Damascus v. Provident Life & Accident Insurance

933 F. Supp. 885, 96 Daily Journal DAR 12153, 1996 U.S. Dist. LEXIS 9934, 1996 WL 396192
CourtDistrict Court, N.D. California
DecidedJune 21, 1996
DocketC-95-4357 WHO
StatusPublished
Cited by2 cases

This text of 933 F. Supp. 885 (Damascus v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Damascus v. Provident Life & Accident Insurance, 933 F. Supp. 885, 96 Daily Journal DAR 12153, 1996 U.S. Dist. LEXIS 9934, 1996 WL 396192 (N.D. Cal. 1996).

Opinion

OPINION AND ORDER

ORRICK, District Judge.

In this insurance action, plaintiff Alexander P. Damascus (“Damascus”) sues defendants Provident Life and Accident Insurance Company (“Provident”) and Lee Francis La-Marca (“LaMarca”), its agent, claiming Provident failed to pay benefits allegedly due him under the provisions of an accident and sickness policy requiring Provident to pay him indemnity “[if] Injuries or Sickness results in Total Disability,” which is defined as “inability to perform the duties of your occupation.” (Harnsberger Deel., Ex. A at 5.) Provident now moves for summary judgment, and for *887 the reasons hereinafter stated, the Court grants summary judgment for Provident on all causes of action. 1 The Court also grants summary judgment, sua sponte, for LaMarca on all causes of action.

I.

In 1980, Provident issued Accident and Sickness Policy No. 6PC-454284 (“the policy”) to Damascus. (Id., Ex. A.) The policy provides for insurance against total disability resulting from “(1) accidental bodily injuries ... or (2) sickness or disease_” (Id. at 1.) The benefits provision of the policy provides, in relevant part, “If Injuries or Sickness result in Total Disability, the Company will pay periodically during the continuance of such Total Disability, indemnity at the rate of the Monthly Benefit for Total Disability shown in the Policy Schedule....” (Id. at 4.) Total Disability is defined as “your inability to perform the duties of your occupation.” (Id. at 5.)

Damascus is a dentist. On September 10, 1990, an Accusation was filed against him with the California Board of Dental Examiners (the “Board”), seeking to revoke his license to practice dentistry because of mental illness and grossly inappropriate care of patients, pursuant to §§ 820 and 822 2 of the California Business and Professions Code. (Hamsberger Deck, Ex. J.) On July 31, 1991, the Board placed Damascus on probation for a five-year period during which Damascus was permitted to practice dentistry only under the supervision of another dentist. (Id., Ex. K at 5-6.) The Board also required Damascus to seek treatment from a psychotherapist and to continue treatment until the Board deemed that no further treatment was necessary. (Id. at 5.) The Board stated that “it is clear that [Damascus] does suffer from a mental illness which interferes with his judgment.” (Id. at 3-4.) This probation order was stayed pending appeal. On May 25, 1994, the California Court of Appeal affirmed the Board’s probation order of July 31, 1991, in an unpublished opinion, and vacated the stay. (Fleming Deck, Ex. H.)

On May 31, 1994, another Accusation was filed against Damascus with the Board, seeking to revoke Damascus’ license to practice dentistry for repeated acts of negligence and unprofessional conduct in violation of §§ 1670 and 1680(p) of the California Business and Professions Code. 3 (Hárnsberger Deck, Ex. L.) Although this Accusation referred to the Board’s prior probation order, it did not seek to revoke Damascus’ dental license on the grounds of mental illness. The Accusation alleged that Damascus performed defective root canal procedures on two patients in 1992 resulting in mechanical perforation of the pulpal wall, but did not notify the patients that-any problem had occurred, and did not refer them to an endodontist. In one of these eases, Damascus allegedly provided the patient with thirty-five percodan and twenty-five penicillin VK tablets without informing the patient of proper use of the medications.

On July 11, 1995, the Board revoked Damascus’ dental license, effective August 11, 1995. (Id., Ex. M.) The July 11,1995, order expressly stated that “The Board’s order in the prior matter ... did not involve unprofessional conduct, acts of gross negligence or repeated negligent acts. Therefore, the pri- or order was not considered in formulating the appropriate penalty or disposition in this matter.” (Id. at 4.) The Board found Damascus’ conduct to constitute gross negligence, unprofessional conduct, and excessive prescribing of drugs. (Id. at 5.)

By a letter dated June 1, 1995, Damascus wrote to Provident requesting benefits due *888 under the policy because “The State Board of Dental Examiners, of the State of California has determined that I suffer from a mental disability that prevents me from practicing dentistry.” (Id., Ex. B.)

On August 8, 1995, Damascus filed a complaint against Provident and Lee Francis LaMarca 4 in the Superior Court for the County of Santa Clara, alleging claims for breach of contract, bad faith, unfair claim settlement practices, breach of statutory duties, conspiracy, fraud, errors and omissions in the sale of insurance, and negligent and intentional infliction of emotional distress. On December 6, 1995, that complaint was removed to this Court.

Provident now moves for summary judgment on the ground that Damascus’ license revocation was due to his negligence and unprofessional conduct, and not due to mental illness; thus, no benefits are due under the policy.

II.

A.

Rule 56(c) of the Federal Rules of Civil Procedure provides that a court may grant summary judgment “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” The Supreme Court’s 1986 “trilogy” of Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986), Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986), and Matsushita Electric Industrial Co. v. Zenith Radio Corp., 475 U.S. 574, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986), requires that a party seeking summary judgment show the absence of a genuine issue of material fact. Once the moving party has made this showing, the nonmoving party must “designate ‘specific facts showing that there is a genuine issue for trial.’” Celotex, 477 U.S. at 824, 106 S.Ct. at 2553 (quoting Fed.R.Civ.P. 56(c)). “When the moving party has carried its burden under Rule 56(c), its opponent must do more than simply show that there is some metaphysical doubt as to the material facts.” Matsushita, 475 U.S. at 586, 106 S.Ct. at 1356. “If the evidence is merely colorable, or is not significantly probative, summary judgment may be granted.”

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Bluebook (online)
933 F. Supp. 885, 96 Daily Journal DAR 12153, 1996 U.S. Dist. LEXIS 9934, 1996 WL 396192, Counsel Stack Legal Research, https://law.counselstack.com/opinion/damascus-v-provident-life-accident-insurance-cand-1996.