Opinion
Civil Action No. 4:19-CV-1858
2021-04-07
Russell HOLMAN, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, Defendant.
John Price McNamara, McNamara Law Offices, Baton Rouge, LA, for Plaintiff. Linda P. Wills, Wilson Elser et al., Houston, TX, for Defendant.
John Price McNamara, McNamara Law Offices, Baton Rouge, LA, for Plaintiff.
Linda P. Wills, Wilson Elser et al., Houston, TX, for Defendant.
MEMORANDUM OPINION AND ORDER
GEORGE C. HANKS, JR., UNITED STATES DISTRICT JUDGE
Pending before the Court are two Motions for Judgment on the Administrative Record under Federal Rule of Civil Procedure 52, one filed by the Plaintiff Russell Holman ("Holman") and the other filed by Defendant Life Insurance Company of North America ("LINA"). After careful consideration of the motions, responses, replies, the administrative record, and applicable case law, LINA's motion for judgment (Dkt. 16) is GRANTED and Holman's motion for judgment (Dkt. 18) is DENIED.
I. BACKGROUND
Holman brought this suit to recover accidental death benefits under a Group Accident Policy (OK-963550) ("Policy") issued by LINA as part of an employee benefits plan governed by the Employee Retirement Income Security Act of 1974 as amended, 29 U.S.C. § 1001, et seq. ("ERISA"). Holman obtained this Policy to cover his wife Debra Holman ("Ms. Holman"). The Policy provides for a death benefit of $125,000 with Holman as the beneficiary.
Ms. Holman died in a hospital nine days after she lost control of her car and crashed into a telephone pole. Holman filed a claim under the Policy for the death benefits with LINA. LINA, the claims administrator for the Policy, reviewed and denied the claim. LINA determined that Ms. Holman did not die from a "Covered Accident," as defined by the Policy. LINA also denied benefits based on a Policy exclusion. After his appeal of LINA's decision was denied, Holman filed this action under 29 U.S.C. § 1132(a)(1)(B) challenging LINA's decision and seeking LINA's payment of the Policy's accidental death benefits to him as the beneficiary. Holman and LINA have now filed cross motions for judgment on the administrative record, each seeking judgment in their favor in this action. The motions are ready for the Court's consideration.
II. LEGAL STANDARD
A. Standard of Review
The parties agree that this action is governed by the ERISA and that the Court's standard of review of LINA's denial of benefits is de novo. (Dkt. 14). "Although the Fifth Circuit has not specified what de novo review requires in ERISA cases, other circuits and district courts provide instructive guidance." Batchelor v. Life Ins. Co. of N. Am. , 504 F.Supp.3d 607, 609 (S.D. Tex. 2020) (Ellison, J.). "Under the de novo standard of review, the court's task is to determine whether the administrator made a correct decision.’ " Pike v. Hartford Life & Accident Ins. Co. , 368 F. Supp. 3d 1018, 1030 (E.D. Tex. 2019) (quoting Niles v. Am. Airlines, Inc. , 269 Fed. App'x. 827, 832 (10th Cir. 2008) ). The decision to deny benefits is "not afforded deference or a presumption of correctness." Id. The court "must stand in the shoes of the administrator and start from scratch, examining all the evidence before the administrator as if the issue had not been decided previously." Byerly v. Standard Ins. Co. , No. 4:18-CV-00592, 2020 WL 1451543, at *18 (E.D. Tex. Mar. 25, 2020), aff'd , 843 Fed.Appx. 572 (5th Cir. 2021) (citation omitted). The court must "independently weigh the facts and opinions in the administrative record to determine whether the claimant has met his burden." See Richards v. Hewlett-Packard Corp. , 592 F.3d 232, 239 (1st Cir. 2010).
B. Burden of Proof
Pursuant to § 1132(a)(1)(B), a "participant or beneficiary" may bring a civil action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan...." 29 U.S.C. § 1132(a)(1)(B). "A plaintiff suing under this provision bears the burden of proving his entitlement to contractual benefits." Horton v. Reliance Standard Life Ins. Co. , 141 F.3d 1038, 1040 (11th Cir. 1998) (citing Farley v. Benefit Trust Life Ins. Co. , 979 F.2d 653, 658 (8th Cir. 1992) ). "But, if the insurer claims that a specific policy exclusion applies to deny the insured benefits, the insurer generally must prove the exclusion prevents coverage." Id. (citing Farley , 979 F.2d at 658 ); See Perdue v. Burger King Corp. , 7 F. 3d 1251, 1254 n.9 (5th Cir. 1993) ; Estate of Thompson v. Sun Life Assur. Co. of Canada , 603 F. Supp. 2d 898, 908-09 (N.D. Tex. 2008) "[A]s a matter of general insurance law, the insured has the burden of proving that a benefit is covered, while the insurer has the burden of proving that an exclusion applies." Mario v. P C Food Markets, Inc. , 313 F.3d 758, 765 (2d Cir. 2002).
C. Federal Rule of Civil Procedure 52
Both Holman and LINA agree that the Court should resolve this case pursuant to Federal Rule of Civil Procedure 52. Rule 52 governs "an action tried on the facts without a jury." Fed. R. Civ. P. 52(a). Under Rule 52, the district court "must find the facts specially and state its conclusions of law separately." Id. " Rule 52(a) does not require that the district court set out findings on all factual questions that arise in a case." Valley v. Rapides Par. Sch. Bd. , 118 F.3d 1047, 1054 (5th Cir. 1997). Instead, a court's "[f]indings satisfy Rule 52 if they afford the reviewing court a clear understanding of the factual basis for the trial court's decision." Interfirst Bank of Abilene, N.A. v. Lull Mfg. , 778 F.2d 228, 234 (5th Cir. 1985). In the context of an ERISA claim, "using Rule 52 is effective ... because courts may resolve factual disputes and issue legal findings without the parties resorting to cross motions for summary judgment." Pike , 368 F. Supp. 3d at 1025.
III. FINDINGS OF FACT
A. The Group Accident Policy
The Group Accident Policy provides for payment of accidental death benefits for a covered accident and states as follows:
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
Covered Loss. We will pay the benefit for any one of the Covered Losses listed in the Schedule of Benefits, subject to all applicable conditions and exclusions, if the Covered Person suffers a Covered Loss resulting, directly and independently of all other causes, from a Covered Accident within the applicable time period specified in the Schedule of Benefits.
A Covered Loss is defined as follows:
A loss that is all of the following: "1) the result, directly and independently of all other causes, of a Covered Accident; 2) one of the Covered Losses specified in the Schedule of Covered Losses; 3) suffered by the Covered Person within the applicable time period specified in the Schedule of Benefits." (A.R. 107).
Additionally, an exclusion in the Policy states as follows:
In addition to any benefit-specific exclusions, benefits will not be paid for any Covered Injury or Covered Loss which, directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits Section: ... 7. Sickness, disease, bodily or mental infirmity ...; (A.R. 107).
B. The Insured's Death
On December 11, 2017, Ms. Holman crashed her car into a pole after failing to maintain her lane and swerving across two lanes of traffic and off the road. Her legs were trapped under the foot pedals and she had to be extricated from the vehicle. She was taken to Bayshore Medical Center by ambulance complaining of chest, abdominal, sternal, and right foot pain. Ms. Holman was conscious throughout her transport and arrival at the hospital, and she was not given any medication in route. She was diagnosed with blunt force trauma, multiple right rib fractures, and a right foot fracture. A CT scan taken later the day of the crash showed an old cerebrovascular infarct on the left side of her brain evidencing a prior cerebral infarction, which is also called a stroke. (A.R. 486). This scan also showed that there were "no acute intracranial bleeds or extra-axial collections, no acute territorial vascular infarction, no herniation or hydrocephalus or midline shift, and chronic white matter ischemic disease and atrophy." (A.R. 486).
On December 13, 2017, Ms. Holman underwent surgery to repair her right ankle but was lethargic and showed signs of altered mental status after the surgery. A brain CT scan on December 14, 2017 revealed a large acute middle cerebral artery ("MCA") infarct that was "resolving" on the right side of her brain. The medical records refer to this as a "new finding from the CT of the brain on admission." (A.R. 201). On December 16, 2017 a CTA scan of Ms. Holman's neck reflected the serious nature of her medical condition, revealing a "complete occlusion of the distal M1 segment and the entire M2 segment of the MCA." (A.R. 270). On December 20, 2017 Ms. Holman unfortunately passed away from the infarct. (A.R. 296).
The middle cerebral artery or MCA is the largest of the three major paired arteries that supply blood to the brain.
At the time of her death, Ms. Holman had a history of hypertensive cardiovascular and atherosclerotic cardiovascular disease including a previous stroke approximately ten years earlier and hypertension which was being treated with the prescription medication Hydrodiuril. Ms. Holman was also taking Plavix, which is a prescription medication to prevent heart attacks and strokes in persons with heart disease, a history of stroke, or blood circulation disease. (A.R. 193).
See https://www.drugs.com/plavix.html ("Plavix (clopidogrel ) prevents platelets in ... blood from sticking together to form an unwanted blood clot that could block an artery. Plavix is used to lower [the] risk of having a stroke, blood clot, or serious heart problem after ... a heart attack, severe chest pain (angina), or circulation problems.")
Dr. Michael Condron, an assistant medical examiner with the Harris County Institute of Forensic Sciences, performed an autopsy of Ms. Holman and signed her death certificate. He found that Ms. Holman's cause of death was a "cerebral infarct associated with hypertensive and atherosclerotic cardiovascular diseases." (A.R. 326). He also found that "complications of blunt force injuries" were another significant condition contributing to her death. The autopsy of Ms. Holman's brain revealed the presence of intracerebral arteriolosclerosis. (A.R. 336).
C. The Benefits Claims Process
Holman submitted a claim for benefits under the Policy. (A.R. 339). While initially investigating the claim, LINA reviewed the proof of loss claim form, the death certificate, the Texas Peace Officer Crash Report, the ambulance service prehospital care report summary, medical records, and the Harris County Institute of Forensic Sciences Autopsy and Neuropathology Report regarding Ms. Holman's death. (A.R. 270). Additionally, LINA requested an independent medical review by Thomas Morgan, MD, a board-certified neurologist. (A.R. 292).
After reviewing the records, Dr. Morgan opined that "to a reasonable degree of medical certainty Ms. Holman had well established, preexistent cerebral vascular disease and prior stroke to the left side of her brain secondary to arthrosclerosis [sic] involving the middle cerebral artery on the left. This preexistent arthrosclerosis [sic] caused or contributed to the occlusion to the right middle cerebral artery hemorrhagic infarct that caused her death." (A.R. 271).
LINA subsequently notified Holman that no accidental death insurance benefits under the Policy were payable for Ms. Holman's death. (A.R. 269–73). LINA denied Policy benefits to Holman, in part on the grounds that the claim fell within an express exclusion in the Policy. (A.R. 269–73). In its denial of benefits letter, LINA informed Holman that the Policy specifically excludes payment for any loss that "directly or indirectly, in whole or in part, is caused by or results from ... Sickness, disease, bodily or mental infirmity." (A.R. 272). LINA determined that "[a]s [Ms. Holman's] death was due to natural causes, specifically a cerebral infarct due to hypertensive and atherosclerotic cardiovascular diseases, and her death was directly or indirectly, caused by or resulting from a sickness, disease, or bodily infirmity, her loss of life is specifically excluded under the terms of the policy." (A.R. 269–73). Holman appealed LINA's decision.
In support of this appeal Holman provided LINA with the medical opinions of Harold Ginzburg, MD, JD, MPH, who is board certified in psychiatry and neurology, and Peter Liechty, MD, FAANS, FACS, who is board certified in neurological surgery, regarding Ms. Holman's cause of death. (A.R. 114, 186). Dr. Ginzburg opined that the infarct and Ms. Holman's subsequent death "to a reasonable degree of medical certainty can be attributed to the automobile accident, its related trauma and subsequent medical and surgical interventions .... directly resulting from the trauma of Ms. Holman's motor vehicle striking a telephone pole." (A.R. 191). "[T]he fatal infarct appears to have occurred as a direct and proximate result of the automobile accident in question and the resultant appropriate medical care." (A.R. 207–08). Dr. Liechty "strongly" agreed with Dr. Ginzburg's report. (A.R. 209–10).
In considering the appeal, LINA requested another external peer review, which was performed by Adel Shaker M.D., a pathologist. (A.R. 174–77). Dr. Shaker opined that Ms. Holman's pre-existing medical conditions, including history of hypertensive cardiovascular and atherosclerotic cardiovascular disease contributed to her death. (A.R. 174–77). After considering the medical opinions, LINA notified Holman that his appeal was denied. (A.R. 159–70).
Holman challenged Dr. Shaker's credibility and motivations for his opinion. In response to these challenges LINA submitted the file for an additional review by Marvin Pietruszka, MD, MSc, FCAP. (AR 114–21). Dr. Pietruszka, who is triple board certified in anatomical and clinical pathology, occupational medicine, and forensic toxicology, opined that both Ms. Holman's pre-existing diseases and the surgery performed for her injuries suffered in the accident were "direct contributors" to Ms. Holman's death. (A.R. 114–21). His report states in pertinent part that:
"[Ms. Holman's] pre-existing history significantly contributed to her course; [she] already has an established medical history significant for cardiovascular disease and a prior left MCA stroke and considering further morbidity with multiple musculoskeletal injuries and associated surgical intervention, these preexisting conditions contributed to [her] recent [cerebrovascular accident], which is deemed as the cause of death. [Ms. Holman's] pre-existing conditions and surgical operation performed for
the injury sustained within the accident are direct contributors to her death. (A.R. 111).
LINA affirmed its denial of death benefits and informed Holman that his administrative appeals rights were exhausted. (A.R. 106–12). Holman later filed this lawsuit. (A.R. 111).
IV. CONCLUSIONS OF LAW
A. Policy Interpretation
ERISA preempts state common-law rules of construction for interpreting insurance policy terms. 29 U.S.C. § 1144(a). Matters of contract interpretation in the context of ERISA insurance policies are instead governed by a uniform federal common law. Because ERISA provides little guidance on matters of contract interpretation, the courts must fashion federal common law rules to govern ERISA suits in an effort to promote uniformity. Wegner v. Standard Ins. Co. , 129 F.3d 814, 818 (5th Cir. 1997) ; Jones v. Ga. Pac. Corp. , 90 F.3d 114, 116 (5th Cir. 1996). The Fifth Circuit Court of Appeals has enunciated several general principles in construing ERISA plan provisions. First, courts must interpret the contract language "in an ordinary and popular sense as would a person of average intelligence and experience," such that the language is given its generally accepted meaning, if there is one. Wegner , 129 F.3d at 818 ; Jones , 90 F.3d at 116. Only if the plan terms remain ambiguous after applying ordinary principles of contract interpretation is the court compelled to apply the rule of contra proferentem and construe the terms strictly in favor of the insured. Id. Further, when construing the policy's language, the court must give effect to all contractual provisions so that none will be rendered meaningless. Tex. Indus., Inc. v. Factory Mut. Ins. Co. , 486 F.3d 844, 846 (5th Cir. 2007).
Next, a court may "draw guidance from analogous state law" in ascertaining the applicable federal common law, but only to the extent it is not inconsistent with congressional policy concerns underlying ERISA. Brandon v. Travelers Ins. Co. , 18 F.3d 1321, 1325 (5th Cir. 1994). Texas contract interpretation law indicates that "[i]f policy language is worded so that it can be given a definite or certain legal meaning, it is not ambiguous and [will be] construe[d] [ ] as a matter of law." Am. Mfrs. Mut. Ins. Co. v. Schaefer , 124 S.W.3d 154, 157 (Tex. 2003). The fact that the parties offer different contract interpretations does not itself create an ambiguity. Id. Ambiguity only exists if the contract language is susceptible to two or more reasonable interpretations. Id.
Finally, the policy at issue here is for accidental death benefits. In Phillips v. Home Sec. Life Ins. Co. , 632 F.2d 1302, 1305 (5th Cir. 1980) the Fifth Circuit noted that the district court must construe such policies very precisely:
Insurance against death by accident is usually, as here, afforded for a small premium and the coverage is correspondingly narrow. The liability is guarded by carefully chosen words, and a court has no more right by strained construction to make the policy more beneficial by extending the coverage contracted for than it would have to increase the amount of the insurance. (quoting Life & Cas. Ins. Co. of Tennessee v. Brown , 213 Ga. 390, 99 S.E.2d 98, 100 (1957) ).
While the Fifth Circuit in Phillips was not considering Texas law, this comment is consistent with state and federal decisions considering Texas law construing such policies. See Fowler v. Peoples Benefit Life Ins. Co. , No. 3:06-CV-1095-L, 2007 WL 2229053, 2007 U.S. Dist. LEXIS 56654 (N.D. Tex. Aug. 3, 2007).
B. Analysis of Policy Exclusion
The Court will consider the twin questions of whether Ms. Holman's death falls within the definition of a "Covered Loss" and whether the Policy's exclusion at issue precludes any recovery of accidental death benefits together under the Court's analysis of the Policy exclusion because the exclusion encompasses the coverage language.
Many policies, like the one at issue here, contain an exclusion which specifically disallows recovery where disease caused or contributed to the loss. In Stroburg v. Ins. Co. of No. Am. , 464 S.W.2d 827, 829–31 (Tex. 1971), the Texas Supreme Court recognized two general types of accidental death policy exclusions addressing the effect of disease on recovery: those which exclude coverage only when disease is a proximate cause of the loss, and those which also exclude coverage when disease is a more remote cause of the loss. See Sekel v. Aetna Life Ins. Co. , 704 F.2d 1335, 1342 (5th Cir. 1983).
In the first category is the exclusion presented in Stroburg which provides that "this policy does not cover loss caused by or resulting from any one or more of the following: ... disease." Stroburg , 464 S.W.2d at 831 (emphasis added). In Texas and most other jurisdictions, exclusions using this language or language similar to it have been construed to preclude recovery only where disease is a shown to be "concurrent proximate cause" of death. Mut. Benefit Health & Accident Ass'n v. Hudman , 398 S.W.2d 110, 115 (Tex. 1965) ; 10 G. Couch et al., Couch on Insurance 2d, § 41:75 at 113–14 (Rev. Ed. 1982 & Supp. 1996); and see 1B Appleman, Insurance Law & Practice § 393, at 64–73 (1981). Where such disease is found to be a "remote" cause of death, however, courts have not barred recovery under these types of exclusions. Stroburg , 464 S.W.2d at 829-31 ; Appleman, supra § 393; Couch et al., supra , § 41:79–80.
As an example of the second category, the Texas Supreme Court cites exclusions containing language precluding payment of benefits if disease contributed "directly or indirectly" to the loss. Stroburg , 464 S.W.2d at 831–32. These types of exclusions have been construed by Texas state and federal courts to "effectively exclud[e] coverage where disease, though a functionally closely related significant contributing factor or cause is nevertheless neither a concurrent proximate nor the most immediately precipitating cause of loss." Sekel , 704 F.2d at 1342. In this case, the Court must determine whether the Policy exclusion at issue falls into either the first or second category of exclusions recognized by the Texas Supreme Court in Stroburg.
Assuming, as argued by Holman, that Ms. Holman's car crash was a "Covered Accident" as defined in the Policy, under the policy exclusion at issue, Holman is still not entitled to benefits under the Policy for her death. This exclusion denies coverage for accidental death benefits with respect to "any loss which, directly or indirectly, in whole or in part, is caused by or results from ... disease." The exclusion is clear and unambiguous in conveying its meaning. As such, the principle of construing insurance contracts strictly against the insurer does not apply, S. Life and Health Ins. Co. v. Simon , 416 S.W.2d 793, 795 (Tex. 1967), and we must give the language of the policy its plain meaning. Argonaut Sw. Ins. Co. v. Am. Home Assurance Co. , 483 F. Supp. 724, 727 (N.D. Tex. 1980) ; Vanguard Ins. Co. v. Stewart , 593 S.W.2d 736, 739 (Tex. Civ. App.—Houston [1st Dist.] 1979), aff'd , 603 S.W.2d 761 (Tex. 1980).
The Court concludes that the Policy exclusion at issue is of the second type described in the Stroburg decision. The exclusion's language is extremely broad and makes clear that it applies regardless of whether the disease is a concurrent proximate cause or a remote cause of death. The Policy language excludes not just losses "caused by or resulting from" a disease—diseases that are concurrent proximately causes of the loss—but "any loss which directly or indirectly, in whole or in part " is caused by or resulting from disease—diseases that are a remote cause of death. (A.R. 15). (emphasis added). To hold otherwise would effectively read this latter clause out of the Policy exclusion. Accordingly, no accidental death benefits are payable when a risk excluded by the Policy—a disease—is a functionally closely related significant cause or contributing factor of the loss even though a covered risk—the car crash—is the proximate and more immediate precipitating cause. See Sekel , 704 F.2d at 1342.
See e.g. , Stroburg , 464 S.W.2d at 831 (" ‘It seems reasonably clear that a policy with the phrase ‘resulting directly, independently and exclusively’ refers to the efficient, substantial and proximate cause of the disability at the time it occurred. On the other hand, a policy which also has the phrase ‘wholly or partly, directly or indirectly, from disease or mental or bodily infirmity’ refers to another contributory cause, whether proximate or remote. ’ " (emphasis added) (citations omitted)).
C. Applying the Policy Exclusion to Ms. Holman's History of Disease and Death
The Court concludes, as evidenced in part by her autopsy report, death certificate, and the medical expert opinions rendered in this case, that Holman's pre-existing cerebrovascular and cardiovascular diseases were closely related significant causes or contributing factors in her death. The results of her brain autopsy, her prescriptions for Plavix and Hydrodiuril, and her medical history of a previous stroke establish that Ms. Holman's diseases were not "dormant and insubstantial" or "transient;" rather they were obviously longstanding "very severe ... disease[s]," something not typical even of the person who is "neither ‘an Apollo or Hercules.’ " Sekel , 704 F.2d at 1342. Unfortunately, Ms. Holman had pre-existing cerebrovascular and cardiovascular disease and died after suffering a stroke, a condition that she was taking medication to prevent and that she had survived approximately ten years earlier. Accordingly, the Court finds that under the express language of the exclusion, benefits are not payable for her untimely death.
While Holman's experts Dr. Ginzburg and Dr. Liechty conclude that the "direct and proximate cause" of Ms. Holman's death was the car crash, neither expressly rules out her disease as a contributing factor in what each describes as the "totality of circumstances" contributing to her death. (A.R. 207). Their opinions also establish the close relationship between Ms. Holman's disease and death. For example. Dr. Ginzburg acknowledges Ms. Holman's "history of cerebrovascular and cardiovascular disease" and opines that it should have been clear that, "based on her prior medical history, she was at increased risk for the ultimate fatal events." (A.R. 198). Likewise, Dr. Liechty acknowledges that while Ms. Holman was "asymptomatic" prior to her death, she had "pre-existing factors for a stroke." (A.R. 163). Dr. Ginzburg also notes that Ms. Holman's pre-existing psychiatric condition—she was being prescribed psychotropic medication prior to the accident in question and during her hospitalization—combined with her pre-existing medical history made her "vulnerable" for a stroke. (A.R. 206–08) At the time of her death Ms. Holman was taking prescription medication used for treating anxiety. (A.R. 193).
Relying on the holding in Wells v. Minn. Life Ins. Co. , 885 F.3d 885, 893 (5th Cir. 2018), Holman argues that the definition of "Covered Loss" and the exclusion are ambiguous as to their application to Ms. Holman's established history of cerebrovascular and cardiovascular disease. (Dkt. 25 at p. 2) Holman argues that to obtain benefits, the definition should be construed as requiring him to establish that the car crash was the "direct" or "proximate cause" of Ms. Holman's death. To preclude payment of death benefits for her death under the exclusion, Holman argues that LINA would then have to prove that the diseases were not "concurrent proximate causes" of her death. Holman argues that he is entitled to prevail in this action because the reports from Dr. Ginzburg and Dr. Liechty not only establish that the car crash was the "direct and proximate" cause of her death, but that Ms. Holman's pre-existing history of disease was not a "concurrent proximate cause" of her death. The Court finds this argument unpersuasive and Holman's reliance on the holding in Wells in support of his argument is misplaced.
The holding of the Fifth Circuit in Sekel makes clear that the express language of the exclusion is unambiguous, and the Court cannot consider any construction of this language, such as the one suggested by Holman, other than the plain meaning of this provision. Sekel , 704 F.2d at 1338. Furthermore, the holding in Wells does not support a finding of ambiguity here. While in Wells the court found the language of the exclusion ambiguous, it was found ambiguous regarding whether the exclusion precluded payment for deaths caused by a non-preexisting infirmity, illness, or disease. Here, that question is not at issue: there is no dispute that Ms. Holman's disease pre-existed the car crash. See Wells , 885 F.3d at 896 n. 10. Even if Ms. Holman's diseases were not proximate or immediate precipitating causes of her death, the Policy exclusion is triggered because at the very least, the diseases were significant contributing factors of her death. Accordingly, the Court finds that the Policy's exclusion precludes Holman from recovering accidental death benefits for Ms. Holman's death and LINA is entitled to judgment in this action.
V. CONCLUSION
For the reasons stated above, LINA's motion for judgment on the administrative record (Dkt. 16) is GRANTED and Holman's claims are DISMISSED WITH PREJUDICE . Holman's motion for judgment (Dkt. 18) is DENIED. The Court will enter final judgment concurrent with this order.