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FEIT v. GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY

October 18, 2005.

FRANI FEIT, INDIVIDUALLY AND AS ASSIGNEE OF IRWIN J. FEIT, Plaintiff,
v.
GREAT-WEST LIFE AND ANNUITY INSURANCE COMPANY, A Colorado Corporation, Defendants.



The opinion of the court was delivered by: HAROLD ACKERMAN, Senior District Judge

OPINION AND ORDER

This matter comes before the Court on a motion for summary judgment pursuant to Federal Rule of Civil Procedure 56 and a motion to dismiss Plaintiff's request for attorney's fees filed by Defendant Great-West Life and Annuity Insurance Company ("Great-West"). For the reasons outlined below, Great-West's motion for summary judgment is GRANTED in part and DENIED in part. Factual Background

  This action concerns the construction and application of an accidental death benefit clause contained in a life insurance policy issued by Defendant Great-West Life and Annuity Insurance Company ("Great-West"). The deceased, Dr. David Feit ("Dr. Feit"), was a practicing dentist and a member of the American Dental Association ("ADA"). Plaintiff Frani Feit ("Mrs. Feit" or "Plaintiff"), is the surviving spouse of Dr. David Feit and one of two designated beneficiaries of Dr. Feit's life insurance policy. Mrs. Feit is proceeding in this action individually and as the assignee of the rights of Irwin Feit, Dr. Feit's father, the other designated beneficiary of the policy.

  The ADA maintained the life insurance benefits at issue, which were available to Dr. Feit under a group term life insurance plan provided by Great-West. Dr. Feit had a $1,000,000 group term life insurance policy at the time of his death and an additional $1,000,000 accidental death benefit. Under the terms of Dr. Feit's insurance policy, in order to receive the accidental death benefit, an insured's death must be the result of a bodily injury that is caused solely by accidental means. Under the policy's terms, Great-West was obligated to pay the additional accidental death benefit only if death occurred within 90 days of an accident, was a direct result of an accident, and was unrelated to any other cause. The accidental death benefit would not be paid if the member's death was in any way connected to a disease, illness, or physical or mental infirmity, including the medical or surgical treatment of any disease or illness.

  Dr. Feit died on July 22, 2002 in Rockland County, New York. The cause of death is the central matter of dispute in this case. At the time of his death, Dr. Feit was forty-four years old, did not smoke, and had no history of cardiac disease or illness, other than an elevated cholesterol level which was controlled with medication. He regularly walked five miles four to five times per week and played basketball on Sundays.

  Sometime during the morning of July 22, 2002, Dr. Feit's car drove off the southbound lane of a highway in Rockland County and crashed into and drove through the guardrail, causing damage to ten feet of the rail. The vehicle then went down a 670-foot grassy slope, struck a chain-linked fence, and stopped at the Spook Rock Industrial Park (the "Park"). The car damaged a sign and part of the fence, and parts of the vehicle were scattered throughout the car's path. The location of Dr. Feit's car was reported to police by the Park's construction manger at approximately 12:11 PM. Police were called to the scene and found Dr. Feit deceased, in the front seat area of the car, clutching his chest and biting his shirt. Dr. Feit did not appear to have worn a seat belt, and the air bags were not deployed. According to the report of the investigator for the County of Rockland Medical Examiner's Office, it looked as though Dr. Feit appeared to have "bounced around" inside the car. The car was totaled in the crash. (Aff. of Gina Goodreau ("Goodreau Aff."), Ex. I at 2.)

  After learning about the crash, Mrs. Feit and Dr. Feit's dental assistant, Joan Van Peenen, went to the Rockland County Medical Examiner's Office to identify Dr. Feit's body. Mrs. Van Peenen was present when Mrs. Feit spoke to the medical investigator. The substance of Mrs. Feit's statements to the investigator is hotly debated, and Mrs. Feit offers Mrs. Van Peenen's certification to support her version of the statements. According to Mrs. Feit, in response to the investigator's questions, Mrs. Feit admitted that Dr. Feit "was a person who tended to sweat profusely from time to time . . . and that he occasionally complained about back pain in the past, which [she] believe[d] was related to his work." (Certif. of Michael J. Epstein ("Epstein Certif."), Ex. A ΒΆ 7.) According to the medical investigator's report, Mrs. Feit "related her husband had casually complained of chest and back pain with profuse sweating about one week" prior to the crash. (Goodreau Aff., Ex. I at 3.) Mrs. Van Peenen corroborates Mrs. Feit's assertion to the medical investigator that Dr. Feit did not suddenly acquire these symptoms prior to his death.

  The autopsy results and death certificate indicated that Dr. Feit died from a "myocardial infarction, old due to atherosclerotic obstruction of coronary arteries." (Goodreau Aff., Ex. G at 4.) The autopsy results also revealed an atherosclerotic obstruction in both coronary arteries, which reached a maximum degree of approximately fifty percent, and patches of thinning in the myocardium. There is no mention in the report of any examination of Dr. Feit's head or nervous system.

  The beneficiaries submitted claim forms to Great-West in August 2002, seeking the full $2,000,000 in available benefits. Great-West replied by letter dated August 15, 2002, enclosing payment of the beneficiaries' respective shares under the life insurance policy, and stating that the accidental death claim was rejected because Mr. Feit's death certificate listed "natural cause," rather than accident, as the cause of death. Great-West further stated in the letter that it would reconsider the accident benefit portion of the claim if additional proof was submitted. Mrs. Feit responded to Great-West with copies of the autopsy report, accident report, EKG report from Dr. Feit's cardiologist, and correspondence from Dr. Feit's car insurance company indicating that his vehicle was totaled in the crash. Great-West submitted this information to a Great-West consulting physician, who rendered a report on October 30, 2002. The consulting physician's report reaffirmed the autopsy finding and stated that it can be "reasonably inferred in the absence of other explanations for the insured's demise that complications of the [myocardial infarction] precipitated the insured's death. . . . As such, there exists no support for the assertion of accidental death." (Id.)

  On October 31, 2002, Great-West's claim analyst wrote to Mrs. Feit again rejecting the accidental death claim, citing to: (1) Dr. Feit's death certificate, which stated the manner of death as "natural cause"; (2) the autopsy report, which supports the finding of death due to natural causes; (3) the autopsy report's absence of any findings of bony fractures or trauma; and (4) the accident report's citation of "heart attack" as the cause of death. (Goodreau Aff., Ex. L.)

  Mrs. Feit commenced this suit on May 15, 2003 in the Superior Court of New Jersey, Passaic County. Great-West subsequently removed this case to District Court pursuant to diversity jurisdiction. Mrs. Feit's original complaint contained four counts. She voluntarily withdrew two of the counts.*fn1 Thus, the only remaining claims before this Court are for breach of contract ("Count I") and breach of the implied covenant of good faith and fair dealing ("bad faith" or "Count II").

  During discovery, Mrs. Feit provided pictures of the crash and named two expert witnesses, whose depositions were taken by Great-West. Mrs. Feit's experts were Dr. Arthur Fisch, a cardiologist, and Dr. Duc V. Duong, a medical examiner. The reports of both experts attest that, given the circumstances of the crash, the manner in which the body was found, Dr. Feit's medical history, and the findings of the autopsy reports, Dr. Feit's atherosclerotic obstruction did not contribute to his death. Analysis

  I. Summary Judgment Standard

  Rule 56 of the Federal Rules of Civil Procedure provides that summary judgment may be granted only if the pleadings, supporting papers, affidavits, and admissions on file, when viewed with all inferences in favor of the nonmoving party, demonstrate that there is no genuine issue of material fact and that the movant is entitled to judgment as a matter of law. See Todaro v. Bowman, 872 F.2d 43, 46 (3d Cir. 1989); Chipollini v. Spencer Gifts, Inc., 814 F.2d 893, 896 (3d Cir. 1987). An issue is "genuine" if a reasonable factfinder could possibly hold in the nonmovant's favor with regard to that ...


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