Audrey Shaps v. Provident Life & Accident Insurance Company, Provident Life and Casualty Insurance Company, a Foreign Corporation

244 F.3d 876
CourtCourt of Appeals for the Eleventh Circuit
DecidedMarch 28, 2001
Docket98-5500, 99-4028
StatusPublished
Cited by27 cases

This text of 244 F.3d 876 (Audrey Shaps v. Provident Life & Accident Insurance Company, Provident Life and Casualty Insurance Company, a Foreign Corporation) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Audrey Shaps v. Provident Life & Accident Insurance Company, Provident Life and Casualty Insurance Company, a Foreign Corporation, 244 F.3d 876 (11th Cir. 2001).

Opinion

MARCUS, Circuit Judge:

This is an appeal of a jury verdict in favor of Defendant Provident Life and Casualty Insurance Company (“Provident Casualty”) in a suit brought by Plaintiff Audrey Shaps alleging two breaches of a disability insurance contract. In a special verdict, the jury determined that Shaps was not continuously disabled within the terms of her Provident Casualty disability policy from September 10, 1990 through October 23, 1994, and thereby rejected her first claim for relief. With respect to her second claim, the jury determined that Shaps was continuously disabled from September 8, 1995 through April 6, 1996, but denied relief because it found that she had failed to comply with certain conditions precedent. On appeal, Shaps argues that the district court committed multiple errors warranting a new trial.

We find all of Shaps’ objections to be unpersuasive on this record, save one that cannot be decided at this time. Shaps contends that the district court erred by determining that a rule of Florida law placing the burden of proof on the insurer in this context was inapplicable because that rule is substantive and the substantive law of New York, not Florida, governs this case. Whether the Florida rule is substantive appears to turn in part upon proper characterization of the Florida Supreme Court’s decision in Aetna Life Insurance Co. v. Fruchter, 283 So.2d 36 (Fla.1973). It is unclear, however, whether the opinion in Fruchter, which discharged a writ of certiorari as improvidently granted, constitutes binding Florida precedent. Moreover, it is unclear to what extent the court’s remarks in Fruchter may be read to address the choice-of-law dispute now before us. Accordingly, we respectfully certify to the Florida Supreme Court the following two questions:

1. Is the burden of proof rule recognized in Fruchter v. Aetna Life Insurance Co., 266 So.2d 61 (Fla.App.3d Dist.1972), cert. discharged, 283 So.2d 36 (Fla.1973), part of the substantive law of Florida, such that it would not be applied in a case where under Florida’s doctrine of lex loci contractus the substantive law of another state (New York) governs the parties’ contract dispute?
2. Would requiring the insured to prove disability in this context violate the public policy of Florida, such that the burden of proof must be placed on the insurer? See Gillen v. United Services Automobile Ass’n, 300 So.2d 3 (Fla.1974).

I.

The background to this appeal is as follows. In June 1987, Provident Casualty issued an individual disability insurance policy to Shaps, who at the time resided and worked in New York. The policy defines “Total Disability” in these terms:

Total disability ... 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 under the care and attendance of a Physician.

The policy defines “Sickness” as “sickness or disease which is first manifested while your policy is in force.” The policy defines “Occupation” as “the occupation (or occupations, if more than one) in which *879 you are regularly engaged at the time you become disabled.” The policy defines “Physician” as “any legally qualified physician.”

The policy also contains the following relevant provisions:

PROOF OF LOSS
If the policy provides for a periodic payment for a continuing loss, you must give us written proof of loss within 90 days after the end of each period for which we are liable. For any other written loss, written proof must be given within 90 days after such loss....
TIME OF PAYMENT OF CLAIMS After receiving written proof of loss, we will pay monthly all benefits then due for disability. Benefits for any other loss covered by this policy will be paid as soon as we receive proper written proof.
LEGAL ACTIONS
No legal action may be brought to recover on this policy within 60 days after written proof of loss has been given as required by this policy. No such action may be brought after three years from the time written proof of loss is required to be given.

Shaps first submitted a claim for disability benefits to Provident Casualty’s New York office on or about July 29, 1989, asserting that the nature of her sickness or injury was “TMJ syndrome” (temporal mandibular joint disorder) and that she last worked in July 1989. Shaps subsequently submitted additional claim forms to Provident Casualty’s New York office, and thereby continued to receive benefits.

On September 7, 1990, Provident Casualty made a final payment to Shaps. Provident Casualty advised Shaps that it had determined that there was no evidence of continuous total disability as defined by her policy, and therefore it was discontinuing payments.

On December 15, 1994, Provident Casualty received from Shaps notice of a new claim for disability benefits, dated December 1, 1994. Shaps now stated that the nature of her disabling sickness or injury was breast cancer and TMJ syndrome. Shaps’ claim form stated that her disabling illness began on October 24, 1994, and that she was disabled as of that date. Provident Casualty initially paid benefits on this claim. In May 1995, however, Provident Casualty stopped paying benefits on this claim. Provident Casualty explained that it stopped paying benefits based on a claim form from Shaps’ physician which indicated that Shaps was no longer totally disabled. After receiving additional information, Provident Casualty sent Shaps a benefit check representing benefits from May through September 1995. Shaps did not submit claim forms to Provident Casualty for the period September 8, 1995 to April 6, 1996, and Provident in turn sent no payments for that period.

Shaps filed this lawsuit on September 18, 1995. In her suit, originally filed in the Circuit Court for Palm Beach County, Florida, and subsequently removed to the Southern District of Florida, Shaps alleged breach of insurance contract, naming Provident Life and Accident Insurance Company (“Provident Accident”) as the defendant. As amended, Shaps’ complaint eventually alleged three separate counts for breach of contract and specific performance against Provident Accident and Provident Casualty, and a count for intentional infliction of emotional distress against both defendants. Provident Accident and Provident Casualty moved for summary judgment on all counts. The district court granted the motion in part, dismissing the count for intentional infliction of emotional distress, and ruling that in the event Shaps prevailed at trial she would have no claim for attorneys’ fees pursuant to Florida law. Shaps thereafter amended her complaint to seek disability benefits from October 1990 through the date of trial.

*880 As noted above, the policy at issue contains a clause providing that no action on the policy may be brought more than three years after the time proof of loss was required.

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Cite This Page — Counsel Stack

Bluebook (online)
244 F.3d 876, Counsel Stack Legal Research, https://law.counselstack.com/opinion/audrey-shaps-v-provident-life-accident-insurance-company-provident-life-ca11-2001.