Ames v. Provident Life & Accident Insurance

942 F. Supp. 551, 1994 U.S. Dist. LEXIS 21006, 1994 WL 906737
CourtDistrict Court, S.D. Florida
DecidedAugust 26, 1994
Docket93-14010-CIV.
StatusPublished
Cited by16 cases

This text of 942 F. Supp. 551 (Ames v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ames v. Provident Life & Accident Insurance, 942 F. Supp. 551, 1994 U.S. Dist. LEXIS 21006, 1994 WL 906737 (S.D. Fla. 1994).

Opinion

ORDER

RYSKAMP, District Judge.

THIS CAUSE came before the court upon Plaintiffs Renewed Motion for Directed Verdict (J.N.O.V.) (Docket Entry “DE” 66), Plaintiffs Alternative Motion for New Trial (DE 67), and Defendant’s Motion to Set Attorney’s Fees and Costs (DE 76).

I. BACKGROUND

In September of 1987, Dr. Ames, a board-certified' orthopaedic surgeon, purchased a disability income policy from Provident Life & Accident Insurance Company. The policy provided separate income protection plans against the eventualities of total and residual disability. The total disability provision is at the heart of Dr. Ames’s complaint, and reads as follows:

Total Disability or totally disabled means that due to Injuries or Sickness:
1. you are not able to perform the substantial and material duties of your occupation; and
2. you are receiving care by a Physician which is appropriate for the condition causing the disability.

(Complaint, Exhibit A).

In April of 1988, Dr. Ames began to suffer from rheumatoid arthritis in his hands, and sought medical treatment for his condition. The ailment became progressively worse, to the point that Dr. Ames was unable to perform surgeries because of the pain and weakness in his hands. Dr. Ames, however, did continue to earn income through the practice of medicine. The exact nature of that practice and its relevance to the terms of the insurance policy were contested at trial.

On April 2, 1990, Dr. Ames executed a Statement of Claim for total disability. Provident refused to grant total disability benefits, claiming that because Dr. Ames was continuing to earn income in his insured specialty, he was only entitled to residual benefits. Thereafter, Provident paid Dr. Ames for those months in which his income was sufficiently low to entitle him to residual benefits under the terms of the policy. Dr. Ames continued to request total disability benefits, and filed the instant lawsuit for breach of contract on November 18, 1992.

On May 25, 1993, Provident filed an Amended Answer to Complaint. The Amended Answer contained Counterclaims for unjust enrichment, common law fraud, negligent misrepresentation, civil theft, and breach of contract. Provident alleged that Dr. Ames submitted false billing information for April through December of 1992, by reporting total billings in an amount that was 30% less than actually billed. According to Provident, these lowér billing figures were incorrect and caused Provident to pay Dr. Ames residual disability benefits although he was not entitled to them. Dr. Ames claims that he reduced the monthly billing statements by 30% in order to accurately state his income, because he generally is unable to collect 30% of his billings.

The ease proceeded to trial on November 3, 1993. After three days of testimony regarding the total disability and reduced billing figure issues, the case went to the jury on the Counts for breach of contract, unjust enrichment, and civil theft. The parties agreed at sidebar that damages would be a simple mathematical calculation that need not be submitted to the jury. (Trial Transcript at 296). The jury found that Dr. Ames was not totally disabled, that he was unjustly enriched, and that he had committed civil theft.

On November 23, 1993, the Court entered Final Judgment, awarding Provident attor- *555 ne/s fees and costs. Subsequently, Dr. Ames filed a Renewed Motion for Directed Verdict and an Alternative Motion for New Trial. Provident has filed a Motion to Set Attorney Fees and Costs.

II. JNOV AND NEW TRIAL STANDARDS

Federal Rule of Civil Procedure 50(a) provides that judgments as a matter of law are appropriate when “there is no legally sufficient evidentiary basis for a reasonable jury to have found for [a] party with respect to [an] issue.” Motions for JNOV “need not be reserved for situations where there is a complete absence of facts to support a jury verdict,” but are appropriate when there is no “substantial conflict in evidence to support a jury question.” Carter v. City of Miami, 870 F.2d 578, 581 (11th Cir.1989). The standard for JNOV is well established in the Eleventh Circuit:

On motions for directed verdict and for judgment notwithstanding the verdict, the Court should consider all the evidence— not just that evidence which supports the non-mover’s case — but in the light and with all reasonable inferences most favorable to the party opposed to the motion. If the facts and inferences point so strongly and overwhelmingly in favor of one party that the Court believes that reasonable men could not arrive at a contrary verdict, granting of the motions is proper. On the other hand, if there is substantial evidence opposed to the motions, that is, evidence of such quality and weight that reasonable and fair-minded men in the exercise of impartial judgment might reach different conclusions, the motions should be denied, and the case submitted to the jury.

Watts v. Great Atlantic and Pacific Tea Co., 842 F.2d 307 (11th Cir.1988) (citing Boeing Co. v. Shipman, 411 F.2d 365, 374-375 (5th Cir.1969)). A trial judge is not-permitted to weigh the evidence in considering a motion for JNOV. Id. at 310; see also Rabun v. Kimberly-Clark Corp., 678 F.2d 1053, 1057 (11th Cir.1982).

Unlike motions for JNOV, “motions for a new trial are committed to the discretion of the district court.” McDonough Power Equipment v. Greenwood, 464 U.S. 548, 556, 104 S.Ct. 845, 850, 78 L.Ed.2d 663 (1984); Hessen v. Jaguar Cars, 915 F.2d 641, 644 (11th Cir.1990). A new trial should be granted when “the verdict is against the clear weight of the evidence ... or will result in a miscarriage of justice, even though there may be substantial evidence which would prevent the direction of a verdict.” Hewitt v. B.F. Goodrich Co., 732 F.2d 1554, 1556 (11th Cir.1984) (citations omitted). “In ruling on a motion for new trial, the trial judge is permitted to weigh the evidence, but to grant the motion he must find the verdict contrary to the great, not merely the great weight of the evidence.” Watts v. Great Atlantic and Pacific Tea Co., 842 F.2d at 310; see also Williams v. City of Valdosta, 689 F.2d 964, 972 (11th Cir.1982).

III. TOTAL DISABILITY

Dr.

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Bluebook (online)
942 F. Supp. 551, 1994 U.S. Dist. LEXIS 21006, 1994 WL 906737, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ames-v-provident-life-accident-insurance-flsd-1994.