United States District Court, D. South Carolina, Columbia Division
ESTATE OF MARION FAYNE ANDERSON, Estate No. 2015ES3200802, by Kerry Brown, its Personal Representative, Plaintiff,
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA., Defendant.
MEMORANDUM OPINION AND ORDER GRANTING DEFENDANT'S
MOTION FOR SUMMARY JUDGMENT
GEIGER LEWIS UNITED STATES DISTRICT JUDGE.
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.
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.
FACTUAL AND PROCEDURAL HISTORY
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.
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.
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
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 ...