Lane v. Provident Life & Accident Insurance

178 F. Supp. 2d 1281, 2001 U.S. Dist. LEXIS 21558, 2001 WL 1669380
CourtDistrict Court, S.D. Florida
DecidedMay 3, 2001
Docket99-2272-CIV-MOORE
StatusPublished
Cited by4 cases

This text of 178 F. Supp. 2d 1281 (Lane v. Provident Life & Accident 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
Lane v. Provident Life & Accident Insurance, 178 F. Supp. 2d 1281, 2001 U.S. Dist. LEXIS 21558, 2001 WL 1669380 (S.D. Fla. 2001).

Opinion

*1283 ORDER

MOORE, District Judge.

THIS CAUSE came before the Court upon the parties’ cross motions for summary final judgment (DE # 119 and 127).

UPON CONSIDERATION of the motion, responses, materials submitted, the pertinent portions of the record, and being otherwise fully advised in the premises, the Court enters the following Order.

A. Background

This is a dispute over whether the Plaintiff, Frank A. Lane, is entitled to disability insurance benefits from the Defendant, Provident Life and Accident Insurance Company. Mr. Lane alleges in his summary judgment motion that he was “totally disabled” under the definition of the policy from about October 1995 through June 1997 and is therefore entitled to disability benefits and a refund of premiums for that time period. Provident argues in its summary judgment motion that Lane is not entitled to the disability benefits because his claim was untimely filed and he failed to carry his burden of proof in showing that Provident was not prejudiced by his delay. In his opposition to Provident’s summary judgment motion, Mr. Lane counters that Provident was not prejudiced by the untimeliness and that Provident waived or is estopped from contesting his entitlement to the disability benefits because of its alleged delays in processing his claim.

Provident’s summary judgment motion must be granted and Lane’s motion denied because (1) evidence either provided by Lane or not contested by him conclusively shows that his claim was untimely filed, (2) Lane failed to produce any evidence capable of showing that Provident was not prejudiced by his untimeliness, and (3) Lane has provided the Court with no valid legal or evidentiary basis for his waiver/es-toppel theory.

B. Undisputed Facts

Lane applied to Provident for disability coverage in March of 1990. Provident then issued Lane a disability income policy with an effective date of June 1, 1990. The policy contains the following provisions regarding the filing of claims:

NOTICE OF CLAIM

Written notice of claim must be given within 20 days after a covered loss starts or as soon as reasonably possible....

CLAIM FORMS

When we receive your notice of claim, we will send you claim forms for filing proof of loss. If these forms are not given to you within 15 days, you will meet the proof of loss requirements by giving us a written statement of the nature and extent of your loss. You must give us this proof within the time set forth in the Proof of Loss section.

PROOF OF LOSS

If the policy provides for periodic payment for a continuing loss, you must give us written proof of loss within 90 days after the end of each period for which we are liable. For any other loss, written proof must be given within 90 days after such loss.
If it was not reasonably possible for you to give written proof in the time required, we will not reduce or deny the claim for this reason if the proof is filed as soon as reasonably possible. In any event the proof must be furnished no later than one year after the 90 days unless you are legally unable to do so. 1

*1284 In October of 1995, Lane first visited a dermatologist, Dr. Cosmides, about severe itching he was experiencing. 2 Dr. Cos-mides diagnosed the pruritus (itching) as Grover’s Disease at Lane’s next visit on January 19, 1996. 3 Lane did not visit Dr. Cosmides again until February 10, 1997 (almost thirteen months later), and was found still to be suffering from Grover’s Disease. 4 At Lane’s subsequent and last visit on June 10, 1997, Dr. Cosmides found Lane’s condition to be resolved. 5

It was March 21, 1997 that Lane first sent Provident notification that he would be filing a disability claim, and requested all claim forms necessary to perfect the claim. 6 On May 5, 1997, Lane submitted the Notice of Claim form, Addendum to Claim Form, and the Insured’s Statement of Claim form, which had been sent to him by Provident. 7 Lane also submitted authorization forms on May 5, but he altered them by crossing out a sentence and adding a sentence regarding the confidentiality of the information gathered by Provident. Lane did not include an “Attending Physician Statement” in his May 5 submissions. He also indicated that he did not complete the “Attorney’s Questionnaire” because he believed that he should have received a “trial lawyer” questionnaire.

Finally, in the May 5 submissions Lane also attached two addendums, providing an explanation of several of the questions in the Insured’s Statement of Claim form. In response to the questions asking for a description of his current impairment, the date he last worked, the date he first sought treatment, the dates of total and complete inability to work, and when he first returned to work or when he expected to, he indicated that he first noticed his symptoms in 1995, “as the summer progressed into fall.” He also indicated that Dr. Cosmides later determined that Lane’s itching was caused by Grover’s Disease, but did not include the date of that diagnosis. Lane concluded the addendum by explaining, “It is difficult therefore to answer the above question specifically as to a specific time or date. I hope therefore that this narrative will fully answer the questions presented on your form.”

On May 15, 1997 Provident sent correspondence to Lane, indicating that it could not process his claim without a completed Attending Physician Statement and an unaltered authorization form. 8 On June 25, 1997, Provident received an “Attending Physician’s Statement” signed by Dr. James Cosmides on May 22, 1997. 9 In response to the directive, “indicate the date restrictions or limitations, if any, began,” Dr. Cosmides wrote, “NA.” After “Remarks or additional comments” he wrote, “This can be an extremely uncomfortable disorder — would be difficult for a patient to perform in public for long periods.” 10

*1285 On July 10, 1997, Provident sent correspondence to Lane indicating that it had received the Attending Physician Statement, but that Dr. Cosmides did not include the exact date Lane became disabled. Provident, therefore, requested an unaltered authorization form so that it could ascertain the date from Dr. Cos-mides’ records. 11

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Cite This Page — Counsel Stack

Bluebook (online)
178 F. Supp. 2d 1281, 2001 U.S. Dist. LEXIS 21558, 2001 WL 1669380, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lane-v-provident-life-accident-insurance-flsd-2001.