Michael v. Trustmark Insurance

16 Mass. L. Rptr. 245
CourtMassachusetts Superior Court
DecidedJanuary 14, 2003
DocketNo. 99739B
StatusPublished
Cited by2 cases

This text of 16 Mass. L. Rptr. 245 (Michael v. Trustmark Insurance) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Michael v. Trustmark Insurance, 16 Mass. L. Rptr. 245 (Mass. Ct. App. 2003).

Opinion

Hines, J.

INTRODUCTION

The plaintiff, David Michael (“Michael”), brought this action against the defendants, Trustmark Insurance Company (‘Trustmark”) and Continental Assurance Company (“CNA”), alleging breach of contract and violation of G.L.c. 93A. The complaint alleges that Trustmark, the successor to Continental, failed to pay the plaintiff benefits due to him under a disability policy and that Trustmark violated G.L.c. 93A by failing to make timely payments of the benefits due under the policy. Trustmark filed a counterclaim seeking the repayment of disability benefits paid to Michael during the period when Trustmark alleges that he was ineligible to receive total disability benefits. These claims were tried to this court sitting without a jury over six days in November 2001 and December 2001. The parties presented further ar[246]*246guments on the G.L.c. 93A claim in August 2002. After considering the testimony of the witnesses and reviewing the exhibits, I make the following findings of fact, rulings of law and order for entry of judgment in this action.

FINDINGS OF FACT

A. The Disability Policy

On January 26, 1986, Michael purchased a disability insurance policy #0286699 (“Policy”) issued by CNA. The Policy has remained in effect at all times since it was issued. In 1995, Trustmark assumed responsibility for claims administration and in 1996 Trustmark purchased the Policy from CNA. The Policy’s total disability benefits clause relevant to the issues in this case provides as follows:

Total disability means that because of Injury or Sickness: (1) You are Disabled from performing the substantial and material duties of Your regular occupation; and (2) You are under the regular care of a licensed physician other than Yourself; and (3) You are not gainfully employed in an occupation reasonably consistent with Your education, training and experience.

The total disability benefit to be paid under the Policy is $4450.00 monthly plus a 5% cost of living adjustment and an $850.00 monthly social security rider.

When the Policy was issued in 1986, Michael was employed by Puritan Pontiac in Hyannis, Massachusetts as a General Manager. Michael left Puritan Pontiac for a position as General Manager for Miskinis Buick/Pontiac (“Miskinis”), which had locations in Bridgewater, West Bridgewater, and Brockton, Massachusetts. Michael was employed at Miskinis as General Manager in March 1990 when the claim which is the subject of this lawsuit arose. At that time, Michael was earning approximately $75,000 annually exclusive of bonuses.

Michael’s Disability

Michael’s position at Miskinis included overseeing the operations of the parts and service departments, overseeing the entire company’s budget, and increasing sales. Michael was also responsible for the hiring and firing of employees, who numbered approximately 120 in 1989. Michael was a “hands-on” executive who prided himself on being personally acquainted with all of the company’s employees. He took an interest in each employee’s welfare and affairs and made a point of visiting and talking with the employees during the work day. Michael identified with the employees because he had worked his way up the automobile dealership hierarchy from a low level position.

By the end of 1989, Miskinis began experiencing a sharp decline in car sales. Because of the market decline and the need to maintain the profitability of the dealerships to the satisfaction of the owner, Michael, in his capacity as General Manager, was forced to lay off approximately half of Miskinis’ employees. These layoffs distressed Michael who felt that he had failed both the owner and the employees. Matters became worse around Christmas 1989, when Robert Miskinis, the owner of the dealerships, personally stated to all of the employees that there would be no further layoffs. Michael was concerned and upset by Miskinis’ statement because he knew that more layoffs would be needed and that the employees to whom he was devoted would be hurt.

It was during this period that Michael first began to suffer symptoms of depression such as insomnia, lack of concentration and energy, frequent crying, withdrawal, and loss of appetite. In March of 1990, Michael spoke with Mr. Miskinis and they both agreed that Michael would benefit from some time off. Miskinis recommended that Michael seek counseling and referred Michael to Dr. George Fournier, a clinical psychologist. Michael took a leave from his employment in late March 1990 and began treating with Dr. FoumierinApril 1990. In accordance with the Policy, Michael applied for and received total disability benefits. Those benefits were paid by CNA and Trustmark from 1990 to January 1999 when Trustmark ceased payments in a dispute with Michael over access to his treatment records.2

By late summer 1990, Michael was anxious to return to work. With Dr. Fournier’s approval, he returned to Miskinis in August 1990.- However, he was assigned only non-managerial tasks. After eight weeks back at Miskinis, it was clear that Michael would not be able to fulfill his responsibilities as General Manager. Michael discussed the matter with Mr. Miskinis and left Miskinis permanently in October 1990. Michael never returned to work as a General Manager or in any other executive capacity at an automobile dealership. Michael is currently self-employed as a dog trainer, an occupation which is not reasonably consistent with his education, training and experience as a general manager of an automobile dealership. As will be discussed in more detail below, Michael is now and since 1990 has been totally disabled from performing the substantial and material duties of his occupation as general manager of an auto dealership. This disability is causally related to the psychiatric illness which Michael suffered in March 1990 while employed at Miskinis.

B. Medical Treatment History

The parties do not dispute, and I so find, that Michael first became disabled in March 1990 when he left Miskinis. The cause of the disability was depression. Since the onset of his disability in 1990, Michael has been under the continuous care of physicians and other mental health providers who have provided appropriate and reasonable care. Dr. Fournier first treated Michael on April 17, 1990 and continued as his psychotherapist until October 1999. When Michael began treatment with Dr. Fournier in April 1990, he had no history of psychiatric illness or treatment. He presented to Dr. Fournier complaining of symptoms, including sleep disturbance, tearfulness, anxiety, guilt and feelings of worthlessness which occurred in the wake of the events at Miskinis in [247]*247late 1989. After performing a clinical evaluation applying the standards in the Diagnostic and Statistical Manual (DSM), Dr. Fournier diagnosed Michael’s condition as Major Depressive Disorder, single episode. Dr. Fournier also performed psychological testing which included the Minnesota Multiphasic Personality Inventory (MMPI). The purpose of the MMPI is to assist the psychologist in making a diagnosis and formulating a treatment plan for the patient. The test consists of 440 true-false questions. Once completed, the patient’s answers are analyzed by the psychologist, often with the aid of a computer, and are charted on various scales and sub-scales, each denoting a specific type of mental or personality disorder. There are also scales designed to evaluate the validity of the test for that patient.

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Bluebook (online)
16 Mass. L. Rptr. 245, Counsel Stack Legal Research, https://law.counselstack.com/opinion/michael-v-trustmark-insurance-masssuperct-2003.