Leitzes v. Provident Life & Accident Insurance

379 F. Supp. 2d 15, 2005 U.S. Dist. LEXIS 11757, 2005 WL 1405999
CourtDistrict Court, D. Massachusetts
DecidedMay 24, 2005
DocketCIV.A.03-12170-NMG
StatusPublished
Cited by1 cases

This text of 379 F. Supp. 2d 15 (Leitzes v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Leitzes v. Provident Life & Accident Insurance, 379 F. Supp. 2d 15, 2005 U.S. Dist. LEXIS 11757, 2005 WL 1405999 (D. Mass. 2005).

Opinion

MEMORANDUM & ORDER

GORTON, District Judge.

In this case, plaintiff, Stanley M. Leitzes, M.D. (“Leitzes”), seeks to recover *16 lifetime disability benefits pursuant to two insurance policies issued by defendant, Provident Life and Accident Insurance Company (“Provident”), and brings claims for declaratory judgment and breach of contract. Before the Court is Provident’s motion for summary judgment with respect to claims under Policy No. 6PC-423865. 1

I. Factual Background

The facts of this case that relate to defendant’s motion for partial summary judgment are undisputed. Leitzes is a licensed physician who specializes in orthopedics and, at least until September, 1999, performed orthopedic surgeries and conducted office visits with patients. In May, 1980, Provident issued an Accident and Sickness Policy to Leitzes, which was assigned Policy No. 6PC-423865 and later changed to Policy No. 33CM23865 (“the Policy”). Leitzes has made payments due under the Policy and it is still in force.

The Policy provides for monthly benefit payments in the event the insured is rendered totally disabled. Before a claimant reaches age 65 or for the first five years of his disability, “total disability” is defined as “your inability to perform the duties of your occupation.” After that time, “total disability” is defined as

your inability to engage in any gainful occupation in which you might reasonably be expected to engage because of education, training or experience, and with due regard to your vocation and earnings at the beginning of disability.

On October 28, 2000, Leitzes submitted a claim for disability benefits under the Policy, claiming that he was rendered totally disabled as a result of a disc herniation. Provident approved his claim for benefits and began paying them under the Policy retroactive to September 6, 1999.

Leitzes reached age 65 on January 8, 2005. Provident contends that because he received benefits under the Policy for at least 5 years and is now over 65 years old, he does not meet the Policy’s definition of “totally disabled” and, therefore, it need not continue to pay benefits to him under the Policy.

It is undisputed that Leitzes continues to work in a capacity similar to that in which he worked prior to his becoming disabled. The only proffered distinction between Leitzes’s pre and post-disability practice is that he used to spend approximately 40% of his time performing surgeries whereas now, because he is unable to perform any surgeries, his entire practice is limited to office visits. Leitzes maintains an office-based orthopedic practice, seeing patients in an office at Bridgewater Goddard Park Medical Associates (“BGPMA”), and earns a salary of approximately $150,000 per year. He handled over 3,200 office visits between January and October, 2004. At Leitzes’s deposition, he testified that he works three full days each week at BGPMA, has no plans to leave that position and feels healthy enough to continue working in that capacity-

Provident contends that Leitzes’s continuing employment demonstrates that he is not unable to “engage in any gainful occupation” and, therefore, he is not entitled to continued disability benefits under the Policy. While Leitzes admits that he continues to work by conducting office visits, he focuses on the requirement that the *17 evaluation of a claimant’s alleged total disability be evaluated in light of many factors, such as a claimant’s training, experience and vocation, and contends that these factors make the question of his total disability an issue of fact for a jury. Leitzes argues that the definition of total disability is either subjective or inherently ambiguous.

III. Discussion

A. Standard of Review

The role of summary judgment is “to pierce the pleadings and to assess the proof in order to see whether there is a genuine need for trial.” Mesnick v. Gen. Elec. Co., 950 F.2d 816, 822 (1st Cir.1991) (quoting Garside v. Osco Drug, Inc., 895 F.2d 46, 50 (1st Cir.1990)). The burden is upon the moving party to show, based upon the pleadings, discovery and affidavits, “that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed.R.Civ.P. 56(c).

A fact is material if it “might affect the outcome of the suit under the governing law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). “Factual disputes that are irrelevant or unnecessary will not be counted.” Id. A genuine issue of material fact exists where the evidence with respect to the material fact in dispute “is such that a reasonable jury could return a verdict for the nonmoving party.” Id.

Once the moving party has satisfied its burden, the burden shifts to the non-moving party to set forth specific facts showing that there is a genuine, triable issue. Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The Court must view the entire record in the light most hospitable to the non-moving party and indulge all reasonable inferences in that party’s favor. O’Connor v. Steeves, 994 F.2d 905, 907 (1st Cir.1993). If, after viewing the record in the non-moving party’s favor, the Court determines that no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law, summary judgment is appropriate.

B. Analysis

The undisputed facts of this case make clear that there is no way a jury could rationally find Leitzes to be “totally disabled” as thát term is defined in the Policy. His ability to engage in a qualifying occupation is demonstrated by the fact that he is currently engaging in such an occupation and has done so since the time he became disabled. His present occupation is gainful, earning him at least $150,000 per year, and it is reasonable to expect him to engage in such a practice because he is educated, trained, experienced and licensed as a doctor. Furthermore, he is engaging in the very same vocation in which he had engaged prior to his disability, although his practice no longer includes surgery, one element of being an orthopedic doctor, as it did before he became disabled.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

ACADIA INSURANCE CO. v. Cunningham
771 F. Supp. 2d 172 (D. Massachusetts, 2011)

Cite This Page — Counsel Stack

Bluebook (online)
379 F. Supp. 2d 15, 2005 U.S. Dist. LEXIS 11757, 2005 WL 1405999, Counsel Stack Legal Research, https://law.counselstack.com/opinion/leitzes-v-provident-life-accident-insurance-mad-2005.