SCOTT WOLF V. INS. CO. OF N. AMERICA, No. 21-35485 (9th Cir. 2022)
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Plaintiff's son died in a single-vehicle collision. At the time, he was intoxicated and driving the wrong way on a one-way road. The accidental death and dismemberment insurance policy obtained from defendant Life Insurance Company of North America (LINA) by the plaintiff via his employer paid benefits for a “Covered Accident,” defined as “[a] sudden, unforeseeable, external event that results, directly and independently of all other causes.”
Applying the Padfield test, Padfield v. AIG Life Ins. Co., 290 F.3d 1121 (9th Cir. 2002), the son’s death was an “accident” because, while the facts demonstrated that the son engaged in reckless conduct, the record did not show that his death was “substantially certain” to result from that conduct. Thus, the Ninth Circuit affirmed the district court's finding.
Court Description: ERISA The panel affirmed the district court’s summary judgment in favor of the plaintiff in an action under the Employee Retirement Income Security Act concerning the denial of an insurance claim based on the plaintiff’s son’s accidental death. The son died in a one-car collision. He was intoxicated and had been driving at a high speed in the wrong direction down a one-way road when he hit a speed bump and lost control of the car, which ultimately flipped over and landed upside down in a body of water adjoining the road. The accidental death and dismemberment insurance policy obtained from defendant Life Insurance Company of North America (LINA) by the plaintiff via his employer paid benefits for a “Covered Accident,” defined as “[a] sudden, unforeseeable, external event that results, directly and independently of all other causes.” Reviewing de novo, the panel held that to determine whether the son’s death was the result of an “accident” under the policy, it must apply the Padfield test, an “overlapping subjective and objective inquiry.” The panel concluded that, under this test, there was insufficient evidence in the administrative record to determine the son’s subjective expectation at the time he died. Proceeding to the objective inquiry, the panel declined to consider for the first time on appeal LINA’s argument that because the policy defined the WOLF V. LIFE INS. CO. OF NORTH AMERICA 3 term “accident” as “a sudden, unforeseeable, external event,” the district court should have asked whether the son’s death was “reasonably foreseeable” rather than applying the Padfield test by asking whether his death was “substantially certain.” Declining to apply an exception for purely legal issues, the panel concluded that the plaintiff would be unduly prejudiced by the belated application of a “reasonably foreseeable” test because not only did LINA fail to raise the argument below, but it also did not use that test when initially denying the plaintiff’s insurance claim. The panel held that, under the Padfield test, the son’s death was an “accident” because, while the facts demonstrated that the son engaged in reckless conduct, the record did not show that his death was “substantially certain” to result from that conduct. Accordingly, the district court correctly determined that the son’s death was covered under the insurance policy. Concurring, Judge Ikuta stated that she wrote separately to emphasize that the panel’s opinion applied the definition of an “accident” set forth in Padfield v. AIG Life Ins. Co., 290 F.3d 1121 (9th Cir. 2002), only because LINA relied on Padfield and forfeited its argument the insurance policy’s own definition of “accident” applied.
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