United States District Court, W.D. Louisiana, Monroe Division
L. HAYES MAG. JUDGE.
G. JAMES UNITED STATES DISTRICT JUDGE.
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
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.
Facts and Procedural History
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. 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.
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.
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.
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].
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