Cohan v. Provident Life & Accident Insurance

140 F. Supp. 3d 1063, 2015 U.S. Dist. LEXIS 133935
CourtDistrict Court, D. Nevada
DecidedSeptember 30, 2015
DocketCase No. 2:13-cv-00975-LDG (CWH)
StatusPublished

This text of 140 F. Supp. 3d 1063 (Cohan v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cohan v. Provident Life & Accident Insurance, 140 F. Supp. 3d 1063, 2015 U.S. Dist. LEXIS 133935 (D. Nev. 2015).

Opinion

ORDER

Lloyd D. George, United States District Judge

. In his complaint, the plaintiff, Jonathan Cohan, M.D., alleges that he purchased a disability insurance policy from defendant Provident Life and Accident Insurance Co., a subsidiary of defendant Unum Group. (For brevity, the Court will collectively refer to the defendants as Unum.) He further alleges in 2010 and 2011, his occupation was as a pulmonary critical care physician. He asserts that he became totally disabled from this occupation as of June 27, 2011, and submitted a total disability claim.1 Unum initially paid total disability payments to Cohan, but subsequently decided to terminate his benefits and demand a repayment for the overpayment of benefits. Cohan alleges claims for breach of contract and bad faith against both defendants, and unfair trade practices against Provident Life.

. As to his claim for breach of contract, Cohan has moved for partial summary judgment (# 135) as to (a) the definition of the term “occupation,” and (b) if a residual disability calculation was appropriate, Unum made an incorrect calculation of his claim. Unum has opposed the motion (# 191).

Unum has moved for summary judgment as to Cohan’s claims for breach of contract, bad faith, and unfair trade practices or, alternatively, partial summary judgment on specific issues concerning these claims (# # 138; 217, 224), which Cohan has opposed (# 186, 231). Cohan has also moved to strike (# 190) certain exhibits that Unum filed in support its motion for summary judgment, which Unum has opposed (# 203). Unum has also moved to [1066]*1066strike (#218) certain of Cohan’s exhibits that he submitted in support of his opposition to Unum’s motion for summary judgment.2 As concerning the motions to strike, the Court will address the arguments raised by the parties as necessary to resolve the cross-motions for summary judgment. Having considered the pleadings, papers, and admissible exhibits, the Court will deny Cohan’s motion for partial summary judgment, and will grant Unum’s motion as to Cohan’s bad faith and unfair trade practices claims, and deny the motion as to Cohan’s claims for breach of contract.

Motion for’ Summary Judgment

In considering a motion for summary judgment, the court performs “the threshold inquiry of determining whether there is the need for a trial — whether, in other words, there are any genuine factual issues that properly can be resolved only by a finder of fact because they may reasonably be resolved in favor of either party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); United States v. Arango, 670 F.3d 988, 992 (9th Cir.2012). To succeed on a motion for summary judgment, the moving party must show (1) the lack of a genuine issue of any material fact, and (2) that the court may grant judgment as a matter of law. Fed. R. Civ. Pro. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); Arango, 670 F.3d at 992.

A material fact is one required to prove a basic element of a claim. Anderson, 477 U.S. at 248, 106 S.Ct. 2505. The failure to show a fact essential to one element, however, “necessarily renders all other facts immaterial.” Celotex, 477 U.S. at 323, 106 S.Ct. 2548. Additionally, “[t]he mere existence of a scintilla of evidence in support of the plaintiffs position will be insufficient.” United States v. $133,420.00 in U.S. Currency, 672 F.3d 629, 638 (9th Cir.2012) (quoting Anderson, 477 U.S. at 252, 106 S.Ct. 2505).

“[T]he plain language of Rule 56(c) mandates the entry of summary judgment, after adequate time for discovery and upon motion, 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, 477 U.S. at 322, 106 S.Ct. 2548. “Of course, a party seeking summary judgment always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of ‘the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,’ which it believes demonstrate the absence of a genuine issue of material fact.” Id., at 323, 106 S.Ct. 2548. As such, when the non-moving party bears the initial burden of proving, at trial, the claim or defense that the motion for summary judgment places in issue, the moving party can meet its initial burden on summary judgment “by ‘showing’ — that is, pointing out to the district court — that there is an absence of evidence to support the nonmoving party’s case.” Id., at 325, 106 S.Ct. 2548. Conversely, when the burden of proof at trial rests on the party moving for summary judgment, then in moving for summary judgment the party must establish each element of its case.

Once the moving party meets its initial burden on summary judgment, the non-moving party must submit facts showing a genuine issue of material fact. Fed. R. Civ. Pro. 56(e); Nissan Fire & Marine Ins. Co. v. Fritz Companies, Inc., 210 F.3d [1067]*10671099, 1103 (9th Cir.2000). As summary judgment allows a court “to isolate and dispose of factually unsupported claims or defenses,” Celotex, 477 U.S. at 323-24, 106 S.Ct. 2548, the court construes the evidence before it “in the light most favorable to the opposing party.” Adickes v. S.H. Kress & Co., 398 U.S. 144, 157, 90 S.Ct. 1598, 26 L.Ed.2d 142 (1970). The allegations or denials of a pleading, however, will not defeat a well-founded motion. Fed. R. Civ. Pro. 56(e); Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). That is, the opposing party cannot “ Test upon the mere allegations or denials of [its] pleading’ but must instead produce evidence that ‘sets forth specific facts showing that there is a genuine issue for trial.’” Estate of Tucker v. Interscope Records, 515 F.3d 1019, 1030 (9th Cir.2008) (quoting Fed. R. Civ. Pro. 56(e)).

Factual Background.

Cohan applied for and obtained an individual disability income insurance policy from defendant Provident Life: Policy No. 06-337-5069835. Pursuant to the policy, Unum agreed to pay a monthly benefit of $12,500 to Cohan for a Total Disability. The policy further defined:

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.

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Related

Adickes v. S. H. Kress & Co.
398 U.S. 144 (Supreme Court, 1970)
Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
United States v. Arango
670 F.3d 988 (Ninth Circuit, 2012)
Estate of Tucker Ex Rel. Tucker v. Interscope
515 F.3d 1019 (Ninth Circuit, 2008)

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Bluebook (online)
140 F. Supp. 3d 1063, 2015 U.S. Dist. LEXIS 133935, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cohan-v-provident-life-accident-insurance-nvd-2015.