Jim Plummer.

Can something as small as a mosquito bite trigger accidental death coverage under an insurance policy?

That's a question that will soon be headed to a federal jury after Houston lawyer Jim Plummer won a ruling from the U.S. Court of Appeals for the Fifth Circuit reviving his client's breach of contract claim against an insurance company.

Plummer represents Gloria Wells, whose husband, Melton Dean Wells, was bitten by a mosquito carrying West Nile Virus (WNV) in 2013. Melton Wells—who was 68 years old and had a history of obesity, diabetes and hypertension—went to a hospital where he was diagnosed with WNV and later died.

Wells' death certificate listed WNV as his cause of death and acute respiratory failure, septic shock and multi-system failure as the conditions leading to the death. And the certifying physician listed Wells' cause of death as “natural” as opposed to “accident” on the death certificate.

Gloria Wells submitted a claim to Minnesota Life Insurance Co. for payment of accidental-death benefits under her husband's life insurance policy. But the company denied the claim, contending that there was no information to support that Melton Wells' death was an accident, and that it appeared his death was exacerbated by diabetes, morbid obesity and old age.

Gloria Wells later filed a lawsuit against the insurance company in U.S. district court in Houston alleging breach of contract and a tort claim for bad-faith investigation. But the trial court dismissed her claim for several reasons, including that Gloria Wells failed to introduce evidence that a mosquito bite should be considered “accidental” under the life insurance police. She appealed that decision to the Fifth Circuit.

The Fifth Circuit recently concluded that Wells had met her burden of showing that there is a genuine dispute of material fact as to whether her husband's death from WNV triggered accidental death coverage under the insurance policy.

“As for the bite itself, the policy explains that an accidental bodily injury is unintended, unexpected, and unforeseen; and there is evidence that Melton did not intend, expect or foresee that he would be bitten by a WNV-infected Culex mosquito,” wrote Judge E. Grady Jolly in a decision reinstating Gloria Wells' breach of contract claim against Minnesota Life.

However, the Fifth Circuit upheld dismissal of the bad-faith claim against the insurance company after concluding the company had a reasonable basis for denying the insurance coverage claim based on Melton Wells' medical record.

Plummer, a partner in Houston's Berg Plummer Johnson & Raval, said the ruling will allow Gloria Wells to present her contract claim to a federal jury.

“We argued that some of the terms of the insurance clause were somewhat ambiguous. And the Fifth Circuit agreed that the reasonable construction of those ambiguous clauses should prevail which permits us to go to the jury on those factual issues,” Plummer said.

Amanda Sotak, a partner in Dallas' Figari + Davenport who represents Minnesota Life Insurance, declined to comment on the ruling.

Plummer noted that Melton Wells had purchased the life insurance policy for his wife after reading literature from Minnesota Life Insurance promising that the policy would pay off the mortgage on the Wellses' Conroe home in the event of his death.

“The marketing material of this company said we sell a promise,” Plummer said. “And we're going to hold them to that promise—if the jury agrees with us.''