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Hester v. Life Insurance Co. of North America

United States District Court, E.D. Kentucky, Northern Division, Ashland

February 24, 2014

CYNTHIA A. HESTER, Plaintiff,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.

MEMORANDUM OPINION AND ORDER

HENRY R. WILHOIT, Jr., District Judge.

This matter is before the Court upon Defendant Life Insurance Company of North America's (hereinafter "LINA") Motion for Judgment [Docket No. 12]. For the reasons set forth below, the Court finds that LINA is entitled to judgment as a matter of law.

I. FACTUAL AND PROCEDURAL BACKGROUND

This case arises from LINA's denial of Plaintiff Cynthia Hester's claim for accidental death benefits following her husband's death.

Plaintiff's husband, David Hester, was an employee of CSX and during his employment with the company obtained a $200, 000 benefit on his life under Group AD&D Policy OK 81 70 74. [Administrative Record, Docket No. 11, p. 37-63]. The Policy provides:

We agree to pay benefits for loss from bodily injuries: a) caused by an accident which happens while an insured is covered by this policy; and b) which, directly and from no other causes, result in a covered loss, (See the Description of Coverage.) We will not pay benefits if the loss was caused by: a) sickness, disease, or bodily infirmity; or b) any of the Exclusions listed on page 2.

[Docket No. 11, p.40].

Page 2 of the Policy provides: No benefits will be paid for loss resulting from: intentionally self-inflicted injuries, or any attempt thereat, while sane or insane (in Missouri, while sane)." [Docket No.11, p. 42].

Mr. Hester died of a self-inflicted gunshot wound to the chest in the garage of the family home on July 16, 2002. [Docket No. 11, p. 10-12] His death was ruled a suicide by the Greenup County Coroner. [Docket No. 11, p. 12] On August 7, 2002, Plaintiff filed a claim for benefits with LINA. [Docket No. 11, p. 11].

By letter dated August 19, 2002, LINA informed Plaintiff that suicide was an exclusion under the policy and invited her to submit any additional information that would "indicate the accidental circumstances of this death." [Docket No. 11, p. 9]. The letter explicitly stated that if she failed to submit additional information, the claim would be closed. [Docket No. 11, p. 9] Plaintiff did not submit any additional information or otherwise respond to the letter.

On September 12, 2002, LINA again sent a letter to Plaintiff, informing her that claim was denied due to the policy exclusion pertaining to self-inflicted injuries. The letter quoted from the pertinent portion of the policy and listed the documents LINA reviewed in making its determination, including the State of Kentucky Certificate of Death. It identified David Hester's cause of death as" [h]emorrhage, due to or as a consequence of 38-cal. gunshot wound to midline of left chest". The manner of death is listed as "Suicide". The death certificate identifies the circumstances surrounding this death "self inflicted 38 ca wound to left mid line of chest". No other significant conditions are listed. In this letter, LINA also pointed out that in Plaintiffs Proof of Loss form, she, too described the circumstances of her husband's death as "[self inflicted 38 ca. wound to lower chest in the garage" [Docket No. 11, p. 7-8]. The letter further informed Plaintiff she could appeal or request a review of the decision in writing within 60 days from the September 12, 2002 denial date. Plaintiff did not request a review.

LINA's policy contains a limitation provision for bringing legal actions.

Legal Actions: No legal action to get policy benefits may be brought less than 60 days nor more than 3 years after written proof has been ...

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