Dekel v. Unum Provident Corp.

593 F. Supp. 2d 516, 2009 U.S. Dist. LEXIS 7834, 2009 WL 144047
CourtDistrict Court, E.D. New York
DecidedJanuary 20, 2009
Docket1:04-cr-00413
StatusPublished

This text of 593 F. Supp. 2d 516 (Dekel v. Unum Provident Corp.) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dekel v. Unum Provident Corp., 593 F. Supp. 2d 516, 2009 U.S. Dist. LEXIS 7834, 2009 WL 144047 (E.D.N.Y. 2009).

Opinion

MEMORANDUM AND ORDER

MAUSKOPF, District Judge.

This action arises from a dispute between Plaintiff Moshe Dekel (“Dekel”) and his insurance company, Defendant Unum Provident Corporation (“Unum”), regarding Dekel’s coverage under the disability insurance policy that Unum issued to Dekel in 1998. Discovery is complete and this matter is nearly ready for trial. Currently before the Court is Unum’s motion in limine seeking (i) exclusion of the “Specialty Letter” dated May 26, 1994; (ii) limitation of the testimony of Drs. Iyer and Sarno; (iii) exclusion of any testimony by Lawrence LaRusso; (iv) exclusion of deposition testimony from Dekel and Dr. David; (v) exclusion of certain hospital records; and (vi) exclusion of Dr. Aaron’s calendar. Only the first of these issues- — -the so-called “Specialty Letter” — requires substantial discussion. For the reasons set forth below, Unum’s motion is GRANTED as to the issues of the Specialty Letter and the testimony of Mr. LaRusso, and DENIED without prejudice as to the remaining issues.

BACKGROUND

The Court assumes the parties’ familiarity with the factual background and procedural history of this case, and will address only those aspects that are relevant to the instant motion. The following facts are taken from the stipulations in the parties’ Joint Pretrial Order, dated November 5, 2007 (Docket No. 41), and the Unum disability insurance policy underlying this action, which bears policy number 0102618856 (the “Policy”). Dekel applied for a disability insurance policy on June 11, 1993, and Unum 1 issued the Policy on June 28,1993.

A. Definitions of Policy Terms

The Policy provided for two types of disability benefits — “Total Disability” and “Residual Disability.” The Policy defines Total Disability as follows:

“Total Disability” means that because of Injury or Sickness:
a. You are unable to perform the important duties of Your Occupation; and
b. You are receiving Physician’s Care. We will waive this requirement if We receive written proof acceptable to Us that further Physician’s Care would be of no benefit to You.

(Policy Part 1.10.) “Residual Disability,” on the other hand, is defined as the inability of the insured either to perform “one or more” of the important duties of his or her occupation (as opposed to all of the important duties), or to perform the important duties of his or her occupation “for more than 80% of the time.” (Policy Part 1.11.)

*518 The term “Your Occupation” is defined in the Policy as “the occupation or occupations in which You are regularly engaged at the time Disability begins.” (Policy Part 1.9) (emphasis added). This type of policy is often referred to as a “Your Occupation” or “Own Occupation” policy, as distinct from an “Any Occupation” policy. Under an “Any Occupation” policy, the insured would not be considered disabled if he or she were working in any occupation during the period of claimed disability. Under a “Your Occupation” policy, by contrast, the insured would be considered disabled if he or she were unable to perform the important duties of the occupation in which he or she had been engaged at the onset of disability, despite the fact that he or she might subsequently work in a different occupation. The “Your Occupation” policy thus, provides a higher level of protection to the insured. Dekel opted for a “Your Occupation” policy, for which he paid an additional premium.

B. Integration Clause

In addition to the foregoing Policy sections, one additional provision merits discussion. Section 10.1 of the Policy sets forth both (i) what documents are included in the Policy (a type of provision often called an “integration” or “merger” clause), and (ii) the procedures for modifying the Policy. That section reads as follows:

10.1 ENTIRE CONTRACT; CHANGES
This Policy (with the application and attached papers) is the entire contract between You and Us. No change in this Policy will be effective until approved by a Company officer. This approval must be noted on or attached to this Policy. No agent may change this Policy or waive any of its provisions.

The parties agree that Dekel’s application papers were attached to the Policy when it was issued, but that the “Specialty Letter” was not so attached. {See n. 2, infra.)

C. The “Specialty Letter”

On May 26, 1994, Unum issued what the parties refer to as the “Specialty Letter.” The Specialty Letter reads as follows:

Subject: Policy # 010 2618856 — Preferred Professional Dear Dr. Dekel:
We are glad to welcome you as a policyholder, and to clarify what we mean in your policy by “Your Occupation.”
Your policy, which includes coverage for “Total Disability In Your Occupation,” provides that you would be considered Totally Disabled if, because of injury or sickness, you were unable to perform the important duties of Your Occupation and were receiving appropriate physician’s care.
By “Your Occupation,” we mean the occupation or occupations in which you are regularly engaged at the time disability begins. We understand your current occupation to be that of a specialist in the field of obstetrics & gynecology.
If immediately prior to the time disability begins, you were performing the important duties of that specialty and then, were unable to perform those duties, you would be considered unable to perform the important duties of Your Occupation. The fact that you could be working in some other occupation or speciality would not preclude the payment of Total Disability benefits.
If you returned to your occupation performing some or all of your important duties, you could be eligible for Residual or Recovery benefits based on proportionate income loss due to the injury or sickness.
*519 The actual payment of benefits, of course, would be determined in accordance with the provisions of your policy. It is a pleasure to provide you with this clarification, and we look forward to the opportunity of providing you with quality service.
Very truly yours,
Michael P. Marr
Vice President, Individual Underwriting The Paul Revere Life Insurance Company

Consistent with the understanding set forth in the Specialty Letter, the parties agree that, until at least 1996, Dekel’s occupation was that of a specialist in the field of Obstetrics and Gynecology (“OB/GYN”).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Robert Goldberger v. Paul Revere Life Insurance Co.
165 F.3d 180 (Second Circuit, 1999)
Kulpa Ex Rel. Kulpa v. Glass
903 F. Supp. 321 (N.D. New York, 1995)
Beal Savings Bank v. Sommer
865 N.E.2d 1210 (New York Court of Appeals, 2007)
Springer v. Allstate Life Insurance
731 N.E.2d 1106 (New York Court of Appeals, 2000)
Dornberger v. Metropolitan Life Insurance
961 F. Supp. 506 (S.D. New York, 1997)
Kraft v. Massachusetts Casualty Insurance
320 F. Supp. 2d 1234 (N.D. Florida, 2004)
Merrill Lynch Realty/Carll Burr, Inc. v. Skinner
473 N.E.2d 229 (New York Court of Appeals, 1984)
National Union Fire Insurance of Pittsburgh v. Xerox Corp.
25 A.D.3d 309 (Appellate Division of the Supreme Court of New York, 2006)
Commissioners of the State Insurance Fund v. Wiz Construction Co.
289 A.D.2d 943 (Appellate Division of the Supreme Court of New York, 2001)

Cite This Page — Counsel Stack

Bluebook (online)
593 F. Supp. 2d 516, 2009 U.S. Dist. LEXIS 7834, 2009 WL 144047, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dekel-v-unum-provident-corp-nyed-2009.