Everett v. American General Life Insurance Company, 1:14-cv-00121

On November 27, 2010 John Whitley sustained a C‑2 (type II odontoid) neck fracture in an automobile accident; he later underwent posterior C1‑2 fusion on February 25, 2011.
On March 5, 2011, while returning home from Mayo Clinic, Mr. Whitley had a cardiac event on the plane, was hospitalized, discharged to hospice, and died on April 6, 2011.
Mr. Whitley owned an accidental death and dismemberment (AD&D) policy providing $100,000 for loss solely resulting from accidental bodily injury, but excluding losses caused by sickness or treatment of sickness.
Beneficiary Deanna Everett (Mrs. Whitley) notified American General of the death on April 29, 2011; American General denied the AD&D claim on October 11, 2011 and this suit followed.
Mrs. Whitley relied on post‑death opinions from Dr. Walter Seale (treating cardiologist) to link the neck injury to the death, but the expert disclosure of Dr. Seale was late and deficient; the death certificate lists cardiac causes (acute pulmonary edema, end‑stage systolic heart failure, ischemic cardiomyopathy).
The court excluded Dr. Seale’s expert opinion as not properly disclosed and not within the treating‑physician exception, found the death certificate dispositive that death was from natural causes, and granted summary judgment to American General (also noting insufficient proof of a covered loss under the policy).

Issue	Plaintiff's Argument	Defendant's Argument	Held
Causation / Coverage under AD&D policy	Whitley: neck fracture from the car accident (per Dr. Seale) was the predominant cause of death, making the death accidental and covered	American General: death resulted from underlying heart disease (sickness); the policy excludes sickness‑caused deaths; death certificate supports natural causes	Court held death was from natural cardiac causes (death certificate prima facie); no coverage under the AD&D policy
Admissibility of treating physician opinion (expert disclosure)	Whitley: Dr. Seale (treating cardiologist) may testify that accident caused death; late letter/affidavit and depositions cure disclosure defects	American General: Dr. Seale was not properly disclosed under Fed. R. Civ. P. 26(a)(2); letter was not a disclosure; opinion formed post‑treatment; prejudice from lateness	Court excluded Dr. Seale’s expert opinion under Rule 37(c)(1) and Rule 26(a)(2)(C) (late/insufficient disclosure); treating‑physician exception did not apply
Proof of loss / Timeliness and sufficiency of claim	Whitley: initial proof submitted July 2011 complied with statutory/contract deadlines	American General: proof did not establish a covered accidental loss; insurer properly requested further proof which was never supplied	Court held proof failed to establish a covered accidental loss; this provided an independent basis for summary judgment in favor of insurer

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (1986) (summary judgment standard and evaluation of evidence in the nonmoving party’s favor)
Celotex Corp. v. Catrett, 477 U.S. 317 (1986) (party moving for summary judgment may point to absence of evidence to support opponent’s case)
Anderson v. Liberty Lobby, Inc., 477 U.S. 242 (1986) (genuine dispute of material fact standard)
Leslie v. Grupo ICA, 198 F.3d 1152 (9th Cir. 1999) (direct testimony of non‑movant must be believed at summary judgment stage)
McLaughlin v. Liu, 849 F.2d 1205 (9th Cir. 1988) (court not required to adopt unreasonable inferences)
Devereaux v. Abbey, 263 F.3d 1070 (9th Cir. 2001) (allocation of burdens on summary judgment)
Fairbank v. Wunderman Cato Johnson, 212 F.3d 528 (9th Cir. 2000) (moving party may point to absence of evidence)
Yeti by Molly, Ltd. v. Deckers Outdoor Corp., 259 F.3d 1101 (9th Cir. 2001) (Rule 37(c)(1) exclusionary principle enforces Rule 26 disclosures)
Goodman v. Staples The Office Superstore, LLC, 644 F.3d 817 (9th Cir. 2011) (treating‑physician opinion is exempt from written‑report requirement only to the extent opinions were formed during treatment)
Corey v. Wilson, 454 P.2d 951 (Idaho 1969) (state precedent admitting death certificate evidence on cause of death)