Opinion ID: 593054
Heading Depth: 2
Heading Rank: 2

Heading: Construing the Insurance Policies

Text: 21 Judicial interpretation of the provisions of the Aetna policy and the Met Life policy requires our examination of the law of the state of Oklahoma. We must determine how the Oklahoma courts would decide the question. 22 We now turn to the district court's determination that Aetna and Met Life appropriately denied coverage for Mr. Henretta's injury. The district court held that functional uselessness of both feet from spinal injury is not equivalent to loss of both feet from severance, as defined by the Aetna and Met Life policies. Henretta v. Chrysler/Met Life, Order at 8; Henretta v. Chrysler/Aetna, Order at 8. 23 We note that under a similar injury and insurance coverage claim, the District Court for the Western District of Oklahoma has applied Oklahoma law to hold that  'loss' of hands unambiguously means severance as opposed to loss of use. Traverse v. World Serv. Life Ins. Co., 436 F.Supp. 810, 812 (W.D.Okla.1977); see also Great N. Life Ins. Co. v. Tulsa Cotton Oil Co., 182 Okla. 107, 76 P.2d 913, 913 (1938) (loss of use of hand mangled in an accident is not covered under policy defining loss as dismemberment between the wrist and elbow joints). 24 The Fourth Circuit recently considered a similar case, DeWitt v. State Farm Ins. Co. Retirement Plan for United States Employees, 905 F.2d 798 (4th Cir.1990). In DeWitt, the plaintiff lost the use of his right foot during kidney transplant surgery when surgeons severed an artery in his leg, causing irreversible nerve damage and rendering his foot flaccid and useless. The accidental death and dismemberment coverage of his employee benefits plan, in a manner common to such coverage, defined the loss of feet as actual severance through or above the ... ankle joints. Id. at 802. The Fourth Circuit held that  'actual severance' is not ambiguous, and ... it should be construed literally, not as a 'functional severance.'  Id. 6 25 We believe that the Oklahoma state courts would arrive at the same conclusion in the case before us for two reasons. First, the term loss from severance in the insurance policies funding the plan is unambiguous--it means physical separation of the foot from the body. The mutation of that definition to loss of function from disruption of a related physical system is an unwarranted expansion and a distorition of the common sense, reasonable definition. Second, the insurance policies funding the benefit plan, and the premiums for those policies, were based on underwriting computations for accidental separation of the feet from the body rather than loss of function due to accidental spinal injury. While functionally Mr. Henretta's feet may be equivalent to those which have been severed, the rate and circumstances of occurrence of accidental severance and accidental spinal injury resulting in paraplegia are not equivalent. In addition, severed feet and paraplegia are conterminous only as to the post-accident function of the feet. The two injuries have very different complications and attendant health dangers, rendering them very different medical problems. 26 We AFFIRM.