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Troeger v. Minnesota Life Insurance Co.

United States District Court, C.D. Illinois

November 18, 2016

JAMIE TROEGER, Administrator of the Estate of Gayle Mitchell, Deceased, Plaintiff,
v.
MINNESOTA LIFE INSURANCE COMPANY, Defendant.

          ORDER AND OPINION

          James E. Shadid Chief United States District Judge

         This matter is now before the Court after a bench trial on November 14, 2016, between Plaintiff Jamie Troeger, Administrator for the estate of Gayle Mitchell, and Defendant Minnesota Life Insurance Company. As set forth in the following Findings of Fact and Conclusions of Law, the Court finds that Plaintiff has established that Mr. Mitchell's death was caused by an accidental injury within the meaning of the policy. Further, the Court finds that Defendant has failed to establish the applicability of a policy exclusion to bar coverage. Therefore, judgment will enter in favor of Plaintiff in the amount of $156, 500, with the Court reserving ruling on the issue of prejudgment interest pending supplemental briefing as directed below.

         Background[1]

         On July 20, 2002, Michael Mitchell fractured his neck after falling head-first into Kickapoo Creek. The fracture resulted in quadriplegia, or paralysis of all four extremities. In September 2005, Michael became a resident at Rose Garden Care Center (“Rose Garden”), a residential care facility in Peoria Heights, Illinois. He developed several medical conditions after his paralysis, including seizure disorder, depression, hypertension, obesity, dyslipidemia, bowl mobility disorder, gastroesophageal reflux disease (“GERD”), deep venous thrombosis, spasticity and chronic pain.

         On at least four occasions between 2005 and 2006, Michael was found “non-responsive” by caretakers at Rose Garden. On June 24, 2006, Michael was admitted to the intensive care unit at Proctor Hospital for respiratory failure after he became unresponsive and stopped breathing during ambulance transport to the hospital. In August 2006, Michael was transferred to OSF Saint Francis Medical Center (“OSF”) when he was found unresponsive and caretakers were unable to feel a pulse. Michael was again found unresponsive by Rose Garden caretakers and transferred to OSF in September 2006. He was successfully resuscitated on each occasion.

         On July 28, 2007, Michael began “actively seizing” at Rose Garden. He was initially breathing on his own, but stopped breathing. Rose Garden called paramedics, and Advanced Medical Transport (“AMT”) transferred Michael to OSF Hospital. AMT paramedics documented Michael's condition during transport, noting “no evidence of trauma” in any location and an “unremarkable” physical examination. ECF Doc. 16, ¶ 22. When paramedics attempted to intubate Michael, they suctioned his airway and aspirated foreign material. ECF Doc. 28, at 13. Michael could not be resuscitated and was pronounced dead at OSF Hospital. Dr. Richard C. Frederick was the emergency room physician who treated Michael at OSF on July 28, 2007. Dr. Frederick signed the medical records prepared by a resident which noted, under the heading of Initial Physical Exam, “General-no evidence of trauma . . . Head/Neck-atraumatic . . . Extremities-no signs of trauma.” See ECF Doc. 16-10. Those records also indicated that Michael had vomit on his face. On October 18, 2007, a Coroner's Inquest into Michael's death was held by Peoria County Coroner Johnna Ingersoll. The jury found that Michael's death was “natural” from “seizure disorder.”

         Michael, as a former employee of the State of Illinois, obtained life insurance coverage under a group policy for state employees. The life insurance policy was issued by Minnesota Life Insurance Company (“Minnesota Life”) and included Accidental Death and Dismemberment (“AD&D”) coverage. Minnesota Life paid Michael's wife, Gayle Mitchell, $156, 500 pursuant to the policy's Basic Life and Optional Life coverage. However, Minnesota Life declined to pay the additional $156, 500 under the AD&D double indemnity provision. The AD&D provision of the policy states:

Accidental death or dismemberment by accidental injury as used in this supplement means that your death or dismemberment results, directly and independently of disease or bodily infirmity, from an accidental injury which is unexpected and unforeseen.
ECF Doc. 16, ¶ 10.

         The policy also stated “injury must occur while your coverage under this supplement is in force” and “death or dismemberment must occur within 365 days after the date of the injury and while your coverage under this supplement is in force.” Id.; ECF Doc. 16-1, at 27. The AD&D policy further provided that “[i]n no event will [Minnesota Life] pay the accidental death or dismemberment benefit where your death or dismemberment results from or is caused directly by any of the following . . . (3) bodily or mental infirmity, illness or disease; or (4) medical or surgical treatment . . . .” Id.

         On August 9, 2016, the Court issued an Order and Opinion denying Defendant's motion for summary judgment. After the final pretrial conference on October 21, 2016, Defendant filed a motion in limine to exclude opinion testimony from Dr. Frederick. See ECF Doc. 34. Defendant's motion reasserted the objections in the prior motion that were denied, and further challenged the admissibility of Dr. Frederick's opinion testimony under Fed.R.Evid. 702 and Daubert. On November 9, 2016, the Court denied Defendant's motion. ECF Doc. 36. At a bench trial on November 14, 2016, Plaintiff presented exhibits of Dr. Frederick's deposition testimony, where he opined that the most likely cause of Michael's death was aspiration of vomit resulting in respiratory arrest. Minnesota Life called retained expert Dr. Bosacker, who testified that Michael's death was not caused by aspiration and opined that Michael's death was likely caused by one of his medical conditions.

         Standard of Review

         In Illinois, “[t]he insured has the burden of proving that his loss comes within the terms of his insurance policy.” Roberts v. Allstate Life Ins. Co., 243 Ill.App.3d 658, 660 (1993); Kolowski v. Metro. Life Ins. Co., 35 F.Supp.2d 1059, 1061 (N.D. Ill. 1998). “Once the insured has brought himself within the terms of his policy, then the insurer must prove the applicability of an exception in the coverage if it wishes to escape liability.” St. Michael's Orthodox Catholic Chruch v. Preferred Risk Mut. Ins. Co., 146 Ill.App.3d 107, 109 (1986)

         Illinois courts have adopted a liberal interpretation of the phrase “accidental means” in insurance policies, construing the term to be synonymous with “accidental result.” Russell, 108 Ill.App.3d at 420 (citing Taylor, 11 Ill.2d at 230)). In Illinois, “the concept of causation with respect to the analysis of life insurance policies is more circumscribed than in tort law . . . only the immediate cause of the insured's death matters . . . not any underlying illness or infirmities that might have contributed to the death by producing the conditions necessary for death to occur.” Schroeder v. Minnesota Life Ins. Co., Case No. 06-2915, 2007 WL 1169706 at*2-4 (N.D. Ill. 2007) (citing Russell v. Metro. Life Ins. Co., 108 Ill.App.3d 417 (1982)). In other words, Illinois courts “need not seek out . . . the cause of the cause.” Russell, 108 Ill.App.3d at 419 (citing Marsh v. Metropolitan Life Ins. Co., 70 Ill.App.3d 790, 796 (1979)).

         Findings of Fact

         The Most Likely Cause of Michael's Death was Respiratory Arrest Resulting from Aspiration of Foreign Material into his Airway

         The records from Rose Garden indicate that Michael was found unresponsive but breathing independently at 5:10 p.m. The nurse called for an ambulance and initiated CPR after he stopped breathing until AMT arrived at 5:17 p.m. Def. Ex. 1, at 6. The AMT records pick up where Rose Garden's records end, noting that another EMS crew already at Rose Garden performed CPR and administered oxygen to Michael with a Bag Valve Mask (“BVM”) at 5:16 p.m. Joint Ex. 4, at 4. AMT paramedics arrived shortly thereafter, and Michael was placed on a stretcher and taken to the ambulance. At 5:24 p.m., AMT paramedics attempted unsuccessfully to intubate the patient while in transit to OSF, noting “suction needed, visualization 0%” and a minute later, “suction: upper airway . . . device: adult suction catheter, aspirate: foreign matter.” Id. at 3. OSF records document that Michael arrived at the hospital with “large amount of vomitus present on face.” Joint Ex. 6, at 2.

         Plaintiff relied on Dr. Frederick. Dr. Frederick was an emergency room physician at OSF St. Francis Hospital in Peoria and one of the treating physicians for Mr. Mitchell. He completed his residency in 1979 and became board certified in emergency medicine in 1986. He was the department chair during his last two years of full time work. He was not a retained expert in this case. Defendant relied on the opinion of Dr. Bosacker. Dr. Bosacker began her residency in the United States Navy, finished it at the University of Florida, and became board certified in faculty medicine in 2005. She saw patients at Fairview Lakes in Minnesota from 2005 to 2011 before accepting employment with Securian Financial Group in April of 2011.[2] She currently serves as the Chief Medical Director for Securian.

         Plaintiff and Defendant present conflicting interpretations of the records from AMT and OSF documenting the events leading up to Michael's death. At Dr. Frederick's deposition on September 19, 2015, the following exchange took place:

Q. And, Doctor, if I understood your prior testimony, is it your opinion that the aspiration is what resulted in ...

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