Harmond Schaefer v. AXA Equitable Life Insurance Co

345 F. App'x 87
CourtCourt of Appeals for the Sixth Circuit
DecidedSeptember 2, 2009
Docket08-2198
StatusUnpublished
Cited by1 cases

This text of 345 F. App'x 87 (Harmond Schaefer v. AXA Equitable Life Insurance Co) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harmond Schaefer v. AXA Equitable Life Insurance Co, 345 F. App'x 87 (6th Cir. 2009).

Opinion

OPINION

WHITE, Circuit Judge.

Plaintiff-Appellant, Harmond Schaefer, brought suit against his former employer, AXA Equitable Life Insurance Company (“Equitable”) and the company that managed Equitable’s disability insurance policies, Disability Management Services, Inc. (“DMS,” and collectively, “defendants”). The district court granted defendants’ motion for summary judgment on the ground that Schaefer’s breach of contract claim was barred by a contractual provision requiring suit to be brought within three years. We reverse in part and remand for further proceedings.

I.

Beginning in 1974, Harmond Schaefer worked for Equitable in Michigan as a licensed insurance agent. In 1976, 1979, 1987 and 1988, Schaefer purchased four long-term disability income policies from *89 Equitable. Schaefer sold these policies to himself; they were not provided as a benefit of his employment with Equitable. 1

All four policies include language regarding the time period for bringing a legal action to recover on the policy. The 1976 and 1979 policies provide:

LEGAL ACTIONS. No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished.

The 1987 and 1988 policies have substantially the same provision, but worded slightly differently:

LEGAL ACTION. No legal action may be brought to recover on this policy within 60 days after written proof of loss has been given as required by this policy. No such action may be brought after 3 years from the time written proof of loss is required to be given.

The 1976 and 1979 policies define proof of loss as follows:

PROOF OF LOSS. Written proof of loss must be furnished to the Equitable at its Home Office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss, within ninety days after' termination of the period for which the Equitable is liable and, in the case of claim for any other loss, within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.

The 1987 and 1988 policies have a significantly shorter definition for proof of loss, which includes the word “monthly” as a modifier for the “period for which [Equitable] is liable”:

PROOF OF LOSS. If the policy provides for periodic payment for a continuing loss, written proof of loss satisfactory to us must be given within 90 days of the end of each monthly period for which we are liable. For any other loss, such proof must be given within 90 days of that loss.

The 1976 and 1979 policies contained the following language regarding time for payment of claims:

TIME OF PAYMENT OF CLAIMS. Benefits payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of the mitten proof of such loss. Subject to due written proof of loss, all accrued benefits for loss for which this policy provides periodic payment will be paid monthly during the continuance of the period for which the Equitable is liable and any balance remaining unpaid upon the termination of that liability will be paid at that time.

The 1987 and 1988 policies stated:

TIME OF PAYMENT OF CLAIMS. After receiving written proof of loss, we will pay monthly all benefits then due *90 you for disability. Any balance that remains unpaid when our liability ends will be paid at that time. Benefits for any other loss covered by this policy will be paid as soon as we receive proper written proof.

After suffering a heart attack in January 1995 that reduced his ability to work, Schaefer applied for benefits under each of the four policies. Equitable approved Schaefer’s claim, and began to pay him monthly disability benefits. In 1995 and 1996, Schaefer raised two objections with Equitable: (1) he contended that his “renewal commissions” should be considered deferred compensation, and not be included in calculating his monthly income; and (2) each of Schaefer’s policies contained language regarding a cost of living adjustment (COLA), yet Schaefer did not receive an adjustment for payments under the 1976 and 1979 policies. These two objections would eventually form the basis for the instant lawsuit.

A. Renewal Commissions and Service Fees

In September 1995, Equitable sent a letter to Schaefer requesting verification of his monthly earnings, stating that his “monthly statements should include 1st year and renewal commissions received from all carriers and all expenses paid during the month.” Schaefer responded with a fax, stating his belief that “renewal commissions are not considered earnings income; they are considered deferred compensation from prior year sales.” On October 80, Equitable responded to Schaefer, explaining that “it is still our position that we must take into consideration the income earned for Renewal and services fees when calculating the Pre Disability Monthly Income as well as Current Monthly Income.” Over the years, Schaefer continued to argue that his renewal commissions should be excluded from his current monthly and yearly income calculation, and Equitable responded with letters on September 9, 1996, September 10 and 16, 1997, August 16, 1999, and September 28, 2000, stating that it considered renewal commissions and service fees to be income. In January 2001, Disability Management Services (DMS) took over administration of Equitable’s long-term disability policies, and on July 1, 2004, DMS addressed Schaefer’s concern again, reiterating the answer that Equitable had provided numerous times before:

Our review of your file reveals that this issue has been discussed and addressed with you since the inception of your file. We note that renewal commissions have always been included in both the calculation of your Prior Monthly figures and Current Monthly Income figures. If these earnings are included in your Pri- or Monthly Income then they need to be included in your Current Monthly Income. Renewal commissions have always been included in these calculations and are considered income for ongoing services that you render to your clients.

B. COLA payments

On May 20, 1996, Schaefer complained to Equitable that he was only receiving COLA payments under the policies purchased in 1987 and 1988, and not the 1976 and 1979 policies as well. A June 19, 1996 letter from Equitable to Schaefer stated:

The COLA riders for [the 1976 and 1979] Policies ... are payable for total disability.

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Bluebook (online)
345 F. App'x 87, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harmond-schaefer-v-axa-equitable-life-insurance-co-ca6-2009.