Owusu-Sampah v. CUNA Mutual Insurance Society, 3:09-cv-02344

Plaintiff Owusu-Sampah, as beneficiary, sued CUNA Mutual Insurance Society and Monumental Life Insurance Company for breach of contract and statutory claims after her husband's death.
Monumental was later dismissed from the action due to a partial settlement, leaving CUNA as the only remaining defendant.
The Policy provides accidental death and dismemberment benefits, with exclusions for death due to disease, illness, or noncompliant drug use; the policy was issued January 1, 2008 to George Sampah and insured his death on May 3, 2008.
Postmortem records initially classified death as natural, later amended to accident, with hydrocodone intoxication and several preexisting illnesses identified as contributing factors.
Three medical experts disagreed on the extent to which hydrocodone intoxication versus preexisting conditions caused death, but all agreed these factors contributed.
The court granted summary judgment for CUNA, finding no coverage because death did not result from an accident independently caused by an injury, as required by the Policy.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the death was an accidental death under the Policy	Owusu-Sampah contends death was the result of an accidental injury tied to hydrocodone intoxication.	CUNA argues death was not caused directly by an accident independently of all other causes.	No; death did not meet the accidental-injury requirement.
Whether hydrocodone intoxication can be the sole or independent cause of death under the Policy	Sampah argues hydrocodone intoxication caused the accident leading to death.	Hydrocodone intoxication was not the sole, independent cause; other comorbidities contributed.	Hydrocodone intoxication was not an independent cause; coverage denied.
Whether preexisting conditions preclude coverage under the Policy	Preexisting illnesses do not automatically bar coverage if death was accidental.	Preexisting cardiovascular disease and sickle cell anemia contributed to death and precluded coverage.	Yes; preexisting conditions contributed and supported denial of coverage.
Whether the evidence supports any alternative basis for denial (e.g., drug usage not in accordance with usage instructions)	Hydrocodone was used per medical orders, arguing coverage should apply.	Record shows lack of evidence that use complied with usage instructions; exclusion applies.	Yes; lack of compliance with usage instructions supported exclusion.

Hudman v. Mutual Benefit Health & Accident Ass'n, 398 S.W.2d 110 (Tex. 1965) (preexisting infirmities may coexist with an accident without defeating recovery)
National Union Fire Ins. Co. v. Hudson Energy Co., 811 S.W.2d 552 (Tex. 1991) (interpretation of policy terms and coverage favored for insured when ambiguous)
Sekel v. Aetna Life Ins. Co., 704 F.2d 1335 (5th Cir. 1983) (insurance contract language given plain meaning; exclusions construed against insurer)
Lincoln Gen. Ins. Co. v. Aisha’s Learning Ctr., 468 F.3d 857 (5th Cir. 2006) (intent to exclude coverage must be clear and unambiguous)
Gilbert Texas Const., L.P. v. Underwriters at Lloyd's London, 327 S.W.3d 118 (Tex. 2010) (policy terms interpreted; ordinary meaning unless technical meaning intended)
State Farm Fire & Cas. Co. v. Reed, 873 S.W.2d 698 (Tex. 1993) (strict construction of policy exclusions)