Bancroft v. Minn. Life Ins. Co.

329 F. Supp. 3d 1236
CourtDistrict Court, W.D. Washington
DecidedJuly 18, 2018
DocketCASE NO. C17-1312JLR
StatusPublished
Cited by2 cases

This text of 329 F. Supp. 3d 1236 (Bancroft v. Minn. Life Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bancroft v. Minn. Life Ins. Co., 329 F. Supp. 3d 1236 (W.D. Wash. 2018).

Opinion

JAMES L. ROBART, United States District Judge

I. INTRODUCTION

Before the court are (1) Plaintiff Colin Bancroft's motion for summary judgment of liability on all claims against Defendant Minnesota Life Insurance Company ("Minnesota Life") (Plf. 2d MSJ (Dkt. # 29) at 2) ("The undisputed facts in this matter lead to the conclusion that Minnesota Life is liable on all claims made by [Mr.] Bancroft."); and (2) Minnesota Life's cross motion for summary judgment of no liability on all of Mr. Bancroft's claims (Def. MSJ (Dkt. # 35) ). The court has considered the motions, the submissions filed in support of and in opposition to both motions, the relevant portions of the record, and the applicable law. In addition, on June 12, 2018, the court heard counsel's oral argument. Being fully advised, the court DENEIS Mr. Bancroft's motion for summary judgment and GRANTS Minnesota Life's cross motion as more fully described herein.

II. BACKGROUND

A. The Accelerated Benefits Policy Rider

Mr. Bancroft is an employee of King County. (10/25/17 Bancroft Decl. (Dkt. # 8) ¶ 2.) Minnesota Life issued a Group Term Life Insurance Policy ("the Policy") to King County. (Compl. (Dkt. # 1-1) ¶ 4; Ans. (Dkt. # 4) ¶ 4.) As a part of his benefits package, Mr. Bancroft is covered under the Policy. (Compl. ¶ 6; Ans. ¶ 6.) The Policy's Basic Life Insurance provision pays one year's salary upon acceptance of a claim. (Id. ) Mr. Bancroft also paid for Supplemental Life Insurance, which provides for an additional four years of salary as a death benefit. (Id. )

Included in the Policy is an Accelerated Benefits Policy Rider ("the ABPR"), which provides "for the accelerated payment of ... the full ... amount of an insured's death benefit ... [i]f the insured has a terminal condition as defined in the [ABPR]." (11/06/17 Marisseau Decl. (Dkt. # 16) ¶ 4, Ex. A at ML 0037.) The ABPR defines a "terminal condition" as "a condition caused by sickness or accident which directly results in a life expectancy of twenty-four months or less." (Id. ) The insured must request the accelerated payment and give Minnesota Life "evidence that satisfies [Minnesota Life] that the insured's life expectancy, because of sickness or accident, is twenty-four months or less." (Id. ) The evidence that the insured provides *1241"must include certification by a physician." (Id. ) The ABPR also states:

[Minnesota Life] reserve[s] the right to ask for independent medical verification of a terminal condition. In the case of a difference of opinion, the insured has the right to mediation or binding arbitration conducted by a disinterested third party who has no ongoing relationship with either party.

(Id. ) Finally, Minnesota Life "retain[s] the right to have the insured medically examined at [its] own expense to verify the insured's medical condition."1 (Id. )

B. Mr. Bancroft's Diagnosis with Stage IV Mantle Cell Lymphoma

Dr. Sherry Hu examined Mr. Bancroft on January 25, 2017. (Hu Decl. (Dkt. # 10) ¶ 5.) On January 25, 2017, Dr. Hu performed a bone marrow biopsy on Mr. Bancroft and ordered a PET/CT scan. (Id. ) On January 30, 2017, Mr. Bancroft underwent a PET/CT scan. (Id. ) On February 1, 2017, Mr. Bancroft returned to the clinic, and Dr. Hu informed him that he had high risk stage IV mantle cell lymphoma and recommended immediate treatment. (Id. ¶ 6; see also Plf. 1st MSJ (Dkt. # 7) at 4 ("On February 1, 2017, [Mr.] Bancroft returned ... for the results of the biopsy and PET/CT.... At that time, Dr. Hu diagnosed him with Stage IV Mantle Cell Lymphoma and recommended immediate treatment."); see also 10/25/17 Bancroft Decl. ¶ 6; Compl. ¶ 16.)

On February 6, 2017, Mr. Bancroft came under the care of Dr. Andrew Cowan. (10/25/17 Bancroft Decl. ¶¶ 6-7.) Dr. Cowan confirmed Dr. Hu's diagnosis. (10/25/17 Cowan Decl. (Dkt. # 9) ¶ 5.) Mr. Bancroft chose to see Dr. Cowan because he is an oncologist with expertise in mantle cell lymphoma. (10/25/17 Bancroft Decl. ¶ 6.) Dr. Cowan prescribed a treatment regime, and Mr. Bancroft started chemotherapy on February 17, 2017. (Id. ¶ 7.)

C. Mr. Bancroft's Claim to Minnesota Life

After his diagnosis, Mr. Bancroft completed a Notice of Claim for Accelerated Benefit, a form provided by Minnesota Life. (Id. ¶ 11, Ex. C.) Mr. Bancroft submitted this form to Minnesota Life on or about May 16, 2017. (Id. ) He requested payment of "100%" of the accelerated benefit at that time. (Id. ) On May 26, 2017, Dr. Cowan signed an Attending Physician's Statement that was provided to Minnesota Life in support of Mr. Bancroft's claim. (See id. )

In the Attending Physician's Statement, Dr. Cowan states that Mr. Bancroft was "diagnosed w/stage IV mantel cell lymphoma high risk leukemia presentation w/elevated LDH." (Id. at 5.) He states that Mr. Bancroft was undergoing VR-CAP treatment,2 indicated that Mr. Bancroft's progress was "[i]mproved," and noted that he expected "[i]mprovement" as a "fundamental or marked change" in Mr. Bancroft's condition.3 (Id. at 5-6.)

Dr. Cowan indicated on the form that Mr. Bancroft's condition was terminal. (Id. at 6.) He states that Mr. Bancroft's Mantel Cell Lymphoma International prognostic index ("MIPI") score is 7.2,4 but Dr. Cowan *1242does not base his prognosis for Mr. Bancroft on this score. (See Cowan Dep. at 56:24-75:5.) Instead, based on a 2007 "publication in Cancer (PMID 17477385)," Dr. Cowan opined that "the median survival for [Mr. Bancroft] would be 24 months." (10/25/17 Bancroft Decl. ¶ 11, Ex. C at 6 (italics added).) The paper on which Dr. Cowan relied was published before the MIPI score was developed in 2008. (11/13/17 Shapland Decl. ¶ 18; see Cowan Dep. at 56:24-57:4 ("Q: ... So Exhibit 13 is the stuff that you're referencing as, well, the only medical literature that you're citing in support of your prognosis? A: Yeah, uh-huh. Q: And that's a 2007 study? A: That's correct."); see id. , Ex. 13.) Dr. Cowan later testified that his "prognosis [also] included [his] overall evaluation of Mr. Bancroft at that time." (10/25/17 Cowan Decl. ¶ 9.) Dr. Cowan provided his contact information on the form, as well as contact information for Dr. Hu.5 (10/25/17 Bancroft Decl. ¶ 11, Ex. C at 6.)

During his deposition, Dr. Cowan conceded that the 2007 Cancer publication is the only medical literature he relied upon to support his 24-month life expectancy estimate. (Cowan Dep. at 56:24-57:5.) He also acknowledged that the 2007 study "could be" outdated and that at least one of the treatments that Mr. Bancroft received was not available during the applicable time period of the 2007 study. (Id. at 58:3-25; 59:8-14.) Dr. Cowan testified that the reason, in part, that he relied on the 2007 study rather than Mr. Bancroft's MIPI score was due to Mr. Bancroft's high white blood cell count and LDH. (Id. at 55:13-56:4.) Yet, Dr. Cowan admitted that these factors are accounted for as part of the MIPI score. (Id.

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329 F. Supp. 3d 1236, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bancroft-v-minn-life-ins-co-wawd-2018.