Merrill v. Crown Life Insurance

22 F. Supp. 3d 1137, 2014 U.S. Dist. LEXIS 71417, 2014 WL 2159266
CourtDistrict Court, E.D. Washington
DecidedMay 23, 2014
DocketNo. 13-CV-0110-TOR
StatusPublished
Cited by15 cases

This text of 22 F. Supp. 3d 1137 (Merrill v. Crown Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Merrill v. Crown Life Insurance, 22 F. Supp. 3d 1137, 2014 U.S. Dist. LEXIS 71417, 2014 WL 2159266 (E.D. Wash. 2014).

Opinion

ORDER ON CROSS-MOTIONS FOR SUMMARY JUDGMENT

THOMAS O. RICE, District Judge.

BEFORE THE COURT are the parties’ cross-motions for summary judgment (ECF Nos. 15 and 19), and Defendant’s Motion to Strike Third Declaration of Robert Merrill (ECF No. 55) and Motion to Expedite (ECF No. 54). These matters were heard with oral argument on May 22, 2014. Steven C. Lacy appeared on behalf of the Plaintiff. Medora A. Marisseau appeared on behalf of Defendant. The Court has reviewed the briefing and the record and files herein, and is fully informed.

INTRODUCTION

Plaintiff sustained a fractured eye socket during a skiing accident in January 2011. This injury caused him to experience double vision. Surgery to repair the eye socket improved Plaintiffs vision, but did not correct it entirely. Despite experiencing fingering vision problems, Plaintiff returned to his practice as an orthodontist in February. By June, however, it became clear to Plaintiff that he could not competently place brackets on patients’ teeth due to his impaired vision. Plaintiff filed for total disability insurance benefits commencing on the date of his injury under three policies issued by Crown Life. Plaintiff continued to perform less visually demanding tasks until November, at which time he sold his interest in the practice to his business partner and retired from the practice of orthodontics.

After performing a thorough claims investigation, Crown Life determined that-Plaintiff was totally disabled — ie., “unable ... to perform the material and substantial duties of [his] regular occupation” — as of the date he sold his practice. With regard to the period that Plaintiff remained employed, however, Crown Life denied total disability coverage and awarded only proportional benefits. The most significant result of this decision was that Plaintiff was denied “Professional Overhead Expense” benefits, payable in the maximum amount of $24,000 per month, for the nine months that he continued working.

In the instant lawsuit, Plaintiff asserts claims for breach of contract, bad faith, and violations of the Washington Insurance Fair Conduct Act (“IFCA”) and Washington Consumer Protection Act (“CPA”) arising from Crown Life’s denial [1141]*1141of total disability coverage from January 2011 to November 2011. Plaintiff now moves for partial summary judgment1 on his breach of contract and CPA claims. Crown Life has filed a cross-motion for summary judgment on all claims.

For the reasons discussed below, the Court concludes that Plaintiff is entitled to partial summary judgment on his breach of contract claim and a single CPA claim arising from a violation of WAC 284-30-330(7). Crown Life is entitled to summary judgment on all remaining CPA claims. Genuine issues of material fact preclude summary judgment on Plaintiffs bad faith and IFCA claims.

FACTS

Plaintiff Robert Merrill (“Plaintiff’) is a retired orthodontist who formerly practiced with his younger brother, Thomas Merrill, in Wenatchee, Washington. At all times relevant to this litigation, Plaintiff was insured under three disability insurance policies issued by Defendant Crown Life Insurance Co. (“Crown Life”). Two ' of these policies provide disability income coverage, while the third provides coverage for professional overhead expenses (“POE”). Both the disability income and POE policies have riders which provide for payment of partial benefits (termed “income replacement benefits” and “proportionate expense benefits,” respectively) in the event that the claimant experiences a loss of business income due to an injury.

On January 14, 2011, Plaintiff was involved in a skiing accident at Alta Ski Resort in Alta, Utah. The accident resulted in a blowout fracture to Plaintiffs left eye socket and caused Plaintiff to experience double vision. Plaintiff underwent surgery one week later to repair his eye socket and the muscles attached to his eye. This surgery improved Plaintiffs double vision, but did not entirely correct it.

Plaintiff returned to his orthodontics practice in late February 2011. Although he was still experiencing problems with double vision, Plaintiff was hopeful that his vision would improve over time. Plaintiff continued to perform the same basic duties he had performed prior to his accident: devising treatment plans, installing braces on new patients, and making periodic adjustments to wires.

In May 2011, Plaintiffs brother began noticing problems with the quality of Plaintiffs work while attending to patients during follow-up visits. Specifically, Plaintiffs brother noted that the brackets on several patients’ teeth had been installed so far off the correct location that they needed to be removed and reinstalled. He and several assistants also observed excessive amounts of glue around many brackets. Plaintiff and his brother discussed these issues, and Plaintiff acknowledged that his vision problems were adversely affecting his work. The following month, the two partners agreed that Plaintiffs brother would assume sole responsibility for initial bracket installations and that Plaintiff would only perform tasks that required less visual acuity such as adjusting wires and removing braces at the conclusion of a patient’s treatment. Because this arrangement placed a significantly higher workload on Plaintiffs brother, the partners reduced Plaintiffs share of the partnership profits from one-half to one-third.

On June 10, 2011, Plaintiff filed claims for disability benefits under his three policies with Crown Life. On his claim form, Plaintiff indicated that, as a result of double vision caused by his skiing accident, he was unable to do “[ajnything requiring [1142]*1142precise visual acuity and three-dimensional perception such as placement of orthodontic braces on teeth, fíne tooth positioning adjustments to wires, removal of excessive adhesive, accurate assessment of tooth positions, etc.” In a recorded statement taken on June 21, 2011, Plaintiff explained that he was applying for proportionate (as opposed to total) disability benefits and provided an overview of his reduced role within the practice. Crown Life opened a claims investigation.

Unfortunately; Plaintiff continued to experience difficulties in his modified role. On September 12, 2011, Plaintiff informed Crown Life that he could no longer competently practice as an orthodontist and that, as a result, he would be selling his interest in the practice. He also advised Crown Life that he now considered himself totally disabled and wished to modify his claims to reflect that fact:

After reading [through] my policies and talking frankly with my family, I now recognize that I have been in denial about my ability to practice orthodontics and realize that I probably should have been filing a claim for full disability since I appear to be fully disabled ... even though I have been trying to work.
While I have been working at a reduced rate of pay, I believe that is mainly due to my partner’s (my brother) kindness and generosity and his hope that my vision could be restored and I would be able to resume practice, and not due to my ability to contribute meaningfully to the income of the practice. I have really been working as a glorified assistant to my brother as far as the tasks I’ve been performing, since my vision isn’t good enough to do the technical aspects of orthodontics that produce any significant income to the practice.

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

Related

(PC) Spencer v. Pulido-Esparza
E.D. California, 2023
Davidow v. Zalnatrav Inc
W.D. Washington, 2022
(PC) Beckett v. Moreno
E.D. California, 2020
(PC) Parrish v. Bugarin
E.D. California, 2020
GB Auctions Inc v. Old Republic
E.D. Washington, 2019
Perez-Crisantos v. State Farm Fire & Casualty Co.
389 P.3d 476 (Washington Supreme Court, 2017)
Perez-Crisantos v. State Farm Fire & Cas. Co.
Washington Supreme Court, 2017
Workland & Witherspoon, PLLC v. Evanston Insurance
141 F. Supp. 3d 1148 (E.D. Washington, 2015)
Navigators Specialty Insurance v. Christensen Inc.
140 F. Supp. 3d 1097 (W.D. Washington, 2015)
Langley v. Geico General Insurance
89 F. Supp. 3d 1083 (E.D. Washington, 2015)

Cite This Page — Counsel Stack

Bluebook (online)
22 F. Supp. 3d 1137, 2014 U.S. Dist. LEXIS 71417, 2014 WL 2159266, Counsel Stack Legal Research, https://law.counselstack.com/opinion/merrill-v-crown-life-insurance-waed-2014.