Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-13-55719/USCOURTS-ca9-13-55719-0/pdf.json

Parties Involved:
National Union Fire Insurance Company of Pittsburgh, PA
Appellee
Bethany Williams
Appellant
Stephen Williams
Appellant

Document Text:

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

BETHANY WILLIAMS; STEPHEN

WILLIAMS, Co-Trustees of the Jack

and Cheryl Williams Revocable

Living Trust,

Plaintiffs-Appellants,

v.

NATIONAL UNION FIRE INSURANCE

COMPANY OF PITTSBURGH, PA, a

Pennsylvania corporation,

Defendant-Appellee.

No. 13-55719

D.C. No.

3:12-cv-01590-

AJB-WMC

OPINION

Appeal from the United States District Court

for the Southern District of California

Anthony J. Battaglia, District Judge, Presiding

Argued and Submitted

May 7, 2015—Pasadena, California

Filed July 7, 2015

Before: Kermit V. Lipez,

*

 Kim McLane Wardlaw,

and Mary H. Murguia, Circuit Judges.

Opinion by Judge Lipez

* The Honorable Kermit V. Lipez, Senior Circuit Judge for the First

Circuit, sitting by designation.

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2 WILLIAMS V. NAT’L UNION FIRE INS. CO.

SUMMARY**

Employee Retirement Income Security Act

Affirming the district court’s summary judgment in an

ERISA action, the panel held that an insurer properly denied

accidental death benefits to the insured’s family because his

death as a result of Deep Vein Thrombosis did not result from

an “accident” as defined by the insurance policy.

COUNSEL

David A. Shaneyfelt (argued), The Alvarez Firm, Calabasas,

California, for Plaintiffs-Appellants.

Sherry L. Swieca (argued), Mark R. Attwood, and Cynthia J.

Emry, Jackson Lewis LLP, Los Angeles, California, for

Defendant-Appellee.

** This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 3

OPINION

LIPEZ, Circuit Judge:

This case, brought under the Employee Retirement

Income Security Act (“ERISA”), stems from the sudden

death of Jack Williams as a result of Deep Vein Thrombosis

(“DVT”) shortly after he completed roughly 28 hours of air

travel in a five-day period. Appellee National Union Fire

Insurance Co. of Pittsburgh, Pennsylvania denied accidental

death benefits to Williams’ family on the ground that his

death did not result from an “accident” under the terms of the

policy. The district court accepted the insurer’s interpretation

of the policy and granted summary judgment for National

Union. Because we agree that Williams’ death did not result

from an “accident” as defined by the policy, and thus was not

a covered “injury,” we affirm.

BACKGROUND

I. Facts

Jack Williams was an acclaimed horticulturist who

traveled extensively in his role as the international product

manager and technical support representative for Paul Ecke

Ranch, Inc., a company based in Encinitas, California. In

October 2010, Williams flew more than 15 hours from Los

Angeles to Tokyo and shortly thereafter took three additional

flights, totaling almost 13 hours, from Tokyo to several

Australian cities. On the morning of October 18, Williams

collapsed as he walked from his hotel to meet a colleague and

was pronounced dead on arrival at a local hospital. An

autopsy report attributed his death to DVT, which had

triggered a pulmonary embolism (“PE”).

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4 WILLIAMS V. NAT’L UNION FIRE INS. CO.

DVT is a known hazard of long flights, with the risk of

developing the syndrome approximately doubling after a

flight of more than four hours and continuing to rise with

increased travel time and multiple flights within a short

period. The blood clots that give rise to DVT occur as a

result of the prolonged seated immobility that accompanies

air travel, likely in combination with dehydration and

underlying risk factors. A clot that breaks off and travels

through the bloodstream is called an embolus, which becomes

life-threatening if it reaches the lungs and blocks blood flow. 

This apparently is what happened to Williams, who was

otherwise in good health.

As a named insured under a policy purchased by his

employer, Williams was eligible for a $1 million accidental

death benefit if injured while traveling by air. The policy,

which is governed by ERISA, defines injury in Endorsement

E-5:

Injury — means 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 this Policy is in

force; (2) which occurs under the

circumstances described in a Hazard

applicable to that person; and (3) which

directly (independent of sickness, disease,

mental incapacity, bodily infirmity or any

other cause) causes a covered loss under a

Benefit applicable to such Hazard.

(Emphasis added.) Pursuant to the policy, Williams’ wife,

Cheryl, submitted a claim form titled “Proof of Loss -

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 5

Accidental Death,” in which she reported the cause of death

as “pulmonary thromboembolism deep vein thrombosis.”1

National Union’s claims administrator concluded that no

benefits were payable, explaining in its letter that “there is

insufficient evidence to support a conclusion that Mr.

Williams experienced a bodily injury sustained as a direct

result of an unintended, unanticipated accident that was

external to the body and which directly (independent of

sickness, disease, mental incapacity, bodily infirmity or any

other cause) caused his death.”2 Cheryl Williams

unsuccessfully appealed the decision to National Union’s

ERISA Appeals Committee, which explained its rejection of

her claim as follows:

Based on the available information, Mr.

Williams’ death was the result of sickness,

disease, bodily infirmity or a cardiovascular

accident or event, an internal reaction of his

body to an extended period of inactivity. 

There was no evidence that there was

anything unusual about Mr. Williams’ flights

during this time period, nor was there

 

1

 Cheryl Williams died before the district court issued its decision, and

the court granted the parties’ motion to substitute Bethany Williams and

Stephen Williams, co-trustees of the Jack and Cheryl Williams Revocable

Living Trust, as named Plaintiffs.

2 The policy expressly excludes from coverage “sickness, disease,

mental incapacity or bodily infirmity whether the loss results directly or

indirectly from any of these,” and “even if the proximate or precipitating

cause of the loss is an accidental bodily injury.” Like the district court, we

do not consider the applicability of the exclusions because we conclude

that the policy does not provide coverage.

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6 WILLIAMS V. NAT’L UNION FIRE INS. CO.

evidence that any unanticipated or unintended

external event or bodily injury occurred which

resulted in his deep vein thrombosis or

pulmonary embolism.3

II. Legal Proceedings

Following the final administrative rejection of her claim,

Cheryl Williams initiated this federal action against National

Union. See 29 U.S.C. § 1132(a)(1)(B) (permitting a

beneficiary of an employee benefit plan governed by ERISA

to bring a civil action to recover benefits owed under the

plan). Both sides moved for summary judgment. Cheryl

Williams claimed that her husband’s death occurred as a

result of an accident as defined by the policy because the

death was both unintended and unanticipated, and its

cause—prolonged sitting on planes—was “external to the

body.” National Union again pressed its view that no benefits

were owed because Williams’ death did not result from an

unanticipated or unintended external event or bodily injury.

The district court ruled for the insurer, concluding that

Plaintiffs had failed to establish entitlement to benefits

because Williams’ death did not result from “an accident

‘external to the body,’” as required by both the express

language of the National Union policy and prevailing

California law. See Williams v. Nat’l Union Fire Ins. Co. of

Pittsburgh, PA, No. 3:12-cv-01590, 2013 WL 1431822, at *8

(S.D. Cal. Apr. 9, 2013) (observing that “California courts

have been unwilling to find that an injury or death was

 

3

 It is undisputed that other prerequisites to coverage (death during the

policy period and injury occurring while traveling as a passenger on a

civilian aircraft) were met.

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 7

‘accidental’ unless ‘it was in some manner caused by an event

or occurrence unforeseen and external to the insured’”

(quoting Khatchatrian v. Cont’l Cas. Co., 198 F. Supp. 2d

1157, 1162 (C.D. Cal. 2002) (footnote omitted)). The court

rejected Plaintiffs’ theorythat Williams’ death was accidental

within the meaning of the policy because the DVT arose from

“unintended external causes.” Although agreeing that the

condition arose unexpectedly, the court held that “the

ordinary and common meaning of ‘accident’ does not

encompass DVT/PE under these circumstances.”

Accordingly, the court denied Plaintiffs’ cross-motion for

summary judgment and granted National Union’s crossmotion. Plaintiffs timely appealed, reiterating their

contention that Williams’ death was a benefits-triggering

injury under the policy.

STANDARD OF REVIEW

We review de novo a district court’s grant or denial of

summary judgment. Lopez-Valenzuela v. Arpaio, 770 F.3d

772, 777 (9th Cir. 2014) (en banc). De novo review also

applies to the denial of benefits under a plan subject to

ERISA where, as here, the plan does not assign the

administrator discretionary authority to determine benefits

eligibility or construe the plan’s terms. See Metro. Life Ins.

Co. v. Glenn, 554 U.S. 105, 111 (2008); Standard Ins. Co. v.

Morrison, 584 F.3d 837, 840 (9th Cir. 2009).

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8 WILLIAMS V. NAT’L UNION FIRE INS. CO.

DISCUSSION

I. Principles of Construction

In construing the language of an ERISA-governed policy,

courts apply federal common law. Padfield v. AIG Life Ins.

Co., 290 F.3d 1121, 1125 (9th Cir. 2002). Under that law,

policy terms are interpreted in the “ordinary and popular

sense as would a person of average intelligence and

experience.” Id. (quoting Babikian v. Paul Revere Life Ins.

Co., 63 F.3d 837, 840 (9th Cir. 1995)). In developing federal

common law to govern ERISA claims, courts may “borrow

from state law where appropriate, and [be] guided by the

policies expressed in ERISA and other federal labor laws.” 

Id. (quoting Babikian, 63 F.3d at 840) (alteration in original).

The policy provision at issue, Endorsement E-5,

articulates three required elements of a covered “bodily

injury”: (1) it directly resulted from an “accident” that was

both (2) “unintended [and] unanticipated,” and (3) “external

to the body.” Hence, our task is to determine whether the

average person, considering these prerequisites as they are

articulated in the policy, would conclude that plaintiffs are

entitled to accidental death benefits. See Dupree v. Holman

Prof’l Counseling Ctrs., 572 F.3d 1094, 1097 (9th Cir. 2009)

(stating that the principles applicable to review of an ERISA

policy “direct us to look to the agreement’s language in

context and construe each provision in a manner consistent

with the whole such that none is rendered nugatory”).

II. Policy Interpretation

In arguing that Williams’ death resulted from an

“accident” as required by the National Union policy,

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 9

Plaintiffs attempt to take advantage of the imprecision of that

word. The term “accident” has been described as a “vague

concept,” Lee R. Russ & Thomas F. Segalla, 10 Couch on

Insurance 3d (“Couch 3d”), § 139:1, at 139-9 (rev. ed. 2009),

that is “disarmingly difficult to define,” McAuley v. Fed. Ins.

Co., No. 4:05CV1826 AGF, 2009 U.S. Dist. LEXIS 52899,

at *52 (E.D. Mo. March 31, 2009). See also Geddes & Smith,

Inc. v. St. Paul-Mercury Indem. Co., 334 P.2d 881, 884 (Cal.

1959) (observing that “[n]o all-inclusive definition of the

word ‘accident’ can be given”). Indeed, the varied definitions

of “accident” include some with broad scope. One general

purpose dictionary describes an accident, inter alia, as “an

undesirable or unfortunate happening that occurs

unintentionally and usually results in harm, injury, damage,

or loss; casualty; mishap.” The Random House Dictionary of

the English Language 12 (2d ed. 1987). A widely used legal

dictionary similarly includes one definition with expansive

reach: “[a]n unintended and unforeseen injurious occurrence;

something that does not occur in the usual course of events or

that could not be reasonably anticipated.” Black’s Law

Dictionary 18 (10th ed. 2014).

Consistently with these definitions, Williams’ death itself

reasonably could be characterized as an “accident.” As

Plaintiffs assert, his loss of life from DVT/PE was a sudden,

unexpected, and out-of-the ordinary happening—a

“casualty.”4 However, the modifying language in

4 As such, Williams’ death differs from fatalities resulting from

progressive conditions, such as a stroke or heart attack. Cf. Khatchatrian

v. Cont’l Cas. Co., 332 F.3d 1227, 1229 (9th Cir. 2003) (rejecting

accidental death coverage where the insured died from a stroke); Geddes

&Smith, 334 P.2d at 884 (emphasizing that an “accident” does not include

“a series of imperceptible events that finally culminated in a single

tangible harm”).

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10 WILLIAMS V. NAT’L UNION FIRE INS. CO.

Endorsement E-5 narrows the availability of benefits in a

significant respect: the accident—i.e., the “unintended and

unforeseen injurious occurrence,” Black’s Law Dictionary, at

18—must have been “external to the body.”

Plaintiffs argue that the external-to-the-body requirement

is met here because Williams’ death resulted from

circumstances that originated outside his body. They assert

that Williams’ “confined sitting set in progress a chain of

events that led directly to his death.” Br. at 30 (emphasis

omitted); see also id. (“[T]he confined sitting was the prime

or moving cause of death[.]” (emphasis omitted)). Hence,

they claim, “the cause of death was external to him, although

it acted internally.” Id. (emphasis omitted).

In relying on this reasoning, however, Plaintiffs fail to

acknowledge the relationship among the multiple

requirements stated in Endorsement E-5. As noted, the

provision covers an injury “sustained as a direct result of an

unintended, unanticipated accident that is external to the

body.” The cause of death thus must be not only external, but

also an “accident”—i.e., an unintended and unanticipated

occurrence. Accordingly, contrary to Plaintiffs’ view,

coverage does not turn on whether “unexpected or unintended

harm arose from an external cause during passenger air

travel,” Br. at 28 (emphasis added), but on whether there

were external, harm-causing circumstances that were

themselves unexpected and unintended. Although Williams’

confined seating on planes may have been an external cause

of his death, there was nothing “unintended” or

“unanticipated”—i.e., nothing accidental—about his seating

arrangement.

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 11

Nor didWilliams encounter unusual circumstances during

his flights that aggravated the impact of his prolonged

seating. Plaintiffs do not assert that he unexpectedly was

prevented from moving around the planes, drinking fluids, or

taking other measures to minimize the risk of DVT. There

was no reported intervention by airline personnel that could

have affected Williams’ physical well-being. Cf. Olympic

Airways v. Husain, 540 U.S. 644, 657 (2004) (characterizing

a death triggered by an asthma attack as accidental where a

flight attendant repeatedly refused to move the passenger

from a seat near the plane’s smoking section). In their brief,

Plaintiffs propose alternative scenarios that could have

resulted in a fatal blood clot in an effort to bolster their

argument that the cause of Williams’ death was “external,”

but the hypothetical situations they offer—luggage falling

from an overhead bin or a dining tray slamming into

Williams’ head—illustrate the difference between an

unexpected occurrence “external to the body” and

unexpected harm resulting from ordinary conditions.5

We thus conclude that no “person of average intelligence

and experience,” Padfield, 290 F.3d at 1125 (internal

quotation marks omitted), would find that Williams died “as

a direct result of an unintended, unanticipated accident that

is external to the body.” Indeed, our analysis based on

careful review of the policy language is reinforced by what

we consider the common understanding of an “accidental

death.” In ordinary parlance, an “accident” connotes an

unintended, unexpected happening that may cause injury or

damage to persons or property. In other words, as popularly

5 Similarly distinguishable are the cases that Plaintiffs cite involving

fatal burns from an accidental fire, a slip-and-fall causing bleeding, and

heart problems caused by a car accident or “unusual” physical stress.

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12 WILLIAMS V. NAT’L UNION FIRE INS. CO.

understood, an accident is an unexpected occurrence separate

from the harm that results from it. Williams’ death does not

fit that mold. See Rodriguez v. Ansett Austl. Ltd., 383 F.3d

914, 919 (9th Cir. 2004) (concluding that the death of an

airline passenger as a result of DVT was not accidental under

Article 17 of the Warsaw Convention).6

CONCLUSION

Plaintiffs plausibly argue that Williams’ confined seating

during his prolonged air travel was an “external” cause of his

death. However, they point to no aspect of his flights or his

seating position that departed from the usual conditions of

such travel. Hence, regardless of whether Williams’ death

may be characterized as an externally caused “accident” when

considering that word in isolation, his loss of life was not

within the policy’s coverage. His fatal injury did not directly

result from an unintended and unanticipated happening

“external to the body.”

6 Plaintiffs insist that Rodriguez and other Warsaw Convention cases

concerning DVT “have no place in the construction of accidental death

insurance policies” because the analysis of an “accident” under the

Warsaw Convention is unique to that treaty-specific context. We agree

that the textual analysis in the Warsaw Convention cases is not directly

applicable here. Nonetheless, those cases are tangentially relevant

because the meaning the Supreme Court has given to “accident” under the

treaty substantially overlaps with the prerequisites for accidental injury

benefits expressly stated in the National Union policy. See Air France v.

Saks, 470 U.S. 392, 405 (1985) (holding that “liability under Article 17 of

the Warsaw Convention arises only if a passenger’s injury is caused by an

unexpected or unusual event or happening that is external to the

passenger”).

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WILLIAMS V. NAT’L UNION FIRE INS. CO. 13

We therefore affirm the district court’s rulings granting

summary judgment for National Union and denying summary

judgment for Plaintiffs.

AFFIRMED.

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