Life Insurance Denial

Dallas life insurance lawyers keep up with court decisions related to life insurance claims. The most recent from the date of the post is from the U.S. 5th Circuit Court of Appeals. It is styled, Lila McWhirter v. AAA Life Insurance Company.
Eugene McWhirter purchased a life-insurance policy from AAA covering accidents that occurred while “exiting from any private passenger automobile . . . .” In December, McWhirter attended a party with his daughter Karen and wife Lila. After the party, Karen drove the family home and backed into the driveway. Shortly thereafter, McWhirter fell. Neither Lila nor Karen witnessed the incident. They discovered McWhirter lying in the grass near the car. McWhirter died as a result of the head injury he sustained during the fall.
Lila filed a claim with AAA seeking death benefits. In the claim forms, she described the accident as follows: “While exiting the vehicle and entering the home hit the entry step and fell backwards into the yard hitting the back of his head to the ground.” She also submitted McWhirter’s death certificate, an EMS report, an affidavit from a neighbor who observed the scene, and a drawing and photograph in which the neighbor showed that McWhirter was found lying parallel to the car on his back. AAA concluded that these documents, as well as Lila’s description of the accident and statements made by Karen in letters to the company, indicated that McWhirter fell after exiting the car. As a result, it determined that the fall was not covered under McWhirter’s policy and denied Lila’s claim.
Lila sued AAA. AAA filed a motion for summary judgment which was granted in favor of AAA. This appeal followed.
AAA claims that Lila failed to put forth evidence showing a genuine dispute as to whether McWhirter fell while exiting the car. Lila claims that her and Karen’s affidavits establish such a dispute. As the district court noted, the statements in the affidavits do not coincide with those in the claim forms submitted to AAA. In the forms, Lila stated in multiple places that McWhirter “hit the entry step and fell backwards into the yard hitting the back of his head to the ground.” She also submitted McWhirter’s death certificate, for which she was the informant. It states that the accident resulted from a “fall from stairs.” In her affidavit, however, Lila stated that McWhirter’s position on the ground indicated that “he had not yet made it” to the entry step. Instead, she suggested that he may have fallen on “an uneven area where the edge of the driveway meets the yard.” Karen’s account also appears to have shifted. In letters to AAA, she stated that McWhirter “died from an accidental fall after exiting a vehicle” and that the fall occurred “after his exit from the rear driver side seat.” In her affidavit, however, she claimed that “I have always believed that Dad’s fall occurred while he was getting out of my car.”
This Court has always held that, “without more, a vague or conclusory affidavit is insufficient to create a genuine dispute of material fact in the face of conflicting probative evidence.” Similarly, the Court noted that summary judgment is appropriate when the only fact issue is which of the plaintiff’s conflicting statements is correct and the plaintiff has not adequately explained the inconsistency.
Lila has not addressed most of the evidence indicating that McWhirter fell while approaching his house, let alone explained its inconsistencies with the affidavits upon which she relies. She does not address her attestation in the claim forms that McWhirter “hit the entry step and fell backwards into the yard hitting the back of his head to the ground.” Nor does she mention the EMS report stating that he fell while “walking outside.” Moreover, she discusses scale and visibility problems with the drawing and photograph showing the orientation of McWhirter’s body but does not actually contest the orientation depicted. In her affidavit, she agrees that McWhirter “was lying on his back in the grass parallel to the car, with his head pointed toward the street.”
Lila emphasizes Karen’s attestation in her affidavit that, while she did not witness McWhirter’s fall, she “always believed” it occurred while he was exiting the vehicle. This statement is not valid summary-judgment evidence, as it is based on belief rather than personal knowledge which is required pursuant to Federal of Civil Procedure 56(c)(4).
Additionally, Lila asserts there were several fact issues the court overlooked or resolved incorrectly. A dispute of fact, though, “must be material,” i.e., it must potentially “affect the outcome of the suit,” to preclude summary judgment. The issues Lila raises do not meet this standard.