McCulloch v. Hartford Life & Accident Insurance

363 F. Supp. 2d 169, 2005 U.S. Dist. LEXIS 5065, 2005 WL 730209
CourtDistrict Court, D. Connecticut
DecidedMarch 28, 2005
Docket3:01 CV 1115(AHN)
StatusPublished
Cited by30 cases

This text of 363 F. Supp. 2d 169 (McCulloch v. Hartford Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McCulloch v. Hartford Life & Accident Insurance, 363 F. Supp. 2d 169, 2005 U.S. Dist. LEXIS 5065, 2005 WL 730209 (D. Conn. 2005).

Opinion

OMNIBUS RULING ON PENDING SUMMARY JUDGMENT MOTIONS

.NEVAS, District Judge.

Plaintiff Candi McCulloch (“McCulloch”) commenced this action against Hartford Life Insurance Company (“Hartford”) and Educators Mutual Life Insurance Company (“Educators”), alleging breach of contract, bad faith, tortious interference with contractual relations, and statutory violations under the Connecticut Unfair Trade Practices Act (“CUTPA”), Conn. Gen.Stat. § 42-110b, and the Connecticut Unfair Insurance Practices Act (“CUIPA”), Conn. Gen.Stat. § 38a-816.

Pending before the court are: 1) Hartford’s motion for partial summary judgment; 2) Educator’s motion for summary *173 judgment; 3) McCulloch’s motion for summary judgment motion as to Hartford’s counterclaim; 4) McCulloch’s motion for summary judgment motion on her claim against Educators. For the following reasons, Hartford’s motion as to McCulloch [doc. # 136] is granted; Educators’s motion as to McCulloch [doc. # 133] is granted in part and denied in part; McCulloch’s motion as to Hartford’s counterclaim is denied [doc. # 183]; McCulloch’s motion as to Educators is denied [doc. # 186].

FACTS

Based on its review of the summary judgment record, the court finds the following material facts are not in dispute:

McCulloch is a physician with a specialty in internal medicine. Prior to becoming disabled, she worked 16 hours per week practicing medicine as an internist and 30 hours per week as the administrative director at a women’s clinic in Florida.

In September 1994, McCulloch purchased disability insurance from Educators under a group plan through the American College of Physicians (“ACP”). Under the policy, McCulloch was entitled to long-term disability benefits of $7,000 per month if she, among other things, became unable to perform the substantial duties of her occupation as they existed at the time a disability began. McCulloch also purchased a disability insurance policy from Unum Life Insurance Company (“Unum”).

In October 1995, McCulloch stopped working due to chronic shoulder and neck pain caused by a February 1995 skiing accident. She applied for long-term disability benefits under both the Educators and Unum policies. Unum denied McCul-loch’s claim but Educators accepted it.

Three provisions of the Educators policy are pertinent here. First, McCulloch was entitled to receive long term disability benefits so long as she remained totally disabled 1 and was under 65 years of age. Second, the policy’s “PROOF OF LOSS” provision requires McCulloch to provide “[l]ater proofs of the continuance of [her] disability ... at such intervals as [Educators] ... reasonably require[d].” Third, the policy’s “EXAMINATION” provision gives Educators “the right to examine, at [its] own expense, any person whose injury ... is the basis of a claim ... when and as often as it may [be] reasonably require[d] while a claim is pending.” Pursuant to those provisions, McCulloch continually submitted evidence to Educators showing that she remained disabled, including attending physician statements, independent medical evaluations, and independent medical reviews.

On April 15, 1997, the ACP terminated its relationship with Educators. As a result, Educators stopped underwriting and accepting premiums for professional disability policies. Nonetheless, it continued to administer the open ACP disability claims which, including McCulloch’s, numbered approximately 35.

In July or August of 1999, Educators assigned the open ACP claims to Hartford in a document titled “Reinsurance Agreement.” In addition, Educators transferred approximately $30 million of reserve funds to Hartford in exchange for an undisclosed amount of money. Under the terms of the reinsurance agreement, Hartford would administer and make benefit payments on *174 the open claims from the statutory reserves that had been set aside for them. However, if the total amount of benefits to which all the claimants were entitled exceeded the total amount of reserves, Hartford would be liable for the excess amount. Conversely, if the total amount of benefit payments was less than the total amount of reserves for all the open claims, Hartford would retain the balance. 2 Approximately $1.3 million dollars in statutory reserves were transferred to Hartford for McCulloch’s claim.

Following the execution of the reinsurance agreement, both Educators and Hartford informed McCulloch and the approximately 35 other claimants whose claims were subject to the agreement that Hartford would be administering their disability claims. In its letter to McCulloch, Educators explained that it would continue to pay her benefits until October 31, 1999, and that after that date, benefit payments and correspondence would be “[ajdminis-tered by Hartford on Behalf of Educators Mutual Life Co.”

Sometime in November or December 1999, a claims examiner at Hartford, Susan Wilk (“Wilk”), reviewed McCulloch’s disability claim. On December 15, 1999, Wilk requested McCulloch to provide an up-to-date attending physician statement (“APS”), complete both a claimant ques-tionaire and a personal profile evaluation, and authorize Hartford to obtain medical information from her doctors. On January 19, 2000, Wilk received the authorization and claimant questionaire from McCulloch, but not the physician statement or personal profile.

In the claimant questionaire, McCulloch described her condition as “chronic pain from neck pathology [with] ... herniation at C5-C6.” She stated that the “pain affects every aspect of my life [and] ... makes me unable to perform the duties of my specialty of internal medicine [and] ... restricts me in all activities.” McCulloch also provided a list of the medical-care providers that she had consulted in the previous 18 months, including her primary care physician, Dr. Carine Porfiri (“Dr.Porfiri”); a neurosurgeon, Dr. Beverly Walters (“Dr.Walters”); and a chiropractor, Bruce Coulombe (“Coulombe”).

On January 28, 2000, Wilk telephoned McCulloch and requested a copy of McCul-loch’s driver’s license to clear up uncertainty as to her date of birth. Wilk did not receive the information and renewed her request two more times, again without a response from McCulloch until April 25, 2000.

On February 2, 2000, Wilk received an APS from Dr. Porfiri stating that McCul-loch suffered from chronic pain, a herniated cervical disc, TMJ, and migraine headaches. Dr. Porfiri concluded that McCulloch could not perform the material *175 duties of her profession, and indicated that she had last seen McCulloch on November 19, 1999. However, when Wilk contacted Dr. Porfiri’s office by telephone, she was told that McCulloch had not visited the office since 1997. Wilk also contacted Unum, McCulloch’s other disability insurance company, to inquire why it had denied her claim. 3

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363 F. Supp. 2d 169, 2005 U.S. Dist. LEXIS 5065, 2005 WL 730209, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcculloch-v-hartford-life-accident-insurance-ctd-2005.