Kaufman v. Provident Life & Casualty Insurance

828 F. Supp. 275, 1992 U.S. Dist. LEXIS 21680, 1992 WL 519125
CourtDistrict Court, D. New Jersey
DecidedJune 15, 1992
DocketCiv. A. 91-4339 (AJL)
StatusPublished
Cited by56 cases

This text of 828 F. Supp. 275 (Kaufman v. Provident Life & Casualty Insurance) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kaufman v. Provident Life & Casualty Insurance, 828 F. Supp. 275, 1992 U.S. Dist. LEXIS 21680, 1992 WL 519125 (D.N.J. 1992).

Opinion

OPINION

LECHNER, District Judge.

This is a breach of contract action brought by plaintiff Jeffrey I. Kaufman (“Kaufman”) against defendant Provident Life & Casualty Insurance Company (“Provident”). Jurisdiction appears to be appropriate pursuant to 28 U.S.C. § 1332 1 and the Declaratory Judgment Act, 28 U.S.C. § 2201, et seq.

Provident moves for summary judgment pursuant to Fed.R.Civ.P. 56. It maintains *277 there are no genuine issues of material fact. 2 For the reasons stated below, summary judgment is granted. Facts

Employment and Business Background

Kaufman, born 1 May 1945, is forty-seven years old. Kaufman Appendix, Exhibit A (“Kaufman Dep.”) at 6. He resides in Englewood, New Jersey. Complaint, ¶ 1. In 1980 Kaufman and Dr. Robert C. Morstein (“Morstein”) formed two companies, Eyexam 21, P.A. (“Eyexam 21”) and Contact Lens 21 (“Lens 21”). Kaufman 12(G) Statement, ¶ 7. Kaufman and Morstein are both officers and fifty percent owners of the companies. Id.

Kaufman’s and Morstein’s first Eyexam 21 store is located on Route 4 in Paramus, New Jersey. Kaufman Dep. at 17. Eyexam 21 leases space from Eyelab (“Eyelab”), a vision superstore owned by Robert Hillman and Larry Kohan. Kaufman 12(G) Statement, ¶¶ 8, 10. Eyexam 21 was Eyelab’s exclusive agent. Kaufman Dep. at 21. Consequently, whenever Eyelab expanded to a new location, Eyexam opened a new store. Id. As a result of the exclusive agency relationship, Eyexam 21 holds the leases to various Eye-labs. Id. In turn, Eyexam 21 subleases space to different optometrists. Id. at 22. Since its formation, Eyexam 21 has had stores at twenty-four Eyelab locations. Id. at 21.

Lens 21, the second company owned by Kaufman and Morstein, is a buying company. Id., ¶ 9. As a buying company, Lens 21 purchases contact lenses and other contact lens materials. Id. It in turn sells these products to Eyexam 21 stores. Id. Lens 21 also acts as the staffing company for Eyexam 21 stores. Id., ¶ 11. Lens 21 further maintains the books and records for Eyexam 21 stores and obtains leases for Eyexam 21 stores. Id.

Kaufman is the President and Chief Executive Officer (“CEO”) of Lens 21. Id., ¶ 12. While in these capacities, Kaufman has duties and responsibilities of reviewing sales figures, reviewing profit and loss statements and dealing with different vendors. Kaufman Dep. at 27, 31. Kaufman calls these functions, management responsibilities. Id. at 31.

Before January 1990, Kaufman’s management responsibilities also required him to travel about once every three weeks to various facilities. Id. at 29. On his visits Kaufman ensured that the optometrisl/tenant in that location was one Kaufman wanted, that the optometrist/tenant’s stock of lenses was the type Lens 21 desired, that the optometrist/tenant ran his practice in a professional manner and that the optometrist/tenant had a sufficient number of employees to handle the patient flow. Id. at 28. Morstein and three other people at Lens 21 assisted in performing these traveling functions. Id. When not traveling, Kaufman focused on his other management responsibilities. Id. at 31.

In addition to being the President and CEO of Lens 21, Kaufman was an optometrist until April 1991. Id. at 33, 129, 131. His practice as an optometrist was centered at the Eyelab located in Paramus, New Jersey. Id. As an optometrist, he saw patients. Id. at 33, 35. On average he estimated he practiced optometry twenty-five to thirty hours a week. Id. at 33.

*278 Total Disability Insurance Policy

On 23 August 1989, Kaufman applied for a total disability income policy with Provident. Kaufinan Dep. at 52; Provident Appendix, Ex. C., at 11. Provident is authorized by the Department of Insurance of the State of New Jersey to issue total disability policies. Complaint, ¶ 2. On 21 November 1989, Provident issued to Kaufinan a total disability income policy, number 36-335-6017593 (the “Policy”). Kaufinan Dep. at 61. Under the terms and conditions of the Policy, Kaufinan will receive total disability benefits if he provides proof that his disability occurred when the Policy was in full force and effect, that his disability lasted beyond the one hundred and eighty day elimination period, 3 and that he is totally disabled 4 from his occupation. 5 Movant’s 12(G) Statement, ¶ 2. If Kaufman meets these conditions, his benefits accrue for life in the sum of $15,000 per month. Id; Complaint, ¶3. At the time Kaufinan entered this insurance contract, his occupation was that of President and CEO of Lens 21 and an optometrist.

Kaufman’s Illness

In January 1990, about a month after receiving the Policy, Kaufinan discovered a lump on his neck. Kaufman Dep. at 97; Kaufman 12(G) Statement, ¶ 15. He was initially treated by Gerson Grotberg, M.D. (“Dr. Grotberg”), an internist. Id Dr. Grotberg ordered a sonogram and an x-ray on Kaufman. Id Dr. Grotberg referred Kaufman to Edward Meyers, M.D. (“Dr. Meyers”), an otolaryngologist; Dr. Meyers referred Kaufman to Miguel Sanchez, M.D. (“Dr. Sanchez”), a pathologist at the Englewood Hospital. Id Dr. Sanchez performed a fine needle aspiration on Kaufman. Id After this procedure, Dr. Meyers diagnosed Kaufinan as suffering from thyroid cancer and recommended surgery. Id; Movant’s 12(G) Statement, ¶ 5. Kaufman consulted with surgeons, Hugh Biller, M.D. and Carl Feind, M.D. (“Dr. Feind”) about the recommended surgery. Kaufinan 12(G) Statement, ¶ 15.

In February 1990, Dr. Feind performed a partial thyroidectomy and a lymphectomy on Kaufinan. Id The surgery was performed at Columbia Presbyterian'Hospital in New York City. Id The morning after the surgery, Dr. Feind told Kaufman the lump was not malignant. Id To compensate for the partial loss of the thyroid, Kaufinan had to take the artificial thyroid medication, Synthyroid. Id At the two week post-operative check up, Dr. Feind told Kaufman the lump was malignant and was comprised of two types of cancers, follicular and papillary carcinomas. Id, ¶ 16. These cancers had metastasized at least to his first lymph node. Id

Dr.

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Bluebook (online)
828 F. Supp. 275, 1992 U.S. Dist. LEXIS 21680, 1992 WL 519125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaufman-v-provident-life-casualty-insurance-njd-1992.