HSK v. Provident Life & Accident Insurance

128 F. Supp. 3d 874, 2015 U.S. Dist. LEXIS 115127
CourtDistrict Court, D. Maryland
DecidedAugust 31, 2015
DocketCivil No. CCB-12-3373
StatusPublished
Cited by4 cases

This text of 128 F. Supp. 3d 874 (HSK v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
HSK v. Provident Life & Accident Insurance, 128 F. Supp. 3d 874, 2015 U.S. Dist. LEXIS 115127 (D. Md. 2015).

Opinion

MEMORANDUM

CATHERINE C. BLAKE, District Judge.

HSK sues the Provident Life and Accident Insurance Co. (“Provident”), alleging failure to pay him disability benefits in breach of an insurance contract. And he sues Provident’s parent corporation, Unum Group (“Unum”), for allegedly interfering with that contract. HSK now moves for summary judgment on his breach of contract claim against Provident, while Unum moves for summary judgment on HSK’s claim of contractual interference. Those motions have been fully briefed, and no hearing is necessary to their resolution. See Local Rule 105.6 (D.Md.2014).1 For the reasons explained below, HSK’s motion for summary judgment on the breach of contract claim will be denied, while Unum’s motion for summary judgment on the contractual interference claim will be granted.

BACKGROUND

Provident is the wholly owned subsidiary of Unum. (See Opp. Unum Mot. Summ. J. Ex. 3, Roth Aff. ¶ 6, ECF No. 126-2.) Unum controls Provident directly through its ownership of over 80 percent of that firm’s shares, and indirectly through two wholly-owned subsidiaries that hold the remaining shares. (See Opp. Unum Mot. Summ. J. Ex. 2, Roth Dep. 39:17-22, ECF No. 126-1.) Provident has no employees. (See Roth Aff. ¶ 7.) Pursuant to a contract between Provident and Unum, Unum administers Provident’s insurance policies. (See id.)

In early 1995, Provident issued a disability insurance policy to HSK. (See HSK Mot. Partial Summ. J. Ex. 26, HSK Aff. ¶ 2, ECF No. 121-26.) HSK has paid the premiums on that policy ever since. (See id. at ¶ 3.) Under that policy, Provident promised, among other things, to pay HSK certain specified benefits if he became “totally disabled,” which “means that due to Injuries or Sickness [HSK is] not able to perform the substantial and material duties of [his] Occupation.” (See HSK Mot. Partial Summ. J. Ex. 1, Policy 4, ECF No. 121-1.)

[877]*877On March 16, 2011, HSK sent Provident a notice that he was claiming disability benefits under the policy, requesting the “proof of loss” forms necessary to document his disability. (See HSK Mot. Partial Summ. J. Ex. 5, Notice of Claim, ECF No. 121-5.) HSK submitted those proof of loss forms roughly three months later. (See HSK Mot. Partial Summ. J. Ex. 2, Proof of Loss Form, ECF No. 121-2.) There, he stated that he had served as an executive in the mortgage industry for 19 years. (See id. at 8.) Before the onset of his alleged disability, HSK worked in both a managerial and a sales capacity at a firm in which he held a partnership interest, supervising employee performance, budgeting, regulatory compliance, and business development, as well as communicating with business partners, among other responsibilities. (See id.) HSK quit that job in early April on account of his alleged disability. (See id. at 2.) Provident accepted that proof of loss as complete. (See HSK Mot. Partial Summ. J. Ex. 3, Weis-sensee Dep. 104:5-7, ECF No. 121-3.)

On the proof of loss form, HSK’s attending physician, psychiatrist Dr. Andrew Feinberg, described HSK’s disability on HSK’s behalf. Specifically,-Feinberg indicated that HSK suffered from “major depression, OCD [obsessive compulsive disorder], panic disorder, ADHD [attention deficit hyperactivity disorder], phobias, generalized anxiety disorder [and] opioid dependence.” (Proof of Loss 12.) Those conditions, Feinberg continued, left HSK with a “low mood, severe anxiety, impaired concentration, impaired working memory, [and] panic attacks.” (See id.) In light of HSK’s condition and symptoms, .Feinberg opined that HSK “can[not] return to his previous occupation without endangering his health.” (See id. at 13.) After leaving his job, HSK’s symptoms improved, according to Feinberg. (See HSK Mot. Partial Summ. J. Ex. 24, Feinberg Aff. ¶ 10, ECF No. 121-24.) HSK used his time away from work to volunteer at the Humane Society, help care for his elderly grandfather, and play tournament poker, a new hobby. (See, e.g., Feinberg Aff. ¶ 11; HSK Mot. Partial Summ. J. Ex. 25, Ci-trenbaum Aff. ¶ 11, ECF No. 121-25.)

After receiving HSK’s proof of loss form, Provident began to collect his medical records, pursuant to an authorization included in his proof of loss. (See Weis-sensee Dep. 210:17-18; Proof of Loss 15; HSK Mot. Partial Summ. J. Ex. 4, Shea Dep. 42:19-43:3, 19-23, ECF No. 121-4.)2 It collected records maintained by Fein-berg, as well as another mental health practitioner treating HSK, psychologist Charles Citrenbaum, and other medical providers. After reviewing HSK’s records, Provident’s in-house medical specialist, Dr. Lloyd Price, observed that Fein-berg’s records “do not document any change in insured’s mental/functional status on/ around [sic] 3/10/11, nor do they contain any recommendation that insured not continue to work.” (Opp. HSK Mot. Partial Summ. J. Ex. 6, Price Review Notes at 4, ECF No. 129-3.) And Price commented on the vagueness of Feinberg’s notes, alongside other alleged failings, which led Price to conclude that those records did not “establish! ]” or “support[]” Feinberg’s diagnosis “due to lack of clinical detail.” (See id. at 4-5.) As Price explained at his deposition, his review of HSK’s medical records suggested that HSK was not disabled, contrary to Feinberg’s representations. (See HSK Mot. Partial Summ. J. Ex. 18, Price Dep. 175:3-5, ECF No. 121-18; see also HSK [878]*878Mot. Partial Summ. J. Ex. 22, Shea Letter 9/6/11, ECF No. 121-22.)

Accordingly, Price sent Feinberg a letter requesting additional information. (See Opp. HSK Mot. Partial Summ. J. Ex. 8, Price Letter 7/25/11, ECF No, 129-8.) Feinberg responded that he had “recommended to [HSK] many times, on many different dates, that he should get out of his business, as the stress of his job was clearly contributing to his depression, anxiety, and obsessive rumination. The stress of his job was clearly a direct trigger for his symptoms, which were in turn, causing significant impairment both at work and at home.” (See Opp. HSK Mot. Partial Summ. J. Ex. 9, Feinberg Letter 7/29/11, ECF No. 129-3.) Price deemed Fein-berg’s letter conclusory, (see Opp. HSK Mot. Partial Summ. J. Ex. 7, Price Dep. 147:23-24, ECF No. 129-3), and it did not alter Price’s opinion. Given Price’s disagreement with Feinberg’s conclusion, Price recommended an independent examination that, in his words, would “act, in effect, as a tie breaker.” (Id. at 176:1.)

Based on Price’s recommendation, Provident “determined that additional information is needed to understand [HSK’s] medical and functional status,” and wrote HSK to request that he undergo a “Psychiatric Independent Medical Exam.” (HSK Mot. Partial Summ. J. Ex. 9, Weissensee Letter 8/10/11, ECF No. 121-9.)3 Soon thereafter, HSK’s attorney responded that the policy authorized Provident to demand only a physical examination, not a psychiatric examination. (See HSK Mot. Partial Summ. J. Ex. 11, McCauley Letter 8/18/11, ECF No. 12111.) On that ground, HSK declined to submit to the examination Provident had requested. (See id.)

In internal correspondence, the insurance adjustor handling HSK’s claim determined that Provident was “unable to complete [its] evaluation of [HSK’s] medical condition” without an independent examination. (HSK Mot. Partial Summ. J. Ex. 12, Shea Communication 11/1/11, ECF No.

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128 F. Supp. 3d 874, 2015 U.S. Dist. LEXIS 115127, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hsk-v-provident-life-accident-insurance-mdd-2015.