Giampa v. Trustmark Insurance

73 F. Supp. 2d 22, 1999 U.S. Dist. LEXIS 8051, 1999 WL 329677
CourtDistrict Court, D. Massachusetts
DecidedFebruary 26, 1999
DocketCiv.A. 97-11977-PBS
StatusPublished
Cited by9 cases

This text of 73 F. Supp. 2d 22 (Giampa v. Trustmark Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Giampa v. Trustmark Insurance, 73 F. Supp. 2d 22, 1999 U.S. Dist. LEXIS 8051, 1999 WL 329677 (D. Mass. 1999).

Opinion

MEMORANDUM AND ORDER

SARIS, District Judge.

INTRODUCTION

This case arises out of a dispute between plaintiff Dr. Joseph D. Giampa, a chiropractor, and defendants Trustmark Insurance Company (“Trustmark”) and Continental Assurance Company (“CNA”) regarding Giampa’s eligibility to receive disability payments. Defendants have moved for summary judgment on the ground that Giampa is not totally disabled as defined by their policies. After hearing and for the reasons set forth below, the motion is DENIED.

FACTUAL BACKGROUND

When all inferences are drawn in favor of the nonmoving party, the facts are as follows:

On July 5, 1994, Giampa injured his back while treating a patient. Prior to and up until his injury, he had spent eighty-five to ninety-five percent of his time treating patients (i.e., conducting examinations and performing manipulations or adjustments) and the remainder of his time managing his two chiropractic facilities. After his injury, he was unable to treat patients and therefore expanded his management duties. Beginning in 1995, Giam-pa and his partners established a number of chiropractic clinics in Massachusetts and Florida. Working primarily from Massachusetts, Giampa monitors the clinics’ activities and advises the chiropractors he hires to operate them. He currently has an interest in more than sixteen such facilities. Giampa’s administrative duties have proven to be significantly more lucrative than his previous work as a treating chiropractor: his income increased from just over $200,000 in 1993 to over $1,000,-000 in 1997.

Giampa claims that he is eligible to receive total disability benefits under the terms of two occupational disability policies he purchased from defendant CNA in 1992. Both policies define “total disability” as follows:

“Total Disability” means that because of Injury or Sickness:
(1) [The insured] cannot perform the substantial and material duties of [his] regular occupation ...; and
(2) [The insured is] receiving care by a Physician which is appropriate for the condition causing [his] Disability.

App.Supp. Defs.’ Mot.Summ.J. at A. 12, A. 20. 1 Both policies also contain residual, or partial, disability provisions, although each *24 policy defines “residual disability” slightly differently:

“Residual Disability,” [under the disability income policy] means that although [the insured is] gainfully employed at [his] regular occupation, [his] Loss of Earnings Ratio is 20% or more because of Injury or Sickness and [he is] receiving care by a Physician which is appropriate for the condition causing [his] Disability.
}>: * 'Jfi * * *
“Residual Disability” [under the business overhead expense policy] means that because of Injury or Sickness
1. [The insured is] receiving care by a Physician which is appropriate for the condition causing [his] Disability; and
2. [The insured is] either:
a. unable to perform one or more of the substantial and material duties of [his] regular occupation; or
b. unable to spend as much time working at [his] regular occupation as [he] did before [his] Disability began.

Id. at A.13, A.20. On his applications for the policies, Giampa listed his “Occupation” as “chiropractor” and described his “Exact Duties” as “practicing chiropractor.” Id. at A.l, A.6.

Soon after his injury, Giampa submitted a claim for benefits under the policies. CNA began making total disability payments to Giampa in December 1994. The payments continued until September 1995, when defendant Trustmark, which had undertaken the administration of Giampa’s policies for CNA, determined that Giampa was not eligible for total disability benefits. Trustmark denied Giampa’s subsequent claim for benefits in January 1996 and assumed Giampa’s policies effective April 1,1996.

This lawsuit followed. In May 1996, Giampa filed a complaint against Trust-mark in Norfolk Superior Court; in August 1997, he filed an amended complaint adding CNA as a defendant and alleging breach of contract and violations of Mass. Gen.L. ch. 93A, § 9, and Mass.Gen.L. ch. 176D, § 3 (unfair claim settlement practices). The defendants removed the case here pursuant to 28 U.S.C. § 1441. They now move for summary judgment on the ground that Giampa is not totally disabled within the meaning of his policies. 2 This Court’s subject matter jurisdiction is predicated on diversity of citizenship. The parties agree that Massachusetts law applies.

DISCUSSION

A. Summary Judgment Standard

A motion for summary judgment must be allowed 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 judgment as a matter of law.” Fed.R.Civ.P. 56(c). “To succeed [in a motion for summary judgment], the moving party must show that there is an absence of evidence to support the nonmov-ing party’s position.” Rogers v. Fair, 902 F.2d 140, 143 (1st Cir.1990); see also Celotex Corp. v. Catrett, 477 U.S. 317, 325, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). “Once the moving party has properly supported its motion for summary judgment, the burden shifts to the non-moving party, who ‘may not rest on mere allegations or denials of his pleading, but must set forth specific facts showing there is a genuine issue for trial.’ ” Barbour v. Dynamics Research Corp., 63 F.3d 32, 37 (1st Cir.1995) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986)). “There must be ‘sufficient evidence favoring the nonmoving *25 party for a [reasonable] jury to return a verdict for that party. If the evidence is merely colorable or is not significantly probative, summary judgment may be granted.’ ” Rogers, 902 F.2d at 143 (quoting Anderson, 477 U.S. at 249-50, 106 S.Ct. 2505) (citations and footnote in Anderson omitted). The court must “view the facts in the light most favorable to the non-moving party, drawing all reasonable inferences in that party’s favor.” Barbour, 63 F.3d at 36.

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Bluebook (online)
73 F. Supp. 2d 22, 1999 U.S. Dist. LEXIS 8051, 1999 WL 329677, Counsel Stack Legal Research, https://law.counselstack.com/opinion/giampa-v-trustmark-insurance-mad-1999.