Timmins v. Stonebridge Life Insurance Company
Filing
71
ORDER GRANTING Plaintiff's 63 Motion for Leave to File Sur-Reply; GRANTING Defendant's 70 Motion for Leave to File Sur-Reply; GRANTING Defendant's 59 Motion for Summary Judgment. Signed by Judge Sam Sparks. (klw)
IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF TEXAS
AUSTIN DIVISION
PATRICIA TIMMINS,
Plaintiff,
Case No. A-13-CA-894-SS
-vs-
STONEBRIDGE LIFE INSURANCE COMPANY,
Defendant.
ORDER
BE IT REMEMBERED on this day the Court reviewed the file in the above-styled cause, and
specifically Defendant Stonebridge Life Insurance Company's Second Motion for Summary
Judgment [#59], Plaintiff Patricia Timmins's Response [#60] thereto, Defendant's Reply [#62]
thereto, Plaintiffs Motion for Leave to File Sur-Reply [#63],' Defendant's Response [#65] thereto,
Plaintiffs Post-Hearing Brief [#67], Defendant's Response [#68] thereto, Plaintiffs Reply [#69]
2
Having reviewed the
thereto, and Defendant's Motion for Leave to File Sur-Reply [#70]
documents, the arguments of the parties during hearing before the Court, the governing law, and the
file as a whole, the Court enters the following opinion and orders.
Background
This case began as a dispute over Defendant Stonebridge Life Insurance Company's
obligation to pay Plaintiff Patricia Timmins a $25,000 accidental death benefit under the terms of
The Court GRANTS Plaintiffs Motion for Leave to File Stir-Reply [#63], and has considered the arguments
in the Sur-Reply [#63-2] attached to the motion in making its rulings.
The Court GRANTS Defendant's Motion for Leave to File Sur-Reply [#70] and has considered the arguments
in the Sur-Reply [#70-2] attached to the motion in making its rulings.
2
her husband's insurance policy following her husband's death. Several months after this suit was
filed, Stonebridge paid the death benefit in full. Despite Stonebridge's decision to pay, however, an
acerbic battle between the parties' attorneys blossomed into the embarrassment of snarky pleadings
presently before the Court. Underlying the continued conflict is the question whether Stonebridge
will be required to pay, in addition to the amount of the claim already paid, statutory interest and
attorney's fees.
See TEX. INS.
CODE
§
542.060(a). Attorneys' fees and costs have no doubt
continued to accrue for all parties involved.
The insurance policy in question provides for payment of a $25,000 accidental death benefit
if an insured suffers an accidental fatal "injury." Def.'s Am. Mot. Summ.
J. [#38-1], Ex. A
(Certificate of Insurance I), at 7. An "injury" is defined by the policy as a "bodily Injury.
. .
caused
by an accident" which "results in Loss covered by the Policy" and "creates a Loss due, directly and
independently of all other causes, to such accidental bodily Injury." Def.'s Second Mot. Summ. J.
[#59-1], Ex. A (Certificate of Insurance 11), at 2. The policy contains a number of exclusions
rendering the benefit non-payable, including injury "due to disease, bodily or mental infirmity, or
medical or surgical treatment of these" and injury that "does not directly and independently of all
other causes create a Loss." Id. at 4.
Plaintiff's husband died on September 19,2011 while alone in his home; Plaintiff found him
and contacted the Blanco County EMS. EMS records show the dispatch was for "Cardiac Arrest."
Def.'s Am. Mot. Summ. J. [#38-1], Ex. C (EMS Records), at
1.
Upon arrival, EMS found Mr.
Timmins "sitting in the corner of the bathroom, with his hands wrapped around a toilet that ha[d]
Neither party attached the complete policy to its pleadings on the instant motion. Certificate of Insurance I,
attached to Stonebridge's pleadings on this motion, is an excerpt from the policy; the complete document, Certificate
of insurance II, is attached to its pleadings on a previous motion.
-2-
been dislodged from the floor and [was] leaning against [him]." Id. There was "[a] significant
amount of blood.
floor." Id.
.
.
in and around [his] mouth and nostrils, down [his] front" and "on the bathroom
Family members told EMS Mr. Timmins suffered from lung cancer; had been
experiencing weakness and "syncopal episodes," the medical term for fainting spells, following
radiation and chemotherapy treatment; had lesions of the esophagus which caused him to spit up
blood; and had "a cardiac history." Id. EMS concluded the death was "Presumed Cardiac" and
"Cardiac Arrest" and noted the "Reason for Encounter" was "Non-Injury." Id. at 2.
The Blanco County Sheriffs Office was also dispatched to the scene; their records accord
with the EMS records, recounting the same medical history and stating Mr. Timmins "appeared to
have suffered from a possible cardiac symptom and fell to the floor. Mr. Timmins attempted to catch
himself by grabbing the toilet.
. .
and.
. .
hit the toilet with his face causing bleeding from the nose."
Id. [#38-1], Ex. C (Sheriffs Narrative), at 1. The Sheriff concluded Mr. Timmins died from "natural
causes." Id.
The Sheriffs Office requested an inquest into the cause of Mr. Timmins' death,
see Pl.'s
App'x II [#40-1], Ex. P-7, Ex. B (Inquest Form), which was performed by Justice of the Peace Terry
Carter. Justice Carter responded to the scene of Mr. Timmins's death; his handwritten notes show
his observations of the scene and reveal he considered a number of possible causes of death,
including Mr. Timmins passing out and falling, slipping and falling, and asphyxiating.
See id. [#40-
1], Ex. P-7, Ex. B (Inquest Worksheet), at 32. Justice Carter's report concluded the death was non-
accidental given Mr. Timmins' s "COPD and other heart problems," "carcinoma," and "throat
lesions," and after consulting with Mr. Timmins's family, found no autopsy was necessary. Id. at
18-19. Justice Carter subsequently assembled a file of materials concerning Mr. Timmins, his
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medical history, and his death in preparation for producing a death certificate, see Id.
P-7 (Carter Aff.), at
¶IJ
1-3;
Id.
[#40-1], Ex.
at Ex. P-7, Ex. B (Inquest File Items List), at 6, and ultimately
concluded, as reflected in the original death certificate, that the "Manner of Death" was "Natural,"
the "Immediate" cause of Mr. Timmins' s death was "Probable Heart Attack," and the "Underlying"
causes were "Coronary Artery Disease," "Hypertension," and "Lung Cancer." Def.'s Am. Mot.
Summ. J.
[#38-1],
Ex. B (Certificate of Death), at 28.
Plaintiff notified Stonebridge of her husband's death on December
16, 2011,
and submitted
her accidental death claim forms, prepared with assistance of counsel, on August 7, 2012.
Second Mot. Summ. J.
7,
Second King Aff. ¶ 3. The materials Plaintiff provided on August
included the following: (1) an affidavit from Plaintiff;
2012,
records;
(3)
Plaintiff's
(6)
[#59-1],
See Def. 'S
(2)
the North Blanco County EMS
the Blanco County Sheriff's Office records and Inquest Form; (4) the records of
9-1-1
call;
(5)
prior medical records from Mr. Timmins's oncologist, Dr. James Uyeki;
prior medical records from Mr. Timmins's cardiologist, Dr. James Williams; (7) an obituary; (8)
the Death Certificate;
(9)
several authorizations for disclosure of medical information; and (10) a
Report of Death from the funeral director. Pl.'s App'x I
[#39-2], Ex.
P-6, Ex. B (Claim File).
On August 14,2012, Stonebridge sent a letter to Plaintiff acknowledging receipt of her claim,
but explaining since "according to the Certificate of Death.. . it was determined that the immediate
cause of death was probable heart attack" with underlying causes of coronary artery disease,
hypertension, and lung cancer, "[t]he manner of death is listed as natural," and thus "[u]ntil such
time as medical evidence is received to show Mr. Timmins's death was due to bodily Injury .
.
caused by an accident due directly and independently of all other causes," the accidental death
benefit was not payable. Id.
[#59-1],
Ex. C (King Letter), at
1-2.
Stonebridge informed Plaintiff
as she was claiming the accidental death benefit, she would need to "provide medical information
from a doctor to support your claim along with a copy of the amended Certificate of Death[,]" and
Stonebridge would be unable "to take further action until [it was] provided with additional proof of
loss[.]" Id. at 2.
Plaintiff failed to respond to Stonebridge' s August 14,2012 letter. She took no further action
concerning her claim until over a year later, when on September 18, 2013, she sent a letter and
"Motion to Reopen the Inquest" to Justice Carter requesting amendment of her husband's death
certificate. Def.'s Am. Mot. Summ. J. [#38-1], Ex. G (Riley Letter & Mot.), at 87. In the Motion,
Plaintiff stated she, through counsel, "ha[d] conducted an investigation" and "consulted with the
decedent's treating oncologist concerning [Mr. Tinimins's] state of health and the likelihood that he
died as a result of an accidental fall rather than from any pre-existing health issues." Id. Plaintiff
argued there was "substantial evidence" Mr. Timmins died from a traumatic brain injury caused by
his fall rather than from a cardiac event or complications related to lung cancer. Id. at 91. The
Motion further indicated Mr. Timmins's oncologist, Dr. Uyeki, was prepared to testify it was likely
his death was caused by traumatic brain injury rather than by cancer or cardiac arrest. Id. Plaintiff
filed this lawsuit on September 18, 2013, the same day she sent the letter and Motion to Justice
Carter.
On October 1, 2013, Justice Carter issued an amended death certificate which changed Mr.
Timmins's "Maimer of Death" from "Natural" to "Accident." Id. [#38-1], Ex. H (Am. Death
Certificate), at 94. The amended death certificate changed the "Immediate" cause of death from
'
Plaintiff filed her Original Petition in the 33rd Judicial District Court of Blanco County, Texas. See App'x
2013.
[#6] at 3 (P1.' s Orig. Pet.). Stonebridge removed the suit to this Court under its diversity jurisdiction on October 8,
See Notice Removal [#1] ¶J 2-5.
-5-
"Probable Heart Attack" to "Asphyxia by Vomitus," and listed the "Underlying" causes of death as
"Blunt Force Injury to Face," "Fall," and "Lung Cancer." Id. On November 13, 2013, Plaintiff sent
a copy of the amended death certificate, unaccompanied by any further information, to Stonebridge.
Second King Aff. ¶ 6. Stonebridge thereafter requested a copy ofJustice Carter's inquest file, which
Plaintiff provided to Stonebridge on December 4, 2013. P1.' s Resp. [#60] at ¶ 10. The inquest file
contained no new documents.
See id.
at ¶ 8; Pl.'s Resp. [#60] at ¶ 3-4.
Stonebridge then requested Mr. Timmins' s medical records directly from Mr. Timmins' s
medical providers, which it received on February 10, 2014.6 Pl.'s Resp. [#60] at 7 n.15. Nothing
in the medical records it received discussed the causes of Mr. Timmins's fall or death. Id. at ¶ 9.
That same day, Stonebridge "was informed there had been no hearing on the Motion" and Plaintiff
had provided no further evidence or testimony to Justice Carter from Dr. Uyeki or anyone else. Id.
at ¶ 12. In Stonebridge's words, "[i]n the absence of anything to support or refute the finding in the
Amended Death Certificate,.
. .
on Friday, February 21,2014, Stonebridge made the decision to pay
the claim for the $25,000 benefit." Id. at ¶ 13.
Plaintiff's Original Petition, filed in state court, raised claims for (1) declaratory judgment
declaring her rights under the policy; (2) breach of contract for failure to pay the benefit owed; and
(3) violations of the Texas Insurance Code, including (i) failure to promptly pay and (ii) violation
of the duty of good faith and fair dealing by refusing to pay without a reasonable basis to do so.
Stonebridge previously moved for summary judgment on all claims; the Court granted summary
The parties dispute the date Stonebridge received the file, despite the fact the dispute is legally irrelevant, as
whether calculated from December 4, 2013, as Plaintiff contends, or December 9, 2013, as Stonebridge contends, using
Plaintiff
the date Stonebridge received the file as the legally operative prompt-payment date produces the same result. As
Plaintiffs preferred date.
is the nonmovant, the Court adopts
6
Again, the parties dispute a legally irrelevant point, and again, the Court adopts Plaintiffs preferred date.
judgment in its favor on the breach of contract and good faith and fair dealing claims, finding
Plaintiff failed to carry her burden to establish coverage under the policy and the evidence
demonstrated only a good-faith coverage dispute between the parties. Aug. 22, 2014 Order [#54]
at 19. The Court denied Stonebridge' s motion as to the statutory prompt-payment claim, however,
as there was insufficient record evidence of crucial dates necessary to resolve the claim. Id. This
motion followed.
Analysis
I.
Legal Standard - Motion for Summary Judgment
Summary judgment shall be rendered when the pleadings, the discovery and disclosure
materials on file, and any affidavits show that there is no genuine dispute as to any material fact and
that the moving party is entitled to judgment as a matter of law.
v.
FED. R.
Civ. P. 56(a); Celotex Corp.
Catrett, 477 U.S. 317, 323-25 (1986); Washburn v. Harvey, 504 F.3d 505, 508 (5th Cir. 2007).
A dispute regarding a material fact is "genuine" if the evidence is such that a reasonable jury could
return a verdict in favor of the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242,248
(1986). When ruling on a motion for summary judgment, the court is required to view all inferences
drawn from the factual record in the light most favorable to the nonmoving party. Matsushita Elec.
Indus. Co.
v.
Zenith Radio, 475 U.S. 574, 587 (1986); Washburn, 504 F.3d at 508. Further, a court
"may not make credibility determinations or weigh the evidence" in ruling on a motion for summary
judgment. Reeves v. Sanderson Plumbing Prods., Inc., 530 U.S. 133, 150 (2000); Anderson, 477
U.S. at 254-55.
Once the moving party has made an initial showing that there is no evidence to support the
nonmoving party's case, the party opposing the motion must come forward with competent summary
-7-
judgment evidence of the existence of a genuine fact issue. Matsushita, 475 U.S. at 586. Mere
conclusory allegations are not competent summaryjudgment evidence, and thus are insufficient to
defeat a motion for summaryjudgment. Turner v, Baylor Richardson Med. Ctr., 476 F.3d 337, 343
(5th Cir. 2007). Unsubstantiated assertions, improbable inferences, and unsupported speculation are
not competent summary judgment evidence. Id. The party opposing summaryjudgment is required
to identify specific evidence in the record and to articulate the precise manner in which that evidence
supports his claim. Adams
v.
Travelers Indem. Co. of Conn., 465 F.3d 156, 164 (5th Cir. 2006).
Rule 56 does not impose a duty on the court to "sift through the record in search of evidence" to
support the nonmovant's opposition to the motion for summary judgment. Id. "Only disputes over
facts that might affect the outcome of the suit under the governing laws will properly preclude the
entry of summary judgment." Anderson, 477 U.S. at 248. Disputed fact issues that are "irrelevant
and unnecessary" will not be considered by a court in ruling on a summary judgment motion. Id.
If the nonmoving party fails to make a showing sufficient to establish the existence of an element
essential to its case and on which it will bear the burden of proof at trial, summary judgment must
be granted. Celotex, 477 U.S. at 322-23.
II.
Application
As the Court explained in its previous Order disposing of the first round of summary
judgment motions, see Aug. 22, 2014 Order [#54], under Texas law, an insurer has fifteen days from
receipt of notice of a claim to "(1) acknowledge receipt ofthe claim; (2) commence any investigation
of the claim; and (3) request from the claimant all items, statements, and forms that the insurer
reasonably believes, at that time, will be required from the claimant."
§
TEX. INS.
CODE
542.055(a)(l)(3). The insurer "may make additional requests for information if during the
investigation of the claim the additional requests are necessary." Id. at
§
542.05 5(b). The insurer
is then required to "notify the claimant in writing of the acceptance or rejection of a claim not later
than the 15th business day after the date the insurer receives all items, statements, and forms required
by the insurer to secure final proof of loss." Id. § 542.056. Once an insurer notifies a claimant it will
pay a claim, the insurer has five business days to do so. Id.
§
542.057. If the insurer delays for more
than sixty days beyond that time period, it is liable for damages in the form of "interest on the
amount of the claim at the rate of 18 percent a year.
. .
together with reasonable attorney's fees."
Id. § 542.058, .060.
Accordingly, the first step in analyzing a prompt-payment claim is determining when the
insurer "receive[d] all items, statements, and forms required by the insurer to secure final proof of
loss." Id.
§
542.056. That date starts the fifteen business day timer to accept or reject a claim, and
it is that date which is disputed by the parties.7
Plaintiff argues starting the fifteen-day clock from February 10, 2014, the date Stonebridge
received the additional medical records from Mr. Timmins's medical providers, controverts the text
of the Texas Insurance Code, as starting the clock from that date would mean Stonebridge did not
receive all materials it required to secure proof of loss until "third parties" furnished the medical
records. Plaintiff contends "items, statements, and forms" as used in
those "items, statements, and forms" which, under
§
§
542.056 must refer only to
542.055, the insurer must "requestfrom
the
claimant" within fifteen days of notice of claim. Thus, under Plaintiffs view, the fifteen-day time
To the extent plaintiff argues the clock began running on August 7, 2012, the date she submitted her original
claim, her argument is rejected. As this Court set forth in its Order on Stonebridge's first motion for summary judgment,
the "record establishes that Plaintiff, at the time she submitted her claim, failed to carry her burden of establishing
coverage under the Policy. Virtually all of the documentation Plaintiff submitted in support of her claim indicated Mr.
Timmins died of a heart attack resulting from his numerous health problems, including his lung cancer." Aug. 22, 2014
Order [#54] at 12.
limit cannot be based upon when the insurer receives materials requested from third parties; the time
limit can be based only upon receipt of those materials reasonably requested from the claimant.
Consequently, Plaintiff argues the fifteen-day clock could not have begun running on the date
Stonebridge received, directly from Mr. Timmins's providers, the additional medical records it
requested.
The Court disagrees with Plaintiff. The fifteen-day timer in § 542.056 is triggered only after
the insurer receives "all items, statements, and forms required" to make a coverage decision.
INS,
CODE
§
TEx.
542.056(a). Plaintiff's argument completely ignores the fact Stonebridge requested
medical records from Plaintiff supporting the claim her husband's death was accidental in its August
14, 2012 response to Plaintiff's notice
information it
of claim. Rather than provide Stonebridge with the
requesteda reasonable request, given the official reports'
total unanimity Mr.
Timmins's death was not an accidentPlaintiff did nothing for a year and a half, then filed this
lawsuit. Plaintiff's real argument has nothing to do with the construction of "items, statements, and
forms" as used in the Texas Insurance Code; in reality, Plaintiff is contending it was unreasonable
for Stonebridge to request additional medical information in the first place, an argument this Court
rejected in its Order on the parties' previous motions for summary judgment: it was Plaintiff's
burden to establish coverage under the policy, and "[w]hen all of the evidence, including a death
certificate, indicate[d] [Mr. Timmins' s] death was not accidental, it [was] not unreasonable for
[Stonebridge] to request some evidence supporting a claim it was accidental." Aug. 22,2014 Order
[#54] at 14n.11.
Construing
§
542.058, which, again, renderes an insurer liable to a claimant if "after
receiving all items, statements, and forms reasonablyrequested and required under Section 542.05 5,"
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the insurer delays payment of the claim for more than 60 days, the Southern District of Texas
concluded liability could not attach until the claimant provided the insurer with the materials it
reasonably requested and required to make a coverage decision. Partain v. Mid-Continent Specialty
Ins. Servs., Inc., 838 F. Supp. 2d 547, 572 (S.D. Tex. 2012). This Court finds, as did the Partain
court in construing
§
542.058, the clock in
§
542.056 does not begin to run until the claimant
provides the insurer with those materials it reasonably requests from the claimant in order to make
a coverage decision. This conclusion accords with the general rule the claimant has the initial
burden to establish coverage under the policy. See Gilbert Tex. Constr., L.P.
Lloyd's London, 327 S.W.3d 118, 124 (Tex. 2010); Addison Ins. Co.
v.
v.
Underwriters at
Fay, 905 N.E.2d 747, 752
(Ill. 2009).8 Making an insurer liable for failure to promptly pay a claim where the claimant has
refused to provide information reasonably requested by the insurer to determine coverage in the first
place suggests the claimant is not required to carry her initial burden. Further, adopting Plaintiff's
construction of § 542.056which requires acceptance of the propositions (1) the date an insurer's
establishment of proof of loss cannot depend upon the date it receives information from third parties
and (2) insured parties may withhold information reasonably requested by insurers to establish proof
of losswould enable insured parties essentially to force violations of
§
542.056 merely by
withholding materials from the insurer for a period of time after submitting insufficient proof of loss.
That result would not onlybe nonsensical, it would contravene the purpose of subchapter 542, which
"shall be liberally construed to promote the prompt payment of insurance claims."
§
TEX. INS.
CODE
542.054 (emphasis added).
The Court previously declined to resolve the parties' choice of law dispute as doing so was unnecessary to
disposition of the issues. See Aug. 22, 2014 Order [#54] at 11. Thus, the Court cites to both Texas and Illinois law
where appropriate.
8
-11-
Plaintiff resists this conclusion by suggesting Stonebridge is liable because the medical
records it received on February 10, 2014, "proved to be unnecessary" as, despite their
inconclusiveness with respect to the cause of Mr. Timmins's death, Stonebridge ultimately paid the
claim. Pl.'s Resp. [#60] at 17. While it is somewhat unclear, Plaintiff appears to be arguing
Stonebridge did not "require" the additional medical records in order to pay the claim, and thus that
Stonebridge had all the materials it "required" either on November 13,2013, when Plaintiffprovided
the amended death certificate, or on December 4, 2013, when Plaintiff provided a copy of Justice
Carter's inquest file. The Court rejects these arguments. First, no supporting documentation was
provided with the amended death certificate, and it was reasonable for Stonebridge to question the
basis for an amendment to the cause of Mr. Timmins's death which came over two years after
issuance of the original death certificate. Second, the inquest file Stonebridge received contained
the same universe of documents Justice Carter relied upon in making his original
findingsdocuments which this Court has already concluded were insufficient to establish coverage
under the policy, as all of the official reports concluded Mr. Timmins's death resulted from natural
causes, rather than from an accident. See Aug. 22, 2014 Order [#54] at 12. It thus remained
reasonable for Stonebridge to require medical information supporting the claim Mr. Timmins's death
was accidentalthe evidence it originally requestedas the sole official piece of evidence which
supported Plaintiff's claim was an amended death certificate which was prepared through reliance
upon the same evidence originally used to support the opposite conclusion.
While not cited by Plaintiff, the Court notes the fact Stonebridge requested information it
reasonably required to determine proof of loss distinguishes this case from Colonial County Mutual
Insurance Company v. Valdez, 30 S.W.3d 514 (Tex. App.Corpus Christi 2000, no pet.), where,
-12-
in interpreting the predecessor statute to
§
542 .056, the court found a claimant's failure to provide
information the insurer requested did not preclude the insurer's liability under the statute. The
Valdez
court found the information requested by the insurer, including "service records, sets of keys,
and photographs of the vehicle," was irrelevant to proving loss under the
whether or not the vehicle had been stolen. Id. at 523. While in
policyin that case,
Valdez,
"[cjommon sense
indicate[d]" the materials requested were irrelevant to proving the loss of the vehicle,
id.,
here,
common sense indicates, given the overwhelming record evidence Mr. Timmins' s death was natural
and not accidental, Mr. Timmins' s medical records were relevant to determining his cause of death,
despite the fact the medical records received were ultimately inconclusive.
Accordingly, the Court finds the fifteen-day clock under § 542.056 did not begin to run until
February 10, 2014, the date Stonebridge received the medical records it originally requested from
Plaintiff a year and a half prior. Following receipt of the inconclusive medical records, Stonebridge
decided to pay the
claim,10
and on February 25, 2014, ten business days later, mailed Plaintiff a
The Valdez court was interpreting Texas Insurance Code section 21.55, which provided:
Except as provided by subsections (b) and (d) of this section, an insurer shall notif' a claimant in
writing of the acceptance or rejection of the claim not later than the 15th business day after the date
the insurer receives all items, statements, and forms required by the insurer, in order to secure final
proof of loss.
TEx. INS. CODE A'mi. art. 21.55 § 3(a) (Vernon Supp. 2000), repealed by Unfair Claim Settlement Practices Act, H.B.
2922, 2003 Tex. Sess. Law Serv. 1274, § 2 (Vernon's).
The Court notes the evidence before Stonebridge when it decided to pay Plaintiff's claim was insufficient
to find Mr. Timmins' s death accidental. With the sole exception of the amended death certificate, all of the evidence
was either silent on the question of cause of death or concluded it was one or more of Mr. Timmins' s several serious
health problems. Further, as Stonebridge points out, even the amended death certificate listed "Lung Cancer" as an
underlying cause ofdeath, and for the benefit to be payable, the policy requires the accidental injury cause death "directly
and independently of all other causes." See Def.'s Resp. P1's Post-Hr'g Brief [#68] at 2 n.5; Certificate of Insurance II
at 4. Stonebridge's decision to pay Plaintiff's claim was not an admission the claim fell within the policy terms, as
"evidence of a coverage dispute is not evidence that liability under the policy had become reasonably clear." First
App'x, No. 13-50657, 2014 WL 6064937, at *4 (5th Cir. Nov.
Cmty. Bancshares v. St. Paul Mercury Ins. Co.,
14, 2014) Qer curiam) (citing and quoting Provident Am. Ins. Co. v. Castaneda, 988 S.W.2d 189, 194 (Tex. 1998)).
10
F.
-13-
notice of acceptance of the claim along with a $25,000 check. Stonebridge thus paid within five
business days of notifying Plaintiff it would pay her claim, see TEx.
INS.
within the sixty-day period prescribed by
§
§
542.060,
see Id.
at
CODE
§
542.057, and well
542.060(a). Consequently,
Stonebridge complied with all of its statutory prompt-payment obligations, and is entitled to
summary judgment.
Conclusion
Accordingly,
IT IS ORDERED that Plaintiff Patricia Timmins's Motion for Leave to File Sur-
Reply [#63] is GRANTED;
IT IS FURTHER ORDERED that Defendant Stonebridge Life Insurance Company's
Motion for Leave to File Sur-Reply [#70] is GRANTED; and
IT IS FINALLY ORDERED that Defendant Stonebridge Life Insurance Company's
Second Motion for Summary Judgment [#59] is GRANTED.
SIGNED this the
/day of November 2014.
7/
SAM SPARKS
UNITED STATESISTRICT JUDGE
894 msj ord ba.frm
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