REVISED - March 28, 2001
UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
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No. 99-41504
Civil Docket #5:98-CV-21
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TIBBY THOMAS,
Plaintiff-Appellant,
versus
AIG LIFE INSURANCE COMPANY,
Defendant-Appellee.
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Appeal from the United States District Court
for the Eastern District of Texas
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March 7, 2001
Before JOLLY, JONES, and SMITH, Circuit Judges.
EDITH H. JONES, Circuit Judge:
The question in this case is whether a death resulting
from complications following stomach stapling surgery was “caused
by an accident” under an ERISA-governed insurance policy. We
affirm the district court’s conclusion that this death was not
accidental.
Appellant Tibby Thomas’s husband owned, through his
employer, two accidental death insurance policies with AIG Life
Insurance Company (“AIG”). Under the policies, Mrs. Thomas was
entitled to benefits if Mr. Thomas suffered a “loss resulting from
injury.” The policies defined injury as “bodily injury caused by
an accident . . . resulting directly and independently of all other
causes . . .” Excluded from the policies were “diseases of any
kind” and “bacterial infections except pyogenic infections which
shall occur through an accidental cut or wound.”
Mr. Thomas suffered from morbid obesity. He had two
stomach stapling surgeries to treat this disease. Following the
second surgery, Mr. Thomas’s sutures broke and he died from sepsis.
Mrs. Thomas filed for benefits under the policies. AIG’s ERISA
Appeals Committee ultimately rejected her claim, and Mrs. Thomas
filed suit. The district court held that because Mr. Thomas’s
death was not accidental under the policies, Mrs. Thomas was not
entitled to benefits. Mrs. Thomas appeals.
The parties dispute the standard of review for AIG’s
decision that Mr. Thomas’s death was not accidental. They concur
that AIG had no discretion as a plan administrator to interpret the
policies. They part company over whether the determination of
accidental death is factual, and reviewed under an abuse of
discretion, or legal, and governed by a de novo standard. See,
generally, Pierre v. Connecticut Life Ins. Co., 932 F.2d 1552, (5th
Cir. 1991). Because Pierre specifically applied the abuse of
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discretion standard to an accidental death finding, we do so as
well.
Mrs. Thomas asserts that she is entitled to benefits
because Mr. Thomas’s death was caused by an accident that took
place during his operation. The Seventh Circuit rejected this type
of argument in a similar case. Senkier v. Hartford Life & Accident
Ins. Co., 948 F.2d 1050 (7th Cir.1991). In Senkier, a patient
receiving treatment for an intestinal disease died when a migrating
intravenous catheter punctured her heart. Her estate argued that
the death was an accident under her insurance policy. The court
held that the patient’s death resulted from her underlying illness.
It refused to characterize the death as an accident under the
policy because it occurred “from the standard complications of
standard medical treatment” for a disease. Id. at 1053.
The Fourth Circuit has stated that a patient’s death was
“accidental” under an accidental death policy where he received an
infected I.V. needle during cataract surgery. Whetsell v. Mutual
Life Ins. Co. of New York, 669 F.2d 955 (4th Cir.1982). But the
precise issue in that case was whether a medical treatment
exclusion clause applied. Id. at 956. The court held that the
exclusion barred the insurance claim. It observed that the clause
would be meaningless if the death were not an accident under the
policy, since “[d]eath is never caused by medical treatment absent
some misdiagnosis or mistake.” When the death results, as in the
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instant case, because proper medical treatment is unsuccessful, the
death is caused by the preexisting infirmity. See Senkier, 948
F.2d 1053. Not only does Whetsell rest on South Carolina law, it
is not inconsistent with our result. Id. at 957.
Adopting the Seventh Circuit’s analysis, we find no
principled basis on which to disassociate Mr. Thomas’s iatrogenic
injury from the disease complications of his obesity. As in
Senkier, his death was the foreseeable result of treatment for his
disease. The decision in Todd v. AIG Life Ins. Co. is
distinguishable. 47 F.3d 1338 (5th Cir.1995)(holding that an
unintended death resulting from auto-erotic asphyxiation was an
accident). The death in that case was not a foreseeable
complication of medical treatment for a disease.
In conclusion, the plan administrator did not abuse its
discretion in finding that Thomas’s injury was attributable to a
disease rather than an accident under the accidental death
policies. The judgment of the district court is AFFIRMED.
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