Merrick v. Paul Revere Life Insurance

Procedural entryThis page is a short order in Merrick v. Paul Revere Life Insurance. Read the opinion of the Court — 500 F.3d 1007
Court of Appeals for the Ninth Circuit·Decided August 31, 2007·No. 05-16380·Published

Opinion

FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT

G. CLINTON MERRICK, JR.,  Plaintiff-Appellee, v. No. 05-16380 PAUL REVERE LIFE INSURANCE  D.C. No. CV-00-00731-JCM COMPANY; PROVIDENT LIFE & ACCIDENT INSURANCE; UNUM PROVIDENT, Defendants-Appellants. 

G. CLINTON MERRICK, JR.,  Plaintiff-Appellee, v. No. 05-17059 PAUL REVERE LIFE INSURANCE  D.C. No. CV-00-00731-JCM COMPANY; PROVIDENT LIFE & ACCIDENT INSURANCE; UNUM OPINION PROVIDENT, Defendants-Appellants.  Appeal from the United States District Court for the District of Nevada James C. Mahan, District Judge, Presiding

Argued and Submitted May 16, 2007—San Francisco, California

Filed August 31, 2007

Before: Cynthia Holcomb Hall, Diarmuid F. O’Scannlain, and Sandra S. Ikuta, Circuit Judges.

11109 11110 MERRICK v. PAUL REVERE LIFE INSURANCE CO. Opinion by Senior Circuit Judge Hall 11112 MERRICK v. PAUL REVERE LIFE INSURANCE CO.

COUNSEL

Evan M. Tager, Mayer, Brown, Rowe & Maw, Washington, DC, for the defendants-appellants. MERRICK v. PAUL REVERE LIFE INSURANCE CO. 11113 Thomas L. Hudson, Osborn Maledon, Phoenix Arizona, for the plaintiff-appellee.

OPINION

HALL, Senior Circuit Judge:

Defendants Paul Revere Life Insurance Company and Unum Provident Corporation (collectively “the insurers”) appeal the district court’s jury verdict awarding $1.65 million in compensatory and $10 million in punitive damages to plaintiff G. Clinton Merrick, Jr. for breach of contract and of the duty of good faith and fair dealing, stemming from the insurers’ denial of Merrick’s disability insurance claim. Among other issues, this appeal requires us to examine the constitutional limits upon the use of evidence of injury inflicted upon nonparties, as discussed in Philip Morris USA v. Williams, 127 S. Ct. 1057, 1063 (2007). The district court had jurisdiction pursuant to 28 U.S.C. § 1332. This court has jurisdiction pursuant to 28 U.S.C. § 1291. We affirm in part, reverse in part, and remand for a new trial on punitive dam- ages due to the district court’s failure to give an adequate lim- iting jury instruction under Williams.

I. Background

A. History of Merrick’s Claim

G. Clinton Merrick, Jr. purchased an “own occupation” dis- ability policy from defendant Paul Revere Life Insurance Company in 1989. Under that policy, if Merrick was “unable to perform the important duties of [his] Occupation” due to “Injury or Sickness,” he was entitled to a “total disability” benefit of $12,000 per month for the duration of his disability. At the time, Merrick was one of three partners at a venture capital firm, responsible for raising capital, evaluating invest- 11114 MERRICK v. PAUL REVERE LIFE INSURANCE CO. ment options, and participating as a director in companies in which the firm invested. Merrick had entered the venture cap- ital arena following a successful career as a marketing execu- tive, where his accomplishments included campaigns for Country Time Lemonade, Crystal Light drink mix, and the “Kool-Aid Man.”

In the early 1990s, Merrick began suffering from fatigue, muscle pain, mental confusion, and other difficulties that affected his work performance. His attending physician, Dr. Simon Epstein, referred him to several specialists to identify the problem. In August 1993, Dr. Stuart Mushlin indicated that Merrick may be suffering from Chronic Fatigue Syn- drome (CFS) and found him unable to work. This diagnosis coincided with his partners’ decision to buy out Merrick’s interest in the firm due to recent underperformance, which Merrick attributed to his health problems.

Merrick first alerted Paul Revere to his disability on May 31, 1994, stating that he was “suffering from a disabling con- dition” but was not yet filing a claim. Merrick then met with additional specialists and underwent a battery of specialized tests at the Mayo Clinic, some of which showed normal results and some of which indicated abnormalities. Dr. Michael Silber, summarizing the Mayo Clinic results, diag- nosed Merrick as suffering from CFS and Lyme Disease, and advised that he “restart work at a much lower stress level than previously.” By this time Merrick was under the regular care of Dr. Alan Rapaport rather than Dr. Epstein; both Epstein and Rapaport concurred with the CFS diagnosis and found Merrick unable to work.

Following the Mayo Clinic’s confirmation of the CFS diag- nosis, Merrick filed a formal claim with Paul Revere. Paul Revere’s in-house physician reviewed Merrick’s documenta- tion, questioned the diagnosis but ultimately agreed that the records supported a finding of “significant impairment.” MERRICK v. PAUL REVERE LIFE INSURANCE CO. 11115 Therefore Paul Revere began paying out Merrick’s claim as of December 1994, when his benefits began to accrue.

Merrick tried to start a new venture capital firm in late 1994, but his illness prevented him from getting beyond the initial stages. Merrick’s other insurer, Northwestern Mutual, notified Paul Revere in June 1995 that Merrick was seeking to enter a new business venture. That August, a Paul Revere field representative offered to settle Merrick’s claim for an amount equal to four months of disability benefits, citing the “return to work and recovery” provision of his claim. Merrick declined, whereupon the representative left him with a check for one month of benefits. Merrick returned this check because he believed an endorsement provision on the check would have settled his claim upon cashing.

Paul Revere then arranged for Dr. James Donaldson to per- form an Independent Medical Examination in December 1995. Dr. Donaldson’s report was inconclusive: based on his tests, he concluded that Merrick “does not have either an active neurological problem or active Lyme disease” but did note his chronic fatigue, attributing it to depression. He also found that Merrick “deserves aggressive treatment, both phar- macotherapy and psychotherapy, by a seasoned psychiatrist.” Paul Revere’s claim file shows that the company interpreted Donaldson’s report as supporting “significant impairment,” and as implying that Merrick could not return to work.1 Dr. Rapaport, Merrick’s treating physician, disputed Dr. Donald- son’s conclusions and reiterated his CFS diagnosis.

Paul Revere conducted an intensive review of Merrick’s claim file, which concluded that “there does not appear to be any neuropsychologically-based disability.” The field repre- 1 Dr. Donaldson’s report did not explicitly state whether he thought Mer- rick could return to work. Paul Revere’s internal examiner recommended that the company ask Donaldson to clarify his findings in this regard, but apparently this follow-up never happened. 11116 MERRICK v. PAUL REVERE LIFE INSURANCE CO. sentative again offered a compromise settlement, which Merr- ick refused. On December 9, 1996, Paul Revere denied Merrick’s claim on the ground that the internal review showed “no objective medical documentation which supports an inability to perform the duties of your occupation as a ven- ture capitalist.” After Merrick protested, Paul Revere agreed to pay two additional months of benefits while Merrick pro- vided the company with objective medical evidence. But the company’s medical consultants rejected the two follow-up reports Merrick offered to document his illness, so Paul Revere continued to deny Merrick’s claim. Merrick filed suit against Paul Revere and its parent corporation, Unum Provi- dent, in April 2000, claiming breach of contract and of the duty of good faith and fair dealing.

B. Pretrial Motion in Limine

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