Kafie v. Northwestern Mutual Life Insurance

834 F. Supp. 2d 1354, 2011 U.S. Dist. LEXIS 138956, 2011 WL 6025867
CourtDistrict Court, S.D. Florida
DecidedDecember 2, 2011
DocketCase No. 11-21251-CIV
StatusPublished
Cited by3 cases

This text of 834 F. Supp. 2d 1354 (Kafie v. Northwestern Mutual Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kafie v. Northwestern Mutual Life Insurance, 834 F. Supp. 2d 1354, 2011 U.S. Dist. LEXIS 138956, 2011 WL 6025867 (S.D. Fla. 2011).

Opinion

ORDER

CECILIA M. ALTONAGA, District Judge.

THIS CAUSE is before the Court upon Defendant, Northwestern Mutual Life Insurance Company’s (“Northwestern[’s]”) Motion for Final Summary Judgment and [1356]*1356to Strike Portions of Plaintiffs Amended Complaint (“Motion”) [ECF No. 65], filed on October 11, 2011. Plaintiff, Gaby Kafie (“Kafie”), filed a Complaint on April 8, 2011, containing two statutory bad-faith claims based on alleged violations of Florida Statute section 624.155 (“section 624.155”). (See Compl. [ECF No. 1]). Northwestern filed a motion to dismiss on May 26, 2011 for failure to state a claim (“First Motion to Dismiss”) [ECF No. 10], which the Court granted on July 18, 2011. (See July 18, 2011 Order [ECF No. 23]). The Court granted Kafie leave to amend. (See id.).

Kafie filed his Amended Complaint on July 27, 2011, alleging one statutory bad-faith claim based on alleged violations of section 624.155. (See Am. Compl. [ECF No. 24]). Northwestern filed a second motion to dismiss the Amended Complaint for failure to state a claim on August 11, 2011 (“Second Motion to Dismiss”) [ECF No. 27]. The Court granted the Second Motion to Dismiss in part and denied it in part, declining to dismiss Kafie’s bad-faith claim in its entirety, but dismissing the portion of Kafie’s claim relating to alleged material misrepresentations and requesting punitive damages. (See Sept. 27, 2011 Order, 2011 WL 4499051 [ECF No. 51]). Kafie filed a motion for reconsideration of the Court’s Order with respect to his claim for punitive damages on October 19, 2011 [ECF No. 67], which the Court granted on November 29, 2011. (See [ECF No. 83]).

Northwestern now brings this Motion for Summary Judgment asking the Court to dismiss Kafie’s bad-faith claim and to strike certain allegations from the Amended Complaint as immaterial. (See Mot. 2-3). Kafie filed a Response in Opposition to the Motion (“Response”) [ECF No. 71] on November 4, 2011, and Northwestern filed its Reply (“Reply”) [ECF No. 75] on November 14, 2011. The Court has carefully considered the parties’ written submissions, the record, and the applicable law.

I. BACKGROUND1

Northwestern issued Kafie a disability income insurance policy (“Disability Policy”) [ECF No. 24-1], dated November 3, 2006. (See Statement of Material Facts (“SMF”) ¶ 1 [ECF No. 65]). Benefits under the Policy are provided on a monthly basis. (See id. ¶ 2). Specifically, the Policy provides:

5.1 CLAIM FOR POLICY BENEFITS
Written Proof of Loss. Written proof of loss must be given to [Northwestern] within 90 days after the end of each monthly period for which benefits are claimed. If the proof is not given within the 90 days, the claim will not be affected if the proof is given as soon as reasonably possible. In any event, the proof required must be given no later than one year and 90 days after the end of each monthly period for which benefits are claims unless the Owner was legally incapacitated.
■A: * *
5.2 TIME OF PAYMENT OF CLAIMS
When [Northwestern] has received satisfactory proof of loss and other information as required by section 5.1 and [Northwestern] has determined that benefits are payable, [Northwestern] will pay benefits on a monthly basis.

(Disability Policy 13-14 §§ 5.1-5.2).

Northwestern also issued Kafie a whole-life insurance policy (“Whole Life Policy”) [ECF No. 24-2], dated December 12, 2008. [1357]*1357CSee SMF ¶3). The Whole Life Policy allows for an annual waiver of its premium during periods when Kafie is totally disabled. (See id. ¶ 4). The Whole Life Policy provides:

Premium Waived On An Annual Basis. Even if premiums have been paid more often than every 12 months, a premium waived on a Policy anniversary will be an annual premium.

(Whole Life Policy 26 § 1).

Kafie submitted a request to Northwestern in June 2008 for disability benefits related to loss of vision. (See SMF ¶ 5 (citing June 2008 Request [ECF No. 65-1] )). Northwestern initially communicated its approval of Kafie’s request in a letter dated July 1, 2008. (See id. ¶ 6 (citing July 1, 2008 Letter [ECF No. 65-2] )). The letter enclosed Kafie’s first disability payment and stated:

Future benefits are payable on the monthly payment date listed above as long as we receive satisfactory proof of a continuing disability. The enclosed Request for Continuance of Disability Benefits form should be completed and returned as close as possible to the date indicated on the form. This will ensure that we receive current information when evaluating your continued eligibility for benefits.

(July 1, 2008 Letter 1). After further evaluation, in a letter dated February 3, 2009, Northwestern informed Kafie that it was discontinuing his disability benefits. (See SMF ¶ 7 (citing Feb. 3, 2009 Letter [ECF No. 65-3])).

Prior to the discontinuation of Kafie’s benefits, Neil Kern (“Kern”), Northwestern’s field consultant, interviewed Kafie at his residence. (See id. ¶ 8 (citing Kern Report [ECF No. 65-4])). In his Investigative Report, Kern wrote that Kafie stated he no longer drove, he used a large LCD screen to watch television, he no longer cooked due to his vision, and he could do limited computer work using special software to enlarge the size of characters on the screen. (See Kern Report 5). Kern also wrote Kafie reported he no longer shaved with a razor, but only used an electric shaver every two to three days, and that it took Kafie longer to dress himself and walk around the house. (See id.). During the interview Kern observed how Kafie’s wife had to assist him to locate a computer on top of the table near where Kafie was sitting, and to sign a document by guiding Kafie’s hand and pen. (See id. 2). Kafie “disputes the accuracy and fairness of Mr. Kern’s report.” (Resp. to Northwestern’s Statement of Material Facts (“SMFO”) ¶ 8 [ECF No. 71]).

Also prior to discontinuing Kafie’s benefits, Northwestern requested that Dr. Marilyn Kay (“Kay”), a neuro-ophthalmologist, conduct a review of medical records from Kafie’s physicians. (See SMF ¶ 9 (citing Oct. 30, 2008 Letter [ECF No. 65-5]; Dec. 1, 2008 Letter [ECF No. 65-6])). Kafie disputes the “independence]” of Kay’s review. (SMFO ¶ 9). Kay wrote in her evaluation that since Kafie’s “visual fields are normal[;] there’s no need for him to be visually limited or have any restrictions on activities. With his normal visual fields there’s absolutely no reason for him to be prohibited from driving.” (Dec. 1, 2008 Letter 2). Kay wrote that in her opinion,

Kafie has had stable mild central serous chorioretinopathy which was stable even as far back as November 2007 and certainly there’s no evidence of activity in subsequent examinations. His normal visual fields of September 2008 combined with normal visual acuity at near in July 2008 suggests that his visual functioning is quite excellent.

(Id. 3). Northwestern also requested a third-party surveillance report of Kafie’s [1358]*1358activities during a several-day period. (See SMF ¶ 10 (citing Spectrum Report [ECF No.

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834 F. Supp. 2d 1354, 2011 U.S. Dist. LEXIS 138956, 2011 WL 6025867, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kafie-v-northwestern-mutual-life-insurance-flsd-2011.