Prather v. Sun Life and Health Ins. Co.
843 F.3d 733 (7th Cir. 2017)Words & Phrases
Attorney FeesAppellate Judge
PosnerHolding
Plaintiff entitled to attorney fees under ERISA because it had complete success on the merits.Fact Summary
The plaintiff’s decedent, Jeremy Prather, was employed by a company that had obtained a Group Insurance Policy from Sun Life which provided accidental death and dismemberment coverage for the company’s employees, in the amount of $92,000 for Prather. The policy limited coverage to “bodily injuries … that result directly from an accident and independently of all other causes.”
The clause was the focus of an appeal from the district court, which had granted summary judgment for Sun Life, which had invoked the clause to deny the payment of death and dismemberment coverage to Prather’s survivor on the ground that Prather’s death had not been the exclusive result of an accident—it had also been the result of “complications from surgical treatment.”
Prather’s widow brought suit “to recover benefits due to [her]” under the plan. 29 U.S.C. § 1132(a)(1). On July 16, 2013, Prather, age 31, had torn his left Achilles tendon playing basketball. He was operated on to repair the torn tendon six days later. The surgery was uneventful and he was discharged from the hospital the same day. He returned to work and was reported as doing well in a follow-up visit to his surgeon on August 2, but four days later he collapsed at work, went into cardiopulmonary arrest, and died the same day as a result of a deep vein thrombosis (blood clot) in the injured leg that had broken loose and traveled through the bloodstream to a lung, thus becoming a blood clot in the lung—that is, a pulmonary embolism— which caused cardiac arrest and sudden death.
Sun Life’s position was and is that the pulmonary embolism and ensuing death were consequences not of—at least not entirely of—the accident to Prather’s Achilles tendon, but of the surgery, and therefore was not covered by the insurance policy, which as we said covered only “bodily injuries … that result directly from an accident and independently of all other causes.” The district court granted summary judgment in favor of Sun Life, Prather’s widow appealed, and we reversed, see Prather v. Sun Life & Health Ins. Co., 843 F.3d 733 (7th Cir. 2016).
We reasoned that Sun Life had failed to make any plausible showing that the surgery on Prather’s ankle, rather than the accident that necessitated the surgery, had caused his death. We instructed the district court to enter judgment in favor of the plaintiff, as in Senkier v. Hartford Life & Accident Ins. Co., 948 F.2d 1050, 1052 (7th Cir. 1991). Prather’s widow has now moved us to award her the attorneys’ fees (that is, to order Sun Life to reimburse her for those fees), amounting to $37,170, that she incurred in her successful suit.