The U.S. Court of Appeals for the Eleventh Circuit, affirming a district court's decision, has ruled that the beneficiary of a life insurance policy was not entitled to the proceeds where the insured's death certificate indicated that she died of a "natural cause" and not as a result of an accident.
The Case
In April 2011, Physicians Mutual Insurance Company issued a life insurance policy to the wife of Henry J. Moody; Mr. Moody was listed as the beneficiary.
The policy provided that, in the first and second policy years, Mr. Moody was entitled to the face value of the policy if his wife suffered an accidental death. If his wife's death was not accidental, however, Mr. Moody was entitled to 110 percent of the premiums paid.
Thereafter, Mr. Moody would receive the face value of the policy following his wife's death, whether accidental or not.
Less than one year after the policy was issued, Mr. Moody's wife, who had amyotrophic lateral sclerosis ("ALS"), also known as Lou Gehrig's disease, fell in her bedroom.
According to Mr. Moody's daughter, her mother struggled to breathe and required the suctioning of blood and mucus from her tracheostomy tube. She died shortly thereafter.
A doctor certified her cause of death as a "natural cause" – respiratory failure "due to (or a consequence of)" her disease.
After his wife's death, Mr. Moody, through his attorney, attempted to claim death benefits from Physicians Mutual.
In response, Physicians Mutual informed Mr. Moody that he was entitled to 110 percent of premiums paid because his wife's death certificate listed her cause of death as a "natural cause" and no autopsy was performed to contradict this cause of death. Physicians Mutual sent a letter to Mr. Moody's lawyer explaining that Mr. Moody's claim for the face value of the policy was denied because his wife's death was not accidental.
Physicians Mutual issued Mr. Moody a check for 110 percent of the paid premiums. He never cashed the check and, instead, sued Physicians Mutual.
The U.S. District Court for the Southern District of Alabama granted summary judgment in favor of Physicians Mutual, and Mr. Moody appealed to the Eleventh Circuit.
The Eleventh Circuit's Decision
The Eleventh Circuit, applying Mississippi law, affirmed.
In its decision, the circuit court ruled that Physicians Mutual had not breached the policy because Mr. Moody's wife's death certificate certified her death as respiratory failure "due to (or as a consequence of)" her ALS.
The circuit court pointed out that, under Mississippi statutory law, a death certificate was "prima facie evidence . . . of the facts therein stated." Therefore, the circuit court decided, Mr. Moody's wife's death was not accidental, and he was entitled to only 110 percent of the paid premiums.
The circuit court was not persuaded by Mr. Moody's argument that his wife's death was accidental given the testimony of his daughter concerning the sound she heard, her discovery of her mother on the floor, and the care she provided to her mother after the fall. According to the circuit court, "a layperson cannot provide evidence as to cause of death."
In the absence of any other competent evidence that contradicted Physician Mutual's showing that Ms. Moody's wife's death was not accidental, Physicians Mutual did not breach the policy, the circuit court concluded.
The case is Moody v. Physicians Mutual Ins. Co., No. 18-13027 (11th Cir. Oct. 11, 2019).
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].