Estate of David Maurice, Jr. v. Life Ins. Co. of N. America ( 2020 )

NOT FOR PUBLICATION FILED
UNITED STATES COURT OF APPEALS FEB 5 2020
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
ESTATE OF DAVID MAURICE, JR.; Nos. 18-55944, 18-55981, 18-
STACY MAURICE, 56558
Plaintiffs-Appellees/Cross- D.C. No. 5:16-CV-2610-CAS-SP
Appellants,
MEMORANDUM*
v.
LIFE INSURANCE COMPANY OF
NORTH AMERICA,
Defendant-Appellant/Cross-
Appellee.
Appeal from the United States District Court
for the Central District of California
Christina A. Snyder, District Judge, Presiding
Argued and Submitted January 24, 2020
Pasadena, California
Before: CLIFTON and LEE, Circuit Judges, and BLOCK,** District Judge.
Life Insurance Company of North America (“LINA”) appeals the district
*
This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
**
The Honorable Frederic Block, United States District Judge for the
Eastern District of New York, sitting by designation.
court’s judgment in favor of the Estate of David Maurice, Jr. (“Maurice”), as well
as its post-judgment order awarding attorneys’ fees and costs. We assume
familiarity with the facts, procedural history, and issues on appeal.
The policies here do not provide coverage “if a preexisting condition
substantially contributed to the disability.” McClure v. Life Ins. Co. of N. Am., 84
F.3d 1129, 1136 (9th Cir. 1996). “The word ‘substantial’ is used to denote the fact
that [the condition] has such an effect in producing the harm as to lead reasonable
men to regard it as a cause, using that word in the popular sense, in which there
always lurks the idea of responsibility, rather than in the so-called ‘philosophic
sense,’ which includes every one of the great number of events without which any
happening would not have occurred.” Dowdy v. Metro. Life Ins. Co., 890 F.3d
802, 809 (9th Cir. 2018) (quoting Restatement (Second) of Torts § 431 cmt. a (Am.
Law Inst. 1965)). “For a court to distinguish between a responsible cause and a
‘philosophic,’ insignificant cause, there must be some evidence of a significant
magnitude of causation. Such evidence need not be presented with mathematical
precision, but must nonetheless demonstrate that a causal or contributing factor
was more than merely related to the injury, and was instead a substantial catalyst.”
Id.
Although the district court cited the correct legal principles, its application
of them to the facts was clearly erroneous. The district court found that Maurice
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cut his feet on glass in a swimming pool; that finding is supported by the record.
However, Maurice’s own medical expert explained that diabetes prevented the cuts
from healing properly and exacerbated the risk of infection. Once the cuts became
infected, diabetes made it more difficult to fight the “bacterial onslaught”—even
with the assistance of antibiotics—allowing the infection to reach the bone.
Eventually, the only way to stop the infection from spreading was amputation. The
effect of diabetes is far more extensive and better-documented here than it was in
Dowdy. The conclusion is inescapable that Maurice’s diabetes “substantially
contributed” to the amputation.
We reject the argument that diabetes had to be the predominant cause of the
amputation. It is an incorrect statement of federal common law. Our cases
expressly note that where, as here, the policy language is conspicuous, a
preexisting condition can bar coverage “even though the claimed injury was the
predominant or proximate cause of the disability.” Dowdy, 890 F.3d at 808
(quoting McClure, 84 F.3d at 1136).1 The rule under California law is different,
see, e.g., Slobojan v. W. Travelers Life Ins. Co., 450 P.2d 271, 278 (Cal. 1969), but
it is preempted, see McClure, 84 F.3d at 1133 (citing Evans v. Safeco Life Ins. Co.,
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An inquiry into a single predominant or proximate cause is necessary if the
policy language is inconspicuous. See McClure, 84 F.3d at 1136 (“[I]f the
language is inconspicuous, a policy holder reasonably would expect coverage if the
accident were the predominant or proximate cause of the disability.”). Maurice
concedes that LINA’s policy language was conspicuous.
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916 F.2d 1437, 1439 (9th Cir. 1990)). We disagree that recent Supreme Court
cases call Evans into question. The Supreme Court has never questioned that
uniform rules of policy interpretation are an essential part of the “federal common
law of rights and obligations under ERISA-regulated plans.” Pilot Life Ins. Co. v.
Dedeaux, 481 U.S. 41, 56 (1987).
Our disposition of the coverage issue makes it unnecessary for us to address
Maurice’s cross-appeal regarding the amount of coverage. In addition, it requires
us to vacate the award of attorneys’ fees and costs.
JUDGMENT REVERSED; ORDER AWARDING ATTORNEYS’ FEES
AND COSTS VACATED; REMANDED WITH INSTRUCTIONS TO ENTER
JUDGMENT FOR LINA.
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