Published by The Pellegrin Firm October 6, 2019

An interesting March 22, 2018, decision from the New Orleans-based U.S. Court of Appeals for the Fifth Circuit found that it can be under Texas law. The court of appeals found the question to be close enough that the federal district court was wrong to grant summary judgment for the insurer. Once the grant of summary judgment was reversed and the case remanded to the district court, the parties reached a confidential settlement.

The basic facts are these: the insured, Melton Wells, died from West Nile Virus after a mosquito bite. The insurer from whom he had purchased an Accidental Death & Dismemberment policy, Minnesota Life Insurance Company, denied his wife’s claim for benefits. The policy was in individual policy not obtained through an employer, thus Texas law applied. The insurer had many excuses for not paying the claim. First, it argued that respiratory failure, organ failure, and septic shock – the ultimate fatal consequences of the West Nile Virus – were the actual causes of death. Also, it argued the mosquito bite was not an accident as contemplated by the policy as the death was too removed from the cause of death itself, be it West Nile Virus or multiple organ failure and septic shock. Finally, the insurer argued that an exclusion applied, because other factors contributed to the death, including diabetes and obesity.

The majority of the court of appeals panel found that there was some basis for a trial on the merits. The mosquito bite was an external trauma – an accident – however slight. Further, it found that the policy contemplated some degree of separation between accident and cause of death, as the policy allows for payment due to deaths that happen a few months after the accident. Finally, it found there was a triable issue on whether other conditions were a substantial factor in the death.

Circuit Judge Owen dissented, finding the West Nile Virus itself was the other contributing disease that caused the death, and thus subject to the exclusion stating there is no coverage if “death is caused directly or indirectly by, results from, or there is a contribution from…bodily or mental infirmity, illness, or disease.”

The case is Wells v. Minnesota Life Insurance Co., 885 F.3d 885 (5^th Cir. 2018).