No. 24-666

Fonda Wicks v. Metropolitan Life Insurance Company

Lower Court: Fifth Circuit
Docketed: 2024-12-19
Status: Denied
Type: Paid
Response Waived
Tags: accidental-injury anoxic-brain-injury contra-proferentum death-benefits insurance-coverage medical-treatment-exception
Key Terms:
Arbitration ERISA
Latest Conference: 2025-02-21
Question Presented (AI Summary)

Whether the Fifth Court of Appeals correctly interpreted the Accidental Death and Dismemberment Plan's provisions regarding coverage for an accidental injury as the direct and sole cause of death

Question Presented (OCR Extract)

QUESTION PRESENTED The 5 Court of Appeals determined, and we agree, that “Wicks was required to show that Mr. Wicks “sustain[ed] an accidental injury that [was] the Direct and Sole Cause of a Covered Loss.” The questions presented to this court are: Whether considering the Accidental Death and Dismemberment Plan, and the facts, Petitioner Wicks is entitled to benefits? Whether the Fifth Court of Appeals failed to apply the contra proferentum and/or a strict interpretation of the entire plan to give meaning to the Covering Clause, the Medical Treatment Exception, the Drug Exception, and the role of the Direct and Sole Clause? Whether the Fifth Court blanket rule that obesity is legal cause of death even if unrelated to the death while undergoing medical procedure materially deviates from the terms of the Plan? Whether “Accidental Injury” as an essential term needing interpretation and whether the Anoxic Brain Injury is the subject “Accidental Injury” or is the Death of Mr. Wicks the Accidental Injury?

Docket Entries

2025-02-24
Petition DENIED.
2025-01-22
DISTRIBUTED for Conference of 2/21/2025.
2025-01-18
Waiver of right of respondent Metropolitan Life Insurance Company to respond filed.
2024-12-16
Petition for a writ of certiorari filed. (Response due January 21, 2025)

Attorneys

Fonda Wicks
Rolando de la GarzaCain Firm, PC, Petitioner
Metropolitan Life Insurance Company
Linda G MooreEstes Thorne Ewing & Payne PLLC, Respondent