Mowers v. Paul Revere Life Insurance

27 F. Supp. 2d 135, 1998 U.S. Dist. LEXIS 18478, 1998 WL 828040
CourtDistrict Court, N.D. New York
DecidedNovember 25, 1998
Docket5:98-cv-00086
StatusPublished
Cited by2 cases

This text of 27 F. Supp. 2d 135 (Mowers v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mowers v. Paul Revere Life Insurance, 27 F. Supp. 2d 135, 1998 U.S. Dist. LEXIS 18478, 1998 WL 828040 (N.D.N.Y. 1998).

Opinion

MEMORANDUM-DECISION AND ORDER

HURD, United States Magistrate Judge.

I. INTRODUCTION

Plaintiff, Howard Mowers (“Mowers” or “plaintiff’), originally commenced this action in state court alleging causes of action for breach of an insurance contract, tortious breach of duty of good faith and fair dealing, and fraud. Defendant, Paul Revere Life Insurance Company (“Paul Revere” or “defendant”) removed the action to federal court and now moves for summary judgment dismissing plaintiffs complaint in its entirety, pursuant to Rules 56(b) and 12(b)(6) of the Federal Rules of Civil Procedure. In the alternative, defendant seeks to have a state court preliminary injunction declared void. Plaintiff has cross-moved for summary judgment on the breach of contract claim. Oral argument was heard on October 1, 1998 in Utica, New York. Decision was reserved.

II. FACTS

Plaintiff was a self-employed chiropractor and purchased a disability insurance policy from Paul Revere beginning in July 1989 which provided coverage in the event that plaintiff became totally disabled from his work. The pertinent contract provision states: “Total disability means that because of injury or sickness: a. You are unable to perform the important duties of Your Occupation; and b. You are under the regular and personal care of a Physician.” (MeKiernan Aff.Ex. A.) In August 1992, Mowers injured his lower back at work and was forced to reduce his work hours, until, eventually, he ceased working entirely.

Plaintiff began receiving disability payments from defendant in November 1992 in the amount of $3760.00 per month. In the fall of 1993, Paul Revere stopped paying benefits to Mowers, requiring further confirmation of his injuries. At the request of Paul Revere, Mowers submitted to five Independent Medical Exams (“IME”) by physicians of the defendant’s choosing between 1993 and 1994. Three of the five explicitly confirmed that he remained totally disabled from his work as a chiropractor. The other two examinations confirmed that plaintiff cannot lift patients. Plaintiff was also under the continuous care of Dr. Gary Witchley. Upon confirmation of Mowers’ continued disability, Paul Revere resumed paying benefits to plaintiff.

In February 1997, plaintiff submitted to a requested sixth IME, performed by Dr. Warren Rinehart. Dr. Rinehart indicated in his report that plaintiff might be able to resume part-time work, limiting his practice to conducting IMEs and working only with patients with problems in their cervical vertebrae. After Dr. Rinehart’s report, the defendant made arrangements for two functional capacity evaluations (“FCE”) for July 28,1997 and September 3,1997 to determine the extent of plaintiffs disability. Plaintiff did not attend either evaluation (the second one was scheduled after plaintiff was unable to attend the first one). Effective September 1, 1997, defendant stopped paying plaintiff benefits based upon Dr. Rinehart’s opinion that plain *138 tiff retained the ability to engage in some aspects of chiropractics.

Mowers filed suit in the Supreme Court of the State of New York, County of Herkimer. He brought an order to show cause for a preliminary injunction requiring Paul Revere to continue paying benefits during the pen-dency of the lawsuit. Acting Supreme Court Justice Patrick Kirk heard the motion on January 14,1998. He granted the injunction by verbal order from the bench, but permitted Paul Revere to stop paying Mowers if he failed to attend a FCE within two months. The defendant removed the action to federal court pursuant to 28 U.S.C. § 1446, filing and serving a petition by mail on January 16, 1998. Judge Kirk did not sign a written order until February 6,1998.

Thereafter, defendant scheduled a FCE three months later, on April 20, 1998, and notified plaintiffs attorney. After plaintiff failed to attend, Paul Revere never resumed disability payments. Plaintiff subsequently voluntarily submitted to a FCE on July 28, 1998, at JobReady, the same place the FCEs had previously been scheduled by defendant. The occupational therapist at JobReady concluded that plaintiff could not do his previous work as a chiropractor.

In its motion for summary judgment, Paul Revere alleges that plaintiff failed to meet a condition precedent in the insurance policy; that plaintiff submit to reasonable independent medical exams and cooperate in determining whether plaintiff is totally disabled. The contract states that defendant “can have a Physician of [its] choice examine [plaintiff] as often as reasonably required while [the] claim is continuing.” (McKiernan’s Aff.Ex. A.)

Defendant also seeks summary judgment on the plaintiff’s fraud claim, arguing that plaintiff has failed to state a claim pursuant to Fed.R.Civ.P. 12(b)(6). More specifically, defendant argues that (1) plaintiff has failed to plead the allegations of fraud with particularity, as required by Fed.R.Civ.P. 9(b) and (2) the Statute of Limitations has expired. Finally, as an alternative to summary judgment, defendant seeks to have the state court preliminary injunction declared void on the grounds that Judge Kirk’s verbal order was ineffective and the state court was divested of jurisdiction at the time of removal.

The plaintiff has cross-moved for summary judgment on the breach of contract claim. He argues: (1) There is no dispute that defendant did not pay him benefits after September 1,1997; (2) he has proven that he is totally disabled from his occupation; and (3) he was reasonable in not attending the FCE requested by Paul Revere after Dr. Rinehart’s examination. Therefore, he claims, no issue of fact exists for a jury and he is entitled to payment of the contract benefits.

III. DISCUSSION

A. SUMMARY JUDGMENT STANDARD

A motion for summary judgment must be granted when the pleadings, depositions, answers to interrogatories, admissions and affidavits show that there is no genuine issue as to any material fact, and that the moving party is entitled to summary judgment as a matter of law. Fed.R.Civ.P. 56; Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Lang v. Retirement Living Pub. Co., 949 F.2d 576, 580 (2d Cir.1991). The moving party carries the initial burden of demonstrating an absence of a genuine issue of material fact. Fed.R.Civ.P. 56; Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986); Thompson v.

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Bluebook (online)
27 F. Supp. 2d 135, 1998 U.S. Dist. LEXIS 18478, 1998 WL 828040, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mowers-v-paul-revere-life-insurance-nynd-1998.