Judge J. Paul Oetken
Nadia Ulyanenko was insured under a group accidental policy issued by Life Insurance Company of North America (LINA). Mother Irina was the policy’s beneficiary. Nadia fell ill in June 2005, was taken to a hospital and suffered seizures and cardiac arrest. She was pronounced clinically dead June 26 and died on July 10. An Aug. 4 autopsy attributing death to a pulmonary embolism showed Nadia had a genetic disorder. LINA denied Irina’s claim for accidental death benefits. It argued that death stemmed from a genetic disorder, and was not a “covered accident.” Because Nadia took birth control, LINA also barred Irina’s claim under the policy’s exclusion for a loss resulting from sickness, disease or medical or surgical treatment. Irina asserted ERISA violations. District court held LINA had no duty to pay Irina as she did not prove Nadia’s death was covered under the policy. The court was not persuaded that an unknown genetic predisposition was a pre-existing condition under the exclusion for “diseases” and “bodily infirmities.” However, given Irina’s failure to meet her burden of proof, it did not need to decide if LINA showed coverage was excluded because of Nadia’s predisposition or her use of birth control.
