Mark Hofkin v. Provident Life & Accident Insurance Company

81 F.3d 365, 1996 U.S. App. LEXIS 7994, 1996 WL 173515
CourtCourt of Appeals for the Third Circuit
DecidedApril 15, 1996
Docket95-1608
StatusPublished
Cited by43 cases

This text of 81 F.3d 365 (Mark Hofkin v. Provident Life & Accident Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Third Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mark Hofkin v. Provident Life & Accident Insurance Company, 81 F.3d 365, 1996 U.S. App. LEXIS 7994, 1996 WL 173515 (3d Cir. 1996).

Opinion

OPINION OF THE COURT

COWEN, Circuit Judge.

In this diversity action we are called upon to interpret the meaning of insurance policy language that a state statute requires to be included in all Pennsylvania insurance contracts. Plaintiff-appellant Mark Hofkin contends that language in the “Proofs of Loss” and “Legal Actions” clauses in his accident and sickness insurance policy require only that he submit adequate proofs of loss within ninety days after the termination of a continuous period of disability. Defendant-appel-lee Provident Life & Accident Insurance Company (“Provident”) argues that it properly denied Hofkin’s claims because the policy language, considered as a whole, requires the insured to submit monthly proofs of loss in order to be eligible to receive disability benefits.

Provident filed a motion to dismiss pursuant to Rule 50 of the Federal Rules of Civil Procedure on statute of limitations grounds. The district court, citing policy considerations that underlie suit limitations provisions, granted Provident’s motion to dismiss. In so doing, the district court declined to follow the majority of state and federal courts that have interpreted identical policy language to require only that a claimant submit adequate proofs of loss within ninety days after an uninterrupted aggregate period of disability covered by the policy.

The language contained in the Provident policy is essentially a verbatim recitation of the terms of the Pennsylvania statute we must interpret. The Pennsylvania courts have not addressed the issue as to when proofs of loss are required to be filed in cases involving a continuous period of disability. We predict that the Pennsylvania Supreme Court would elect to follow the majority of courts that have interpreted the phrase “period for which the insurer is liable” to require the insured to submit proofs of loss within ninety days after the termination of a continuous period of disability, rather than on a monthly basis during the entire period of disability.

Under our interpretation of the policy language, an issue of fact remains as to whether Hofkin was totally disabled for the continuous period of time that he has alleged. As such, the order of the district court granting Provident’s Rule 50 motion to dismiss will be reversed and the matter remanded for further proceedings. As to the other issues raised on this appeal, we will affirm the district court’s rejection of Hofkin’s argument that his claims were denied in bad faith. The district court’s denial of Hofkin’s application to amend his complaint will also be affirmed.

I.

Mark Hofkin was insured by Provident under an accident and sickness policy that took effect in July of 1980. At that time, Hofkin was the sole proprietor of a heating and air conditioning installation company. On March 13, 1986, Hofkin was involved in an automobile accident in which he injured his neck, back, left wrist and elbow. Hofkin contends that he has never recovered fully from the injuries he sustained in this accident.

On September 13, 1986, Hofkin had his attorney submit to Provident a supplementary statement of claim form. On this form, *368 Hofkin indicated that he had been totally disabled 1 from March 13,1986 through June 16,1986. Hofkin also contended that he was partially disabled from June 17 up until the time he submitted his claim form in September. On September 16, 1986, Provident paid Hofkin $6,760.00 for the time he was totally disabled in the months immediately following the accident. In addition to the cash payment, Provident also sent Hofkin a claim form that he was required to complete in order to be eligible to receive residual disability benefits. 2

On January 19, 1987, Hofkin submitted an application for residual disability benefits, alleging that he had been unable to work full time since June of 1986. Hofkin failed, however, to include necessary details as to the amount of income he had lost as a consequence of the March 1986 accident. In a letter dated January 23, 1987, a Provident claims representative responded by sending Hofkin a letter requesting the additional information he would be required to provide in order to be eligible to receive any residual disability benefits.

In March of 1987, Hofkin submitted a statement of claim for residual disability benefits, a supplementary statement of claim, an accountant’s report and a 1985 tax return. Again, specific financial information as to Hofkin’s alleged loss of income, which was required to calculate residual disability benefits, was omitted. Within a week, a Provident representative contacted Hofkin’s attorney and reiterated the insurer’s need for more complete information. Hofkin responded on April 29, 1987, with a revised claim form for residual- benefits, simply stating “None” where he was asked to indicate his present income. On June 25, 1987, Provident sent yet another letter to Hofkin requesting further documentation of his alleged reduction of income and additional information regarding the extent to which his business activities had been curtailed.

On March 8, 1990, after almost a three-year gap in communication between Hofkin and Provident, Hofkin’s counsel again wrote to Provident requesting additional claims forms. Although Provident supplied the forms, Hofkin never completed them. Additional proofs of loss were sent to Provident only after the onset of litigation. On March 12,1993, June 17,1993, June 30,1993, March 7,1994, and March 10,1994, Hofkin provided supplementary proofs of loss in support of his claim for total disability benefits.

Hofkin’s attorney filed a writ of summons in the Court of Common Pleas of Philadelphia County in January of 1993. In March of 1993, this matter was removed to the District Court for the Eastern District of Pennsylvania. Hofkin asserted the following claims in his district court complaint: (1) he is entitled to total disability benefits from June of 1986 until the present; (2) in the alternative, he is entitled to residual disability benefits from June of 1986, until the present; and (3) Provident has acted in “bad faith” under 42 Pa. Cons.Stat.Ann. § 8371 by refusing to pay Hofkin’s claims and failing to inform him of his alleged eligibility for total disability benefits at a much earlier date.

Hofkin filed a motion for leave to file an amended complaint which was denied. On December 1,1994, after a four day jury trial, the district court granted Provident’s motion for judgment as a matter of law on the basis of the Legal Actions clause contained in the Provident policy. Hofkin then filed a motion to vacate the judgment as a matter of law, a motion for a new trial, and requested leave to file an amended complaint pursuant to Fed.R.Civ.P. 59. By order dated June 30, 1995, the district court denied Hofkin’s post-judgment motions. This appeal followed.

*369 II.

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

Related

Sayegh v. Unum Group
S.D. New York, 2022
Petron Scientech Inc v. Ronald Zapletal
701 F. App'x 138 (Third Circuit, 2017)
Gray v. United of Omaha Life Insurance Co.
251 F. Supp. 3d 1317 (C.D. California, 2017)
Haase v. Metropolitan Life Insurance Co.
198 F. Supp. 3d 412 (E.D. Pennsylvania, 2016)
Ralph Leporace v. New York Life and Annuity
619 F. App'x 172 (Third Circuit, 2015)
Cordance Corp. v. Amazon. Com, Inc.
658 F.3d 1330 (Federal Circuit, 2011)
Harmond Schaefer v. AXA Equitable Life Insurance Co
345 F. App'x 87 (Sixth Circuit, 2009)
Knoepfler v. Guardian Life Insurance Co. of America
438 F.3d 287 (Third Circuit, 2006)
Williams v. Meyers
165 F. App'x 201 (Third Circuit, 2006)
Harris v. Prudential Insurance Co. of America
93 F. App'x 139 (Ninth Circuit, 2004)
R.W. Sidley, Inc. v. United States Fidelity & Guaranty Co.
319 F. Supp. 2d 554 (W.D. Pennsylvania, 2004)
Moussa v. Pennsylvania Department of Public Welfare
289 F. Supp. 2d 639 (W.D. Pennsylvania, 2003)
Furleigh v. Allied Group Inc.
281 F. Supp. 2d 952 (N.D. Iowa, 2003)
Jurimex Kommerz Transit v. Case Corp.
65 F. App'x 803 (Third Circuit, 2003)
Lang v. Continental Assurance Co.
54 F. App'x 72 (Third Circuit, 2002)
McLaughlin v. UNUM Life Insurance Co. of America
224 F. Supp. 2d 283 (D. Maine, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
81 F.3d 365, 1996 U.S. App. LEXIS 7994, 1996 WL 173515, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mark-hofkin-v-provident-life-accident-insurance-company-ca3-1996.