United States District Court, E.D. Washington
MELISSA GOETZ, beneficiary and as Personal Representative of the Estate of Michael D. Greever, Plaintiff,
LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.
ORDER DENYING CROSS MOTIONS FOR SUMMARY JUDGMENT AND
ENTERING JUDGMENT ON THE RECORD IN FAVOR OF
SALVADOR MENDOZA, JR. UNITED STATES DISTRICT JUDGE.
September 5, 2017, the Court held a hearing on the
parties' cross motions for summary judgment, ECF Nos. 32
and 37. The Court denied both motions. The Court also heard
oral argument on Ms. Goetz's underlying benefits claim
and took the matter under advisement. This Order supplements
and memorializes the Court's order on the motions for
summary judgment and enters judgment in favor of LINA on the
basis of the administrative record.
case arises from Ms. Goetz's claim for accidental death
benefits following the death of her brother, Michael Greever.
On October 11, 2015, Michael Greever was found dead in his
mother's swimming pool. ECF No. 36-4 at 4. The medical
examiner determined his cause of death was drowning, but
there were no witnesses to the accident itself. ECF 36-2 at
83. Accordingly, it was not apparent what caused Mr.
Greever's fall into the pool or why he failed to
extricate himself from the water. The autopsy did not reveal
any trauma to the head or neck, but the medical examiner
noted Mr. Greever had a bite mark on his tongue. ECF No. 36-2
at 12. Because Mr. Greever had a history of epilepsy, the
medical examiner presumed a seizure had precipitated the
fall. ECF No. 36-1 at 111. The death certificate notes causes
of death as “drowning” caused by “presumed
epileptic seizure.” ECF No. 36-2 at 83.
after Mr. Greever's death, Ms. Goetz submitted a claim
for accidental death benefits under his Group Accident Policy
No. OK 966394 (the Policy) with Life Insurance Company of
North America (LINA). ECF No. 36-1 at 1. LINA denied Ms.
Goetz's claim, finding Mr. Greever's death was not
covered under the Policy. The Policy contains two
“sole-cause” clauses that limit the scope of
coverage. The first defines a Covered Loss as the
“result, directly and independently of all other
causes, of a Covered Accident.” Id. at 27. The
second defines a Covered Accident as a sudden and
unforeseeable accident that “is not contributed to by
disease, Sickness, mental or bodily infirmity.”
Id. LINA denied Ms. Goetz's claim, reasoning
that the loss was not the result of a covered accident
because Mr. Greever's fall was caused by an epileptic
seizure. ECF No. 36-2 at 36. Ms. Goetz appealed, and LINA
affirmed its decision. ECF No. 36-1 at 67.
parties move for summary judgment under Federal Rule of Civil
Procedure 56. Because a substantial issue of material fact
exists as to whether Mr. Greever's epilepsy contributed
to his drowning accident, summary judgment is not proper.
LINA also moves for judgment under Rule 52. ECF No. 37 at 9.
Because this is an ERISA case reviewing the plan
administrator's decision de novo, judgment under
on the record is proper in this case. There is some
conflicting evidence regarding whether Mr. Greever suffered a
seizure immediately prior to his drowning accident. However,
the lack of physical evidence supporting an alternative
explanation makes a seizure the most likely cause of death.
Because Ms. Goetz has the burden to show Mr. Greever's
epilepsy did not substantially contribute to his accident,
entry of judgment in favor of the LINA is proper.
issued a Group Accident Policy No. OK 966394 to Mr.
Greever's employer, Wagstaff, Inc. No. 36-1 at 15. The
Policy is governed by ERISA. Id. at 45-46. The
Policy provides accidental death benefits as follows:
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
Covered Loss We will pay the benefit for any one of the
Covered Losses listed in the Schedule of Benefits, if the
Covered Person suffers a Covered Loss resulting directly and
independently of all other causes from a Covered Accident
within the applicable time period specified in the Schedule
Id. at 40. The Policy also includes the following
Accident A sudden, unforeseeable, external event that
results, directly and independently of all other causes, in a
Covered Injury or Covered Loss and meets all of the following
1. occurs while the Covered Person is insured under this
2. is not contributed to by disease, Sickness, mental or
3. is not otherwise excluded under the terms of this Policy.
Loss A loss that is all of the following:
1. the result, directly and independently of all other
causes, of a Covered Accident;
2. one of the Covered Losses specified in the Schedule of
3. Suffered by the Covered person within the applicable time
period in the Schedule of Benefits.
Id. at 27. The Policy contains the following
In addition to any benefit-specific exclusions, benefits will
not be paid for any Covered Injury or Covered Loss which,
directly or indirectly, in whole or in part, is caused by or
results from any of the following unless coverage is
specifically provided for by name in the Description of
* * *
7. Sickness, disease, bodily or mental infirmity, bacterial
or viral infection or medical or surgical treatment thereof .
. . .
Id. at 32.
Loss Facts and Investigation
October 11, 2015, Michael Greever was winterizing a swimming
pool at his mother's home. ECF No. 36-4 at 4. Shortly
before his death, his mother, Cindy Greever, observed Mr.
Greever standing near the pool talking on the phone.
Id. Ms. Greever then left the pool area and returned
approximately five minutes later. Id. At that time,
she discovered Mr. Greever floating face-down in the deep end
of the pool. Id. There were no witnesses to the
Greever had a history of epilepsy resulting in tonic-clonic
(grand mal) seizures. He also had a heart condition for which
he was taking medication at the time of his death.
See 36-3 at 115-16. Mr. Greever had not experienced
a seizure in several years. ECF 36-1 at 111. Some records
indicate his last seizure was eighteen years prior to his
death. Id. However, an electroencephalogram (EEG)
performed in 2005 indicated Mr. Greever had
“spikes” and wave epileptiform complexes, making
him at risk for future epileptic seizures. Id. Mr.
Greever was prescribed seizure medication but had not filled
the prescription since February 3, 2009. ECF No. 36-3 at 116.
police arrived, the investigating officer asked Ms. Greever
about her son's medical history. Id. She advised
the officer that Mr. Greever had suffered seizures until
about ten years prior, at which time the seizures stopped and
he was taken off medication. Id. She also advised
the officer that Michael had not consumed alcohol that day,
but had “tied one on” the previous evening and
was tired. ECF No. 36-3 at 3. The investigating officer asked
medical responders whether there was any sign Mr. Greever had
hit his head and was told Mr. Greever had a mark on his right
temple. Id. The officer then searched the edge of
the pool and ladder railings for blood but found none.
Examiner Sally Aiken, M.D. (Forensic Pathologist) for the
Spokane County Office of the Medical Examiner performed an
autopsy of Mr. Greever on October 13, 2015, two days after
his death. ECF No. 36-1 at 110. In the accompanying autopsy
report, the Medical Examiner summarized her case findings.
The autopsy report indicated Mr. Greever had various cuts and
bruises on his face, mouth, and body. Id. at 116.
The report noted that some of the injuries may have been