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Pepper v. Mutual of Omaha Insurance Co.

United States District Court, W.D. Louisiana, Monroe Division

April 13, 2017

VICKI PEPPER
v.
MUTUAL OF OMAHA INSURANCE CO.

          KAREN L. HAYES MAG. JUDGE.

          RULING

          ROBERT G. JAMES UNITED STATES DISTRICT JUDGE.

         This is a dispute over a denial of accidental death insurance benefits. Defendant Mutual of Omaha Insurance Co. (“Mutual of Omaha”) issued a policy of insurance to Kenneth A. Pepper (“Mr. Pepper”) in 2008. When he died in 2014, Mutual of Omaha denied payment to Mr. Pepper's wife and beneficiary, Plaintiff Vicki Pepper (“Mrs. Pepper”).

         Pending are cross-motions for summary judgment filed by Mrs. Pepper [Doc. No. 30] and Mutual of Omaha [Doc. No. 32]. For the following reasons, Mutual of Omaha's Motion for Summary Judgment is GRANTED, and Mrs. Pepper's Motion for Summary Judgment is DENIED.

         I. Facts and Procedural History

         Mr. Pepper purchased an Accidental Death Insurance Policy No. E428ADR41-928667-27M (“the Policy”) from Mutual of Omaha with an effective date of July 26, 2008.[1] The Policy listed Mrs. Pepper as beneficiary. [Doc. No. 30, Exh. A]. Mr. Pepper made premium payments of $8.95 per month for the Policy, which provided coverage only for “Accidental Death.” Under the Policy, benefits were to be paid in the case of three classes of accidental death: (1) Class 1 provided for benefits of $750, 000.00 in the event of a common carrier or scheduled airline injury, (2) Class 2 provided for benefits of $225, 000.00 in the event of private automobile or pedestrian injury, and (3) Class 3 provided for benefits of $150, 000.00 in the event of all other unspecified “injuries sustained in a manner not specified under Class 1 or Class 2 and not otherwise excluded under the policy.” [Doc. No. 30, Exh. B, pp. 1-2]. “Injury” is defined as

bodily harm which:
(a) is the direct result of an accident or trauma that occurs while your policy is in force; and
(b) results in loss independently of sickness and all other causes (except for sickness caused by the injury).

Id. at p. 1.

         Mr. Pepper had a history of medical conditions and treatments, which included arthritis, congestive heart failure, gastrointestinal bleeding, heart disease, heart stents, heart pacemaker, high cholesterol, atrial fibrillation, gout, and diverticulitis. Mr. Pepper had also suffered from peptic ulcer disease since he was a teenager.

         In 2014, Mr. Pepper's gastroenterologist, Dr. Brian Levantino, diagnosed him with peptic ulcer disease with gastric outlet obstruction. During this time, Mr. Pepper lost twenty-seven pounds in three weeks. Dr. Levantino referred Mr. Pepper to Dr. Walter Sartor, a general surgeon.

         Dr. Sartor determined that surgery was necessary. Without surgery, Mr. Pepper would not have been able to eat and “probably”would have died of malnutrition. [Doc. No. 32-6, Sartor Depo., p. 14].

         On May 6, 2014, at St. Francis Hospital in Monroe, Ouachita Parish, Louisiana, Mr. Pepper had surgery. He was first placed under general anesthesia, and then Dr. Sartor performed a laparoscopic truncal vagotomy, antrectomy with Billroth-II ...


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