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Estate of Marion Fayne Anderson v. National Union Fire Insurance Co. of Pittsburgh PA.

United States District Court, D. South Carolina, Columbia Division

March 22, 2018

ESTATE OF MARION FAYNE ANDERSON, Estate No. 2015ES3200802, by Kerry Brown, its Personal Representative, Plaintiff,
v.
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA., Defendant.

          MEMORANDUM OPINION AND ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT

          MARY GEIGER LEWIS UNITED STATES DISTRICT JUDGE.

         I.INTRODUCTION

         This is an action for bad faith breach of contract and related claims arising out of a refusal to pay insurance benefits under an insurance policy. The Court has jurisdiction over this matter under 28 U.S.C. § 1332.

         Pending before the Court is Defendant National Union Fire Insurance Company of Pittsburgh, Pa.'s (Defendant or NUFIC) motion for summary judgment. ECF No. 30. Having carefully considered Defendant's motion, the response, the reply, the record, and the applicable law, it is the judgment of the Court Defendant's motion for summary judgment will be granted.

         II. FACTUAL AND PROCEDURAL HISTORY

         Marion Fayne Anderson (Mr. Anderson) was a resident of Lexington County, South Carolina. ECF No. 1-1 at 15. Kerry Brown is the personal representative of Plaintiff, Estate of Mr. Anderson. Id. at 5. Because Brown is acting on behalf of the estate, the Court will refer to him as Plaintiff.

         On May 15, 2008, Mr. Anderson enrolled in a Group Accident Insurance Policy (the Policy) issued by Defendant; the Policy was effective July 14, 2008. Id. at 24-38. American International Group, Inc. (AIG) distributed NUFIC products, and reviewed claims under the Policy. Id. at 19-23. The Policy provided benefits for emergency treatment, family leave, and permanent total disability. Id. at 24-38.

         The emergency treatment benefit provided coverage for medically necessary emergency treatment for an injury if sought within seventy-two hours of the accident that caused the injury. Id. at 31. The family leave benefit provided coverage for the insured's leave of absence or resignation from employment to care for a family member who was disabled due to an injury, or for a family member's leave of absence or resignation from employment to care for the insured who was disabled by an injury if the disability occurred within ninety days of the accident causing the injury, and the leave or resignation occurred within 180 days of the accident. Id. at 31-32. The permanent total disability benefit provided a lump-sum payment if the insured was rendered permanently totally disabled within ninety days of an accidental injury as a result of that injury; that benefit was payable after twenty-four months of permanent total disability. Id. at 29, 33.

Injury, which was central to all three benefits, was defined under the Policy as:
bodily injury: (1) which is sustained as a direct result of an unintended, unanticipated accident that is external to the body and that occurs while the injured person's coverage under the Policy is in force; (2) which directly (independent of sickness, disease, mental incapacity, bodily infirmity or any other cause) causes a covered loss; and (3) which occurs while such person is participating in a Covered Activity.

Id. at 30. The Policy also contained the following exclusion:

No coverage shall be provided under the Policy and no payment shall be made for any loss resulting in whole or in part from, or contributed to by, or as a natural and probable consequence of any of the following excluded risks even if the proximate or precipitating cause of the loss is an accidental bodily injury.
2. sickness, or disease, mental incapacity or bodily infirmity whether the loss results directly or ...

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