Engelhardt v. Paul Revere Life Ins. Co.

77 F. Supp. 2d 1226, 1999 U.S. Dist. LEXIS 19003, 1999 WL 1132128
CourtDistrict Court, M.D. Alabama
DecidedNovember 19, 1999
DocketCiv.A. 96-D-699-N, Civ.A. 98-D-20-N
StatusPublished
Cited by10 cases

This text of 77 F. Supp. 2d 1226 (Engelhardt v. Paul Revere Life Ins. Co.) is published on Counsel Stack Legal Research, covering District Court, M.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Engelhardt v. Paul Revere Life Ins. Co., 77 F. Supp. 2d 1226, 1999 U.S. Dist. LEXIS 19003, 1999 WL 1132128 (M.D. Ala. 1999).

Opinion

JUDGMENT

DE MENT, District Judge.

In accordance with the attached Memorandum Opinion And Order and Rule 58 of the Federal Rules of Civil Procedure, it is CONSIDERED, ORDERED and ADJUDGED as follows:

1. Defendant Paul Revere Life Insurance Co.’s Motion For Summary Judgment, filed August 23, 1996, be and the same is hereby DENIED AS MOOT in part and DENIED in part.

2. Plaintiff Miller B. Engelhardt’s Cross Motion For Summary Judgment, filed July 30, 1998, be and the same is hereby DENIED AS MOOT in part and GRANTED in part. Pursuant to 29 U.S.C. § 1132(a)(1)(B), the court hereby CLARIFIES that Plaintiffs amendment to his policy does not exclude eye conditions which are unrelated to glaucoma and Plaintiffs eye condition resulting from a detached retina entitles Plaintiff to total disability benefits until the age of 65 so long as Plaintiff continues to meet the policy’s definition of “totally disabled from your own occupation or total disability from your own occupation.”

3. Plaintiff Miller B. Engelhardt be and the same is hereby AWARDED prejudgment interest at a rate of 1.5% per month from the date Defendant Paul Revere Life Insurance Co. first denied Plaintiffs claim to the date it paid Plaintiff past benefits due under the policy.

4. Defendant Eric Baum’s Motion For Summary Judgment, filed October 19, 1998, be and the same is hereby GRANTED in favor of Defendant Eric Baum and that Plaintiff take nothing by his said suit against Defendant Eric Baum.

5. Plaintiffs Motion To Remand, filed January 26, 1998, be and the same is hereby DENIED.

6.There being no remaining triable issues, the Clerk is directed to close this consolidated action.

MEMORANDUM OPINION AND ORDER

Before the court are the following motions:

1. Defendant Paul Revere Life Insurance Co.’s (“Paul Revere”) Motion For Summary Judgment (“Paul Revere’s Mot.Summ.J.”) and supporting Memorandum Of Law (“Paul Revere’s Mem.”), both filed August 23, 1996;
2. Plaintiff Miller B. Engelhardt’s (“Plaintiff’) Cross Motion For Summary Judgment And Opposition To Defendant’s Motion For Summary Judgment (“Pl.’s Mot.Summ.J”), filed July 30,1998;
3. Plaintiffs Request For Attorney’s Fees, which the court construes as a Motion For Attorney’s Fees, filed August 31,1999;
4. Defendant Eric Baum’s (“Baum”) ■ Motion For Summary Judgment (“Baum’s Mot.Summ.J.”) and Statement Of Undisputed Facts And Memorandum Of Law In Support Of Motion For Summary Judgment (“Baum’s Mem.”), both filed October 19,1998; and
5. Plaintiffs Motion To Remand, filed January 26,1998.

The court has examined the Parties’ respective motions and the numerous responses, replies and surreplies filed in support of and in opposition to the above motions. After careful consideration of the arguments of counsel, the relevant law, and the record as a whole, the court finds as follows:

1. Paul Revere’s Motion For Summary Judgment is due to be denied as moot in part and denied in part;
2. Plaintiffs Cross Motion For Summary Judgment is due to be denied as moot in part and granted in part;
*1229 3. The court will reserve ruling on Plaintiffs Motion For Attorney’s Fees and will set a briefing schedule for the Parties to address the five factors in Florence Nightingale Nursing Svc. Inc. v. Blue Cross/Blue Shield of Alabama, 41 F.3d 1476, 1485 (11th Cir.1995);
4. Baum’s Motion For Summary Judgment is due to be granted; and
5. Plaintiffs Motion To Remand is due to be denied.

I. JURISDICTION AND VENUE

The court exercises subject matter jurisdiction over this action pursuant to the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1001 et seq., and 28 U.S.C. § 1331 (federal question jurisdiction). The parties do not contest personal jurisdiction or venue.

II. PROCEDURAL HISTORY AND FACTUAL BACKGROUND

A. Plaintiffs Claim Against Paul Revere, Civil Action No. 96-D-699-N

The procedural history and undisputed facts pertaining to Plaintiffs action against Paul Revere are set forth in Engelhardt v. Paul Revere Life Ins. Co., 139 F.3d 1346 (11th Cir.1998) (“Engelhardt I”), from which the court summarizes. Plaintiff was one of four surgeons who had formed a group practice. The practice joined a “multi-employer trust” established by Paul Revere, which provided group disability insurance coverage to the surgeons and the eligible employees within the surgeons’ group practice. Id. at 1348.

In Plaintiffs application for disability insurance coverage, he informed Paul Revere that he had been diagnosed with glaucoma. Id. As a condition of coverage, Paul Revere required Plaintiff to sign an amendment excluding benefits for any disability related to “ ‘either or both eyes.’ ” Id.

Plaintiff agreed to sign the amendment only after receiving certain assurances from both Paul Revere and Stan Montgomery (“Montgomery”), the “independent insurance agent” who sold Plaintiff the policy. Id. Montgomery told Plaintiff that the amendment solely applied to glaucoma-related problems, and Paul Revere wrote in a letter to Plaintiff that the amendment would be applied “ ‘with common sense and reason.’ ” Id. Approximately two years after Plaintiffs policy became effective, Plaintiff suffered a detached retina and was no longer able to perform surgery. The detached retina was “unrelated to” Plaintiffs glaucoma. Id. Plaintiff filed a claim with Paul Revere for disability benefits under the policy. Paul Revere, which “had the exclusive right to determine eligibility for benefits,” denied the claim based on the aforementioned amendment. Id.

Plaintiff filed an administrative appeal of Paul Revere’s denial and asserted that he had been assured by an agent that the exclusion only applied to conditions caused by glaucoma. Id. Paul Revere then requested Plaintiff to provide additional information, such as the name of the agent who made the promise or documentation related to the agent’s representation. Id. At that point, Plaintiff abandoned his administrative appeal and filed this lawsuit. Id.

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Bluebook (online)
77 F. Supp. 2d 1226, 1999 U.S. Dist. LEXIS 19003, 1999 WL 1132128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/engelhardt-v-paul-revere-life-ins-co-almd-1999.