Cardiner v. Provident Life & Accident Insurance

158 F. Supp. 2d 1088, 2001 U.S. Dist. LEXIS 18088, 2001 WL 931106
CourtDistrict Court, C.D. California
DecidedJuly 10, 2001
DocketCV00-2021DTAIJX
StatusPublished
Cited by9 cases

This text of 158 F. Supp. 2d 1088 (Cardiner v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cardiner v. Provident Life & Accident Insurance, 158 F. Supp. 2d 1088, 2001 U.S. Dist. LEXIS 18088, 2001 WL 931106 (C.D. Cal. 2001).

Opinion

ORDER GRANTING DEFENDANT PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY’S REQUEST. FOR JUDICIAL NOTICE; AND GRANTING DEFENDANT PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY’S MOTION FOR PARTIAL SUMMARY JUDGMENT

TEVRIZIAN, District Judge.

I. Background

A. Factual Summary

This action is brought by Plaintiff Barry M. Cardiner (“Plaintiff’) against Defendant Provident Life and Accident Insurance Company (“Provident”) for breach of contract and breach of the duty of good faith and fair dealing.

The following facts are undisputed 1

*1090 Provident issued individual disability Policy No. 6-835-8080449 (“Policy”) to Plaintiff effective September 24, 1987. In September 1990, Plaintiff submitted a claim to Provident contending that on or after September 21, 1990, he was totally disabled from his occupation from dys-thymic disorder and post-traumatic stress disorder (“PTSD”). His disability claim was supported by his attending psychiatrist, Dr. Davidson, who stated Plaintiff was “[u]nable to concentrate, relax, or work properly.”

On an occupational questionnaire, Plaintiff described his job duties as a stockbroker as including “cold calls” to prospects, speaking to clients trying to sell them stocks and bonds, managing some clients’ portfolios, and trading commodity futures and options. In explaining why his disability prevented him from performing such duties, Plaintiff stated that his extreme stress level and chronic depression caused physical and emotional pain which prevented him from doing his job. Provident confirmed with Plaintiffs employer, Oppenheimer, that he voluntarily resigned.

Following the 90 day elimination period in the Policy, Provident began paying Plaintiffs disability claim. As permitted by the Policy, Provident obtained periodic supplementary statements of claim from Plaintiff and attending physician’s statements (“APS forms”) from his treating physicians. Provident periodically solicited reports from Plaintiffs attending physicians throughout the course of his claim.

In late 1992, Provident requested information from his then treating psychiatrist, Geoffrey A. Tucker, including comment on rehabilitation efforts. Dr. Tucker advised that there was no goal to return Plaintiff to work as a stockbroker, due to “severe anxiety, depression and guilt.” According to Dr. Tucker, Plaintiff “cannot drive by a brokerage house or listen to news of Wall Street without exacerbating his symptoms and decreasing his ability to function.”

In an interview with Provident in December 1990, Plaintiff stated that he had earned in excess of $100,000 per year while working as a stockbroker at Oppenheimer & Company, that he was a “high producer,” that he worked approximately 12 hours daily making “cold calls,” and that he was “unable to deal” with the then current depressed stock market and that he had gone into a major depression. The interviewer noted “no outward indication either physical or mental of disability.” However, during the interview, Plaintiff “reiterated the fact that due to stress, depression and anxiety caused by positive HIV testing, he stopped working at Oppenheimer.” As a follow-up on the interview, Provident requested that Plaintiff give authorization to speak with Dr. Davidson regarding his claim of experiencing stress, depression and anxiety as a result of his positive HIV testing. Plaintiff responded that the interviewer had misunderstood, and that his illness “was brought on by [his] work,” not his HIV status, and that he had merely “expressed to him [his] concerns on the effect that the work related illness would have on activating and accelerating the HIV virus.”

In June 1991, Provident interviewed Plaintiffs supervisors at Oppenheimer. In contrast to Plaintiffs reports of work related stress, anxiety and depression, the supervisors reported that Plaintiff had “done fairly well as a salesman and displayed no outward signs of depression. He performed his duties like anyone else, and there were no problems with absenteeism, irritability, work deficiencies or for that matter any obvious work impairment. He did not complain of work stress to anyone, to their knowledge.” Further, *1091 Plaintiff did not file a worker’s compensation claim in connection with his purported work-related stress.

In June 1992, Plaintiff requested that Provident permanently waive its requirement of the submission of periodic APS forms. Provident informed him that it would consider modifying the frequency of the APS requirement after he was evaluated by an independent medical examiner, but, due to the psychiatric nature of his claim, a permanent waiver would not be appropriate.

On July 9, 1992, Plaintiff was examined at Provident’s request by a psychiatrist, Bruce Kagan, M.D. As indicated by his report of the examination, Dr. Kagan took a thorough history from Plaintiff, who stated that his depression began in September 1989 due to work related stress, but he continued to work until he decided to stop working as a stockbroker in 1990. Plaintiff described his dissatisfaction of the long working hours associated with stockbro-kering, guilt when clients lost money, and what he perceived to be unethical and possibly illegal activities which his employers required of him. Plaintiff reported that an unnamed internist “felt that all his symptoms were of psychological origin and not physical in nature and recommended a vacation.” Plaintiff noticed a significant improvement in his symptoms, reporting that “[h]is physical symptoms took approximately six months to disappear.” He further reported having stopped antidepressant medication in March 1991 “because of the improvement in his depressive symptoms.” Plaintiff also stated that upon stopping work as a stockbroker, he undertook a variety of physical and mentally challenging activities, including art courses, scuba diving, and volunteer counseling of AIDS patients at the Shanti Foundation. Dr. Kagan’s report of his mental status examination states:

Appearance and behavior. The patient is neat, cooperative, and appropriately dressed. There is no psychomotor agitation or retardation. Sensorium is clear. He is alert and oriented x3. His cognitive functions appear grossly intact and his memory appears quite intact. Mood is mildly anxious. Affect is appropriate and wide-ranging. His thought is coherent, relevant, and goal-directed. There is no evidence of psychotic thinking. No hallucinations. No delusions. There is no suicidal or homicidal ideation.

Despite this relatively normal examination, Plaintiffs own noted improvement, and his ruling out a diagnosis of PTSD, Dr. Kagan gave Plaintiff a diagnosis of “major depression, recurrent, without psychotic features, in partial remission” and concluded that Plaintiff was totally disabled from performing the duties of his employment as a stockbroker in the usual and customary manner. While Dr. Kagan felt Plaintiff was disabled at that time, he commented, “It is ... possible, although it cannot be predicted with any certainty, that with further psychotherapy and appropriate medication the patient might possibly be able to resume his previous duties.”

On July 22, 1992, Plaintiffs own attending psychiatrist, Dr.

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Bluebook (online)
158 F. Supp. 2d 1088, 2001 U.S. Dist. LEXIS 18088, 2001 WL 931106, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cardiner-v-provident-life-accident-insurance-cacd-2001.