Adipietro v. Chubb Life American

736 F. Supp. 29, 1990 U.S. Dist. LEXIS 5630, 1990 WL 60971
CourtDistrict Court, E.D. New York
DecidedMay 7, 1990
DocketNo. 86 CV 3521
StatusPublished
Cited by3 cases

This text of 736 F. Supp. 29 (Adipietro v. Chubb Life American) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Adipietro v. Chubb Life American, 736 F. Supp. 29, 1990 U.S. Dist. LEXIS 5630, 1990 WL 60971 (E.D.N.Y. 1990).

Opinion

MEMORANDUM AND ORDER

McLAUGHLIN, District Judge.

Plaintiff, Grace C. Adipietro, is a New York citizen. Defendant Colonial Life Insurance Company of America (“Colonial”) is an insurance company incorporated under the laws of New Jersey with its principal place of business in New Jersey.1 This Court’s jurisdiction is based upon diversity of citizenship. 28 U.S.C. § 1331.

FACTS

On September 1, 1982 Loriann Adipietro, plaintiff’s daughter, suffered severe injuries which left her comatose for three and one-half months. Loriann was hospitalized from September 1, 1982 until November 1983. Thererafter, Loriann received therapy at Children’s Specialized Hospital in Mountainside, New Jesey on an out-patient basis until May 1984.

During this therapy, Loriann’s physician recommended that she continue her treatment at a facility closer to her home. To that end, Loriann sought and gained admission to the New York University Medical Center Head Trauma Rehabilitation Program (the “Program”) beginning in fall 1984.

At the time Loriann entered the Program, her mother, plaintiff Grace C. Adipietro, was employed full-time by TDK Electronics Corp. According to plaintiff, all full-time employees of TDK were entitled to family medical benefits under Colonial Group Policy Number 305377-000 (the “Policy”).

Apparently, plaintiff sought assurance from Colonial that she would be reimbursed for Program expenses incurred by Loriann. On approximately June 21, 1984, Colonial informed plaintiff that Program expenses would not be covered under the Policy.

In December 1984 plaintiff brought an action in this Court captioned Grace C. Adipietro v. The Chubb Life American and the Colonial Life-Insurance Company of America, 84 CV 4873 (the “1984 Action”). Plaintiff brought the 1984 Action to recover compensatory and punitive damages for Colonial’s allegedly “arbitrary” denial of benefits, and for a judgment declaring that the Policy obligated [31]*31Colonial to “pay for all cognitive therapy prescribed up to the present time ...” (Affidavit In Support of Motion (“Aff. In Supp.”), Exh. A at 7).

On October 1, 1985 the parties entered into a stipulation settling the 1984 Action (the “Stipulation”). The present controversy centers on the Stipulation, which provides in part that:

1. Defendant [Colonial] agrees to reimburse plaintiff for the cost of plaintiffs daughter Loriann’s participation in the [Program] as described in ... Exhibit 1.
2. Reimbursement shall be for the fees actually incurred and limited to the amount of $24,910.00 as set forth in Exhibit 1.
3. Plaintiff agrees to accept the foregoing reimbursement in full satisfaction of all plaintiff’s claims set forth in the complaint and the [1984 Action] is discontinued with prejudice ..., and
4. [E]vidence of this ... settlement shall not be admissible in any future litigation pertaining to any future treatment programs for plaintiff’s daughter ... (emphasis added)

Exhibit 1 of the Stipulation provides a detailed description of the Program’s intensive remedial phase.

Subsequently, Loriann participated in the Program’s intensive remedial phase. Colonial fulfilled its obligation under the Stipulation by reimbursing plaintiff for $24,-910.00 in fees incurred in connection with this treatment.

After the intensive remedial phase completed by Loriann, most patients progress to the second and final Program phase— the “occupational trial.” (Aff. In Supp. at 24-25). When Loriann completed the intensive remedial phase, however, it was concluded that she was not prepared to enter an occupational trial.

From March 6, 1986 until July 10, 1986, Loriann participated in a “second cycle” of the intensive remedial phase. This “second cycle” of therapy was conducted within the same “framework” or “format” as the first cycle, and involved repetition of cognitive exercises performed therein. (Aff. In Supp., Exh. J at 33-34). The second cycle differed from the first because “the exercises were special clinical problems tailor-designed for [Loriann].” (Id. at 33). These exercises were intended to address areas in which Loriann made insufficient progress during the first cycle.

On October 17, 1986 plaintiff filed the complaint in the instant action, alleging that Colonial improperly refused to pay plaintiff medical benefits under the Policy. The payment at issue relates to fees incurred by Loriann during the “second cycle” of the Program.

Defendant Colonial moves for summary judgment pursuant to Fed.R.Civ.P. 56(b) on the ground that plaintiff’s benefits claim is precluded by the Stipulation. Plaintiff contends that defendant is not entitled to summary judgment because, among other things, it is a question of fact whether the “second cycle” was a future treatment program outside the scope of the Stipulation.

DISCUSSION

I. SUMMARY JUDGMENT STANDARD

Summary judgment is appropriate “after adequate time for discovery ... against a party who fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986). The movant bears the initial responsibility of setting forth the basis for its motion and identifying any portions of the record which demonstrate the absence of a genuine issue of fact. Id. at 323, 106 S.Ct. at 2552. The non-movant, however, “ ‘may not rest upon mere allegations or denials of his pleadings, but ... must set forth specific facts showing that there is a genuine issue for trial.’ ” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 2510, 91 L.Ed.2d 202 (1986) (quoting Fed.R.Civ.P. 56(e)). If the nonmovant “fails to substantiate the existence of a genuine dispute, a proper [32]*32concern for judicial efficiency and the mandate of Rule 56(c) require summary disposition of the issue.” Shering Corp. v. Home Ins. Co., 712 F.2d 4, 9 (2d Cir.1983).

II. THE STIPULATION

Effectively, the Stipulation caps at $24,-910 Colonial’s liability for the treatment described in Stipulation Exhibit 1. Defendant has already reimbursed plaintiff $24,-910 for this treatment. Defendant contends that the “second cycle” of treatment is merely a repeat of the treatment described in Exhibit 1 and, therefore, that plaintiff is not entitled to reimbursement for the “second cycle.” Plaintiff maintains that whether the “second cycle” is a mere repeat or a different “future treatment program” is a question of fact which precludes summary judgment.

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Cite This Page — Counsel Stack

Bluebook (online)
736 F. Supp. 29, 1990 U.S. Dist. LEXIS 5630, 1990 WL 60971, Counsel Stack Legal Research, https://law.counselstack.com/opinion/adipietro-v-chubb-life-american-nyed-1990.