gay v. Stonebridge, 660 F.3d 58 (1st Cir.
2011) (distinguishing between “accidental” death from trauma and
non-accidental death resulting from stroke).
If an accident was
not the “sole cause” of Mr. Phan’s death or his death results
from “in any way” or was contributed to by disease (and more
precisely in this case, cardiovascular disease), then Mrs. Phan
is not eligible for recovery under the Accidental Death Rider.
Gay is helpful in understanding the scope and application of
the coverage terms in Mr. Phan’s policy.
There, the insurance
policy at issue “provided for coverage if the death was caused by
an accident ‘directly and independently of all other causes,’ and
denied coverage if the death was caused by an injury ‘due to
disease, bodily or mental infirmity, or medical or surgical
treatises are consulted and even when a conclave of twelve
world-knowledgeable individuals agree as to whether a certain set
of facts made out an accident, the question may not yet be
settled, and it must be reheard in an appellate court.” Wickman
v. Northwestern Nat. Ins. Co., 908 F.2d 1077, 1086-87 (1st Cir.
1990) (quoting Brenneman v. St. Paul Fire and Marine Ins. Co.,
192 A.2d 745, 747 (Pa. 1963)).
-12-
treatment of these.’” Gay, 660 F.3d at 60.
The district court
determined (in a ruling that was not challenged on appeal) that
this policy language “required [the plaintiff] to prove that the
skull fracture resulting from the fall was ‘the direct cause of
[the decedent’s] death independent of any preceding medical
condition; that is, that the fall, as opposed to the stroke, was
the “dominant cause” of her death.’” Id. (citations omitted).
Moreover, “because the evidence indicated that more than one
factor contributed to [decedent’s] death--the stroke and the
skull fracture--[the plaintiff] bore the burden of separating out
the consequential causes from the inconsequential causes of . . .
death.”
Id.
The language in Mr. Phan’s policy, requiring that the
accident be the “sole cause of death” and providing an exclusion
where the loss of life is “in any way results from, or is caused
or contributed to: by . . . physical or mental illness,” is at
least as demanding as the language in the policy at issue in Gay
requiring that death be caused by accident “independent[] of all
other causes.”
To survive summary judgment, Mrs. Phan must at
least clear the hurdle set by the district court in Gay.
2.
The Factual Evidence Regarding the Cause of Death
In support of its motion for summary judgment, the Defendant
has offered several pieces of evidence to establish that the
death was caused by cardiovascular disease.
-13-
First, the autopsy
report of Dr. Nields lists the “Cause of Death” as “I.
Hypertensive and Atherosclerotic Cardiovascular Disease, II.
Blunt Trauma to Chest.”
This finding was supported in the
autopsy report by the finding of a “85-90% stenosis of the
proximal left anterior descending coronary artery.”
That
determination was reiterated in the death certificate issued by
the State of Massachusetts, which listed the “Immediate Cause” of
death as “Hypertensive and Atherosclerotic Cardiovascular
Disease” and indicated that “Blunt Trauma to Torso” was an “other
significant condition contributing to death.”9
Finally, the
Defendant’s expert corroborates this theory with his opinion.
Like Dr. Nields’ findings, Dr. Goldman’s opinion that “the cause
of [Mr. Phan’s] death . . . is hypertensive and atherosclerotic
cardiovascular disease” is supported by “the finding of severe
cardiomegaly . . . and the finding of an ‘85-90% stenosis of
[the] proximal left anterior descending coronary artery.’”
The medical evidence regarding the cause of death is
corroborated the circumstantial evidence in the police and
emergency room reports, which provide no evidence of a traumatic
accident.
The police report indicates that Mr. Phan was found in
his car with the airbag undeployed and less than $1,000 damage to
the car.
The emergency report from the admitting hospital
9
The Standard Form Certificate of Death indicates that the
line for the “Immediate Cause” of death should be filled in with
the “Final disease or condition resulting in death.”
-14-
indicated that there were “no obvious signs of trauma” and “no
open wounds.”
To rebut this evidence, Mrs. Phan relies primarily on two
sources.
First, she points to the statement in the autopsy
report of Dr. Nields which indicates that the “manner of death”
was an “Accident (Driver of Motor Vehicle Drove Off Highway Into
a Wooded Area.)”
This single statement in the autopsy report,
however, cannot be considered out of context.
Taken as a whole,
the autopsy report clearly conveys Dr. Nields’ opinion that one
of the “cause[s] of death” (and, indeed, the primary, if not
only, one), was cardiovascular disease.10
The second, and more substantial piece of evidence, is the
expert opinion of Dr. Belliveau.
In his declaration, Dr.
Belliveau opined that “Mr. Phan died accidentally due to blunt
trauma causing a sudden and unexpected cardiac event in reaction
to his vehicle leaving the road.”
For two reasons, that opinion is insufficient to avoid
summary judgment.
First, assuming that the events occurred
precisely as Dr. Belliveau described them, the sequence describes
a death that was contributed to by cardiac disease.
10
In Vickers,
I note, of course, that this opinion is not necessarily
determinative. See Vickers v. Boston Mutual Life Ins. Co., 135
F.3d 179, 180 (1st Cir. 2008) (In an autopsy report, the state
medical examiner “choosing between ‘Natural’ and ‘Accident,’ [for
the manner of death] . . . chose ‘Accident.’ Whether this was an
accident within the policy terms, however, depends upon the
policy terms.”)
-15-
135 F.3d at 181 (citing Bohaker v. Travelers’ Insurance Co., 102
N.E. 342, 344 (Mass. 1913)), the First Circuit explained:
A sick man may be the subject of an accident, which but
for his sickness would not have befallen him. One may
meet his death by falling into imminent danger in a
faint or in an attack of epilepsy. But such an event
commonly has been held to be the result of accident
rather than of disease.
However, if the converse occurs and an accident11 triggers a
fatal episode of disease, the ultimate fatality is “caused or
contributed to” by disease, rather than by (or, at very least, as
well as by accident).
In this setting, an accident is not the
“sole cause” of death.
The converse is what Dr. Belliveau
postulates; that some accident precipitated an episode of fatal
cardiovascular disease.
This is explained succinctly in a
colloquy during Dr. Belliveau’s deposition:
Q:
. . . [Y]ou think Mr. Phan was sort of scared to
death and had a heart incident?
A:
Yes.
Q:
That was the cause of his death?
A:
Yes.
Q:
And your position is that that’s an accidental
death?
A:
Yes.
11
I assume for present purposes that the incident may be
characterized as an accident despite the blanks in the record
regarding the circumstances. See Note 2, supra, and accompanying
text.
-16-
Q:
But whatever was found in autopsy in terms of
heart defects, that certainly contributed to his
coronary event?
A:
Yes.
This testimony, from the plaintiff’s own expert, shows that heart
disease was at least a contributing factor to Mr. Phan’s death.12
The facts asserted by Dr. Belliveau are distinguishable from
those in Vickers.
In Vickers, the decedent suffered a heart
attack which, alone, was insufficient to cause the decedent’s
death.
That heart attack, however, precipitated a fatal car
crash.
Vickers, 135 F.3d at 180 (“The undisputed facts are that
12
Under similar circumstances, where a policy provided for
coverage “only if the death of the insured results as a
consequence of bodily injury effected solely through external,
violent, and accidental means within sixty days after such injury
independently and exclusively of all other causes” and would “not
be payable if the death of the insured results directly or
indirectly from disease or from bodily or mental infirmity,” the
Massachusetts Supreme Judicial Court has denied coverage where a
doctor, called by the plaintiff, “agreed that ‘the disease of the
heart actively cooperated with the accident to cause this death,’
a statement which, if believed, showed that the heart disease was
sufficiently a cause of the insured’s death to make it a
‘contributing’ cause, so that the injuries could not be the sole
cause ‘independently of all other causes.’” Brown v. U.S.
Fidelity & Guaranty Co., 147 N.E.2d 160, 161-163 (Mass. 1958).
See also Howe v. National Life Ins. Co., 72 N.E.2d 425 (Mass.
1947) (denying coverage under policy requiring that fatality
result “from bodily injury effected solely and exclusively by
violent, external, and accidental means” “independently of all
other causes” where evidence showed death resulted from “joint
operation of a pre-existing disease and an accident”); Bouchard
v. Prudential Ins. Co. of America, 194 A. 405, 406-07 (Me. 1937)
(denying coverage death for death resulting from combination of
heart disease and physical blows under exclusion for loss of life
resulting “directly or indirectly from bodily or mental infirmity
or disease in any form”).
-17-
the crash was caused by Vicker's heart attack, but the sole
physiological cause of death was the physical injury sustained in
the crash.
The heart attack alone would not have been fatal.”).
Taking as true Dr. Belliveau’s assumption that some accident
occurred and precipitated a heart attack, Dr. Belliveau’s
testimony is that the accident alone was not a fatal one.
Rather, the immediate and consequential cause of death was a
coronary event caused by disease.
The logic of Vickers dictates
that such a fatality is one caused by disease, not by accident.13
Dr. Belliveau’s opinion is insufficient for a second reason.
While he postulates that Mr. Phan’s cardiac event was brought
about by a preceding accident, the Plaintiff has set forth no
evidence that any such accident actually took place.
Dr.
Belliveau was able to say only that Mr. Phan’s cardiac event was
“concurrent to his leaving the road,” and he was unable to rule
out the possibility that “the cardiac event caused [Mr. Phan] to
lose control of his vehicle” resulting in Mr. Phan veering off
13
The present case is distinguishable from Vickers v.
Boston Mut. Life Ins. Co., 135 F.3d 179 (1st Cir. 1998) in
another way. The exclusion in the insurance policy in Vickers
provided that “[n]o benefit will be paid for loss resulting from
. . . [s]ickness, disease or bodily infirmity.” Id. at 180.
This is a narrower exclusion than that in Mr. Phan’s policy which
excludes coverage where death “in any way results from, or is
caused or contributed to by” illness. See Louis v. Genworth Life
and Health Ins. Co., 2008 WL 4450264 (D. Mass. 2008)
(distinguishing Vickers and explaining that a “if [plaintiff’s
pre-existing] condition played any role in his fall, it would
also be consistent with a layman’s understanding to say that his
condition contributed to his disability”) (emphasis in original).
-18-
the road.14
In his declaration, Dr. Belliveau explains that
“[d]eath from cardiovascular disease may be associated with
accidental circumstances.”
14
The possible association of events,
Dr. Belliveau’s testimony was as follows:
Q.
So is it your testimony that you don't know whether Mr. Phan
had a cardiac event that caused him to leave the road or
that it happened after he left the road?
A.
My opinion is that he had a cardiac event which caused him
to -- concurrent to his leaving the road. I believe he had a
reaction to the loss of control of his vehicle.
Q.
Well, it is possible, is it not, that the cardiac event
caused him to lose control of his vehicle?
A.
Anything is possible.
Q.
Can you rule that out?
A.
Not absolutely, no.
Q.
Well, do you rule it out?
A.
No.
Q.
And again, based on the opinions that you have formulated in
this case, would you have filled the certificate of death
out differently than Dr. Nields filled it out?
A.
No.
. . .
A.
. . . It is my opinion that he lost control of his vehicle
and the experience of that caused him to have a cardiac
event.
Q.
What’s the basis of that?
A.
My opinion.
My experience.
-19-
however, does not demonstrate that such is the case here.15
The trial court in Gay v. Stonebridge Life Ins. Co., 585
F.Supp.2d 171 (D. Mass. 2008), was faced with a situation that is
instructive here.
There, the defendants presented evidence, in
the form of a death certificate and testimony from the physician
performing the autopsy, indicating that the cause of death was a
stroke--which neither side denied fell outside of the accidental
coverage policy.
Id. at 173-74.
The claim survived summary
judgment, however, because the plaintiff was able to present
evidence showing that the decedent fell, striking her head and
fracturing her skull, and that this head trauma resulting from “a
trip and fall” was sufficient alone to explain the medical
evidence surrounding the insured’s demise.
Id. at 174.
Nevertheless, judgment was ultimately entered for the insurer
after trial.
Gay v. Stonebridge, 660 F.3d 58.
15
Both parties’ experts agree that the liver injury noted
in the autopsy report was insufficient to have caused Mr. Phan’s
death and that it did not precede the cardiac event. As Dr.
Belliveau explained: “[i]f his heart had been beating, given the
degree of the laceration, there would have been a massive bleed
into the abdomen.”. For much this reason, plaintiff appears to
have abandoned its earlier theory, set forth in its Chapter 93A
demand letter, that trauma to the liver was the cause of death.
Faced with a similar absence of evidence regarding the cause
of an alleged accident (arising in the context of deferential
ERISA review), the First Circuit rejected as “speculation” a
claimant’s suggestion that an “accident could have been caused by
an attempt to avoid a collision with another vehicle or with an
animal.” Stamp v. Metropolitan Life Ins. Co., 531 F.3d 84, 94
(1st Cir. 2008).
-20-
Here, in contrast, Mrs. Phan has failed to show evidence of
some accident sufficiently grave to cause Mr. Phan’s death, while
MetLife has provided ample evidence that his death was caused by
cardiovascular disease.
On such a record, it would be simply
impossible for any reasonable jury to conclude that Mr. Phan’s
death was caused by an accident.
3.
The Covenant of Good Faith and Fair Dealing
The failure to present sufficient evidence of a breach of
contract dooms Mrs. Phan’s claim for a breach of the covenant of
good faith and fair dealing as well.
Under Massachusetts law,
the covenant of good faith “may not . . . be invoked to create
rights and duties not otherwise provided for in the existing
contractual relationship, as the purpose of the covenant is to
guarantee that the parties remain faithful to the intended and
agreed expectations of the parties in their performance.”
Uno
Restaurants v. Boston Kenmore Realty Corp., 805 N.E.2d 957, 964
(Mass. 2004).16
Because MetLife had no obligation to pay the claims under
the terms of the “Accidental Death Rider” to Mr. Phan’s insurance
16
Similarly, under Rhode Island law, a bad faith insurance
claim “does not exist until the plaintiff first establishes a
breach of contract.” Wolf v. Geico Ins. Co., 682 F. Supp. 2d
197, 198 (D.R.I. 2010). See also Lamoureaux v. Merrimack Mut.
Fire Ins. Co., 751 A.2d 1290, 1293 (R.I. 2000) (per curiam)
(“Before a bad-faith claim can even be considered, a plaintiff
must prove that the insurer breached its obligation under the
insurance contract.”).
-21-
policy, the covenant of good faith and fair dealing cannot be
invoked to impose liability based upon MetLife’s denial of Mrs.
Phan’s claims.
C.
Massachusetts General Law Chapter 93A
Although Mrs. Phan asserts a range of allegations in support
of her claim under Mass. Gen. Laws c. 93A, those allegations can
be classified as falling into two categories: (1) bad faith and
unfair refusal to pay benefits owed under the Accidental Death
Rider; and (2) selling a life insurance policy that failed to
meet the standards required by Massachusetts law.
The first of these fails for essentially the reasons the
claims for breach of contract and breach of the covenant of good
faith and fair dealing fail.
Under Massachusetts law, Chapter
93A does not apply where the parties are engaged in a good faith
dispute regarding the meaning of a contract.
Spence v. Berkshire
Life Ins. Co., 561 F. Supp. 2d 126, 130 (D. Mass. 2008).
See
also Duclersaint v. Fed. National Mortgage Ass’n, 696 N.E.2d 536,
540 (Mass. 1998) (“[A] good faith dispute as to whether money is
owed, or performance of some kind is due, is not the stuff of
which a c. 93A claim is made.”).
Having prevailed on the
contract claim, it is clear that MetLife’s position was a good
faith and reasonable one, and accordingly, MetLife’s denial of
Mrs. Phan’s claim does not violate Chapter 93A.
See Graham v.
Malone Freight Lines, 948 F. Supp. 1124, 1139 (D. Mass. 1996)
-22-
(Chapter 93A claim was invalid where insurer had “good faith
basis” for refusing to settle claim “since liability was not
reasonably clear.”).
As to the second category of alleged Chapter 93A violation,
beyond alleging that the insurance policy sold by MetLife was
unfairly ambiguous--an allegation disposed of by the discussion
above--Plaintiff has failed to set forth reasons that MetLife’s
policy is unsatisfactory.
Summary judgment is the moment in a
case when litigants must show that their claims have evidentiary
support.
See Maldonado-Denis v. Castillo-Rodriguez, 23 F.3d 576,
581 (1st Cir. 1994) (“[A] party opposing summary judgment must
‘present definite, competent evidence to rebut the motion.’”)
(quoting Mesnick v. General Elec. Co., 950 F.2d 816, 822 (1st
Cir. 1991)).
Because the Plaintiff has failed to do so here,
summary judgment is appropriate.
IV.
CONCLUSION
For the reasons set forth more fully above, defendant’s
motion for summary judgment, Dkt. No. 25, is GRANTED.
/s/ Douglas P. Woodlock
DOUGLAS P. WOODLOCK
UNITED STATES DISTRICT
-23-
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?