Ramirez v. United of Omaha Life Insurance Co., No. 16-11660 (5th Cir. 2017)Annotate this Case
The Fifth Circuit affirmed the district court's grant of summary judgment for United in plaintiff's action seeking benefits under an accidental death and dismemberment and life insurance policy provided by his employer. The court held that plaintiff's eye infection was not an "Accident" within the meaning of the policy. Furthermore, plaintiff's loss of sight from a fungal infection was not "independent of Sickness," and was not covered by the policy. The court reasoned that the policy's extension of coverage did not turn on whether the death or loss was caused by a condition that arose after the inception of the policy. Rather, the nature and cause of the loss determine whether there was coverage. In this case, the contra proferentem rule did not apply because the policy terms were not unambiguous and the court need not construe the policy against United.