McMurtry v. Paul Revere Life Insurance

67 F. App'x 290
CourtCourt of Appeals for the Sixth Circuit
DecidedMay 28, 2003
DocketNo. 01-6579
StatusPublished
Cited by3 cases

This text of 67 F. App'x 290 (McMurtry v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McMurtry v. Paul Revere Life Insurance, 67 F. App'x 290 (6th Cir. 2003).

Opinion

PER CURIAM.

Plaintiff Cecil McMurtry appeals from the order of the district court granting summary judgment to Defendant The Paul Revere Life Insurance Co. as to McMurtry’s estoppel claim in this ERISA action. Because the issues raised in this appeal following remand are beyond the scope of our previous mandate and are contrary to the law of the case, the judgment of the district court is AFFIRMED.

I.

This case arises out of a disability insurance policy issued to McMurtry, a physician, by Paul Revere.1 Under the policy, an insured is entitled to total disability benefits if he is unable to perform the “important duties” of his “regular occupation,” is not engaged “in any gainful occupation,” and is “under the regular and personal care of a Physician.” The policy also provides that an insured is entitled to lifetime total disability benefits if the total disability is due to “injury.” If the disability is due to “sickness,” the benefits end at age 65. Residual disability benefits are generally not paid beyond age 65, and proof of loss of income is necessary to recover these benefits.

In 1989, McMurtry purchased a “rider” to his disability insurance policy. The rider to the policy redefines “total disability” as simply that the insured is “unable to perform the important duties of your regular occupation,” and that the insured is “under the regular and personal care of a Physician.” Thus, the rider had the effect of amending the basic policy’s definition of “total disability” to eliminate the basic policy’s “[n]o other gainful occupation” limitation. The basic policy defined the “maximum benefit period” as “the longest period of time We will pay benefits during any continuous period of Disability. It is shown on the Policy Schedule.” The rider also contained a temporal limitation, stating that the rider would end “[w]hen the Policy ends; or [o]n the first premium due date after Your 65th birthday: whichever happens first.” Thus, the rider permitted McMurtry to work at some “other gainful occupation” and still collect total disability [292]*292benefits until he turned 65 or until the underlying basic policy ended.

McMurtry’s second amended complaint sought past and future benefits, pursuant to 29 U.S.C. § 1132(a)(1)(B); injunctive relief against Paul Revere, pursuant to 29 U.S.C. § 1132(a)(3); estoppel, pursuant to 29 U.S.C. § 1132(a)(3)(B); and attorney fees, pursuant to 29 U.S.C. § 1132(g)(1). In its original ruling, the district court granted McMurtry’s motion for summary judgment and denied Paul Revere’s. The district court held that McMurtry was entitled to lifetime total disability benefits, attorney fees, and prejudgment interest. Specifically, the district court held that despite McMurtry’s continued employment as a physician, after a disabling injury and after he turned 65, he was entitled, under the rider, to “total disability” benefits for life.

Both parties appealed. Significantly, McMurtry raised the estoppel issue. (Brief of Plaintiff-Appellee/Cross-Appellant Cecil McMurtry, M.D., pp. 2-7, 41).

On appeal and cross-appeal we held that McMurtry was entitled to total disability benefits prior to his 65th birthday, but that he was not entitled to lifetime total disability benefits awarded by the district court because he did not meet the definition of total disability as provided in the controlling policy language. We reasoned that “[w]hen the rider, with its modified definition of ‘total disability,’ expired upon the plaintiffs 65th birthday, the original definition of ‘total disability’ was reinstated requiring the plaintiff to meet the ‘original,’ stricter definition of ‘total disability.’ ” Thus, under the definition of “total disability” in the original policy, no longer subject to the rider, an insured may not be “engaged in any other gainful occupation.” Since McMurtry admittedly continued to work as a physician, he was clearly engaged in a form of “gainful occupation.” We therefore held that he was not entitled to total disability benefits under the plain language of the policy, and reversed the district court’s order granting benefits to McMurtry beyond age 65.

We further held that McMurtry was entitled to attorney fees, but only to the extent that he “prevailed” in establishing his entitlement to total disability benefits prior to his 65th birthday. We remanded to the district court “for a decision whether, given our disposition of the issues on appeal, it is the plaintiff or the defendant who has ‘prevailed.’ ” Lastly, we held that the district court did not abuse its discretion in setting the prejudgment interest rate at 5.413%, the federal statutory post-judgment rate.

McMurtry petitioned for rehearing, raising the estoppel issue. (Petition for Panel Rehearing of Plaintiff-Appellee/Cross-Appellant Cecil McMurtry, M.D., pp. 11-13). Specifically, McMurtry asserted that “[t]he Court’s opinion limits the remand to ‘a redetermination of the attorney’s fee question in a manner consistent with this opinion.” ’ The panel denied the petition.

Following the issuance of our mandate, the district court remarked that “[o]n remand from the Sixth Circuit Court of Appeals, this Court now faces a number of issues: (1) whether Plaintiff was a prevailing party and is entitled to attorney’s fees under ERISA; and (2) whether Plaintiff may proceed with his estoppel claim.” Memorandum Opinion dated April 9, 2001, at 1. Before turning to an analysis of the issues presented on remand, the district court stated:

[T]he Court will briefly summarize its understanding of the current procedural posture. During the trial proceedings this Court addressed Plaintiffs ERISA claims. The Court made two principle findings: (1) that Defendant had an insufficient basis for terminating Plain[293]*293tiffs total disability benefits based upon finding that his current job duties overlap those of his prior job; and (2) that the definition of total disability was fixed by contract after Plaintiff turned 65. Because these findings resolved the case, the Court did not consider Plaintiffs theory of estoppel. The Sixth Circuit left unchanged Plaintiffs first finding, but disagreed with the second. Therefore, under the law of this case, Plaintiff is entitled to total disability benefits to age 65, which amounts to $110,000, plus interest at the rate of 5.43 percent and attorney’s fees, if applicable. However, Plaintiff is not entitled to total disability benefits since he turned age 65 and so long as he remains gainfully employed.

Id. at 1-2. In that decision, the district court ultimately determined McMurtry was a prevailing party “entitled to reimbursement of 40 percent of his requested fees, or $23,683.” Id. at 4-5.

The district court did not address the estoppel issue in its April 9 decision. However, the court noted that

the parties dispute whether Plaintiff is entitled to pursue his estoppel claim. The Court has not considered that claim and if the Sixth Circuit did so, it remained very quiet about it. Nevertheless, the Sixth Circuit’s opinion may have very negative implications for that claim.

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

Related

McMurtry v. Wiseman
445 F. Supp. 2d 756 (W.D. Kentucky, 2006)

Cite This Page — Counsel Stack

Bluebook (online)
67 F. App'x 290, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcmurtry-v-paul-revere-life-insurance-ca6-2003.