Nichols v. NATIONAL UNION FIRE INS. OF PITTSBURGH

509 F. Supp. 2d 752, 2007 U.S. Dist. LEXIS 67103, 2007 WL 2609816
CourtDistrict Court, W.D. Wisconsin
DecidedSeptember 10, 2007
Docket07-C-0021-C
StatusPublished
Cited by8 cases

This text of 509 F. Supp. 2d 752 (Nichols v. NATIONAL UNION FIRE INS. OF PITTSBURGH) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nichols v. NATIONAL UNION FIRE INS. OF PITTSBURGH, 509 F. Supp. 2d 752, 2007 U.S. Dist. LEXIS 67103, 2007 WL 2609816 (W.D. Wis. 2007).

Opinion

OPINION and ORDER

BARBARA B. CRABB, District Judge.

In this civil action for declaratory and monetary relief, which was removed from state court, plaintiffs Shannon and Lee Nichols contend that defendant National Union Fire Insurance Company of Pittsburgh, Pa breached an insurance contract and acted in bad faith when it denied disability benefits to plaintiff Shannon *754 Nichols following a motor vehicle accident that caused her severe injury. Jurisdiction is present under 28 U.S.C. § 1332.

This case is before the court on cross motions for summary judgment. Plaintiffs raise two issues: whether the policy requires “specific total loss” for disability coverage, and, if so, whether this requirement is unenforceable as unconscionable. Defendant raises a third issue, contending that plaintiffs cannot prove their claim that defendant acted in bad faith when it denied disability coverage. Because I conclude the policy requires specific total loss for disability coverage and is not unconscionable, I will grant defendant’s motion for summary judgment and deny plaintiffs’ motion for summary judgment on these issues. And because plaintiffs have failed to respond to defendant’s motion for summary judgment on plaintiffs bad faith claim, I will grant defendant’s summary judgment on this issue as well.

The facts in this case are straightforward and largely undisputed. Nonetheless, I have disregarded those proposed findings of fact and responses that constituted legal conclusions, were argumentative or irrelevant, were not supported by the cited evidence or were not supported by citations specific enough to alert the court to the source of the proposal. From the parties’ proposed findings of fact, I find the following facts to be material and undisputed.

UNDISPUTED FACTS

A. Parties

Plaintiffs Shannon and Lee Nichols are citizens of Wisconsin, residing in Poynette, Wisconsin. (Although defendant failed to establish plaintiffs’ citizenship when it removed the case to this court, it remedied the omission in response to this court’s order.) National Union Fire Insurance Company of Pittsburgh, Pennsylvania is an insurance company licensed to sell accident and disability insurance in Wisconsin, with its principal place of business in New York City. National Union is incorporated in the state of Pennsylvania. (Defendant has not explicitly indicated its state of incorporation, but has stated that it is a citizen of the states of Pennsylvania and New York, and its website states that defendant “was incorporated under the laws of Pennsylvania.” http://www.aignational union, com/nationalunion/publie/natabou-tus/0,2136,401,00.html (last visited Aug. 29, 2007).)

B. Insurance Coverage

Defendant issued an Accident Insurance Policy to plaintiffs that became effective July 1, 2003. The policy provided for different coverages, including $35,000 for “Accidental Death”; $1,000,000 for “Accident Medical Expense”; $100,000 for “In-hospital Indemnity”; and $250,000 for “Permanent Total Disability.” The policy defined “permanent total disability” as follows:

PERMANENTLY TOTALLY DISABLED/PERMANENT TOTAL DISABILITY-as used in this Description of Coverage, means:
1. That the Insured Person has suffered a Permanent Total Loss of Use of:
a. both hands or feet; or
b. one hand and one foot; or
c. sight in both eyes; or
d. hearing in both ears; or
e. the ability to speak;
2. the Insured Person is permanently unable to perform the material and substantial duties of any occupation for which he or she is qualified by reason of education, experience or training; and
3. the Insured Person is under the continuous care of a Physician unless the *755 Insured Person has reached his or her maximum point of recovery.

Plaintiffs’ policy included a cover letter describing its coverage. The letter included a warning to “please read this description of coverage carefully,” a toll-free number to call with questions and a clause allowing an insured to return the policy to the company for a refund of premiums and an annulment of benefits. In addition, the description of coverage included a warning that the policy

provides ACCIDENT-ONLY coverage. It does NOT provide basic hospital, basic medical, major medical or sickness coverage. The Policy provides limited benefits which are supplemental and are not intended to cover all medical expenses. The Policy does not provide automobile liability insurance coverage.

Plaintiff Shannon Nichols was eligible for coverage as a customer of Chase Mortgage, and paid a monthly premium of $21.90 for the coverage.

On June 5, 2004, an intoxicated driver crossed the centerline of Highway J in Columbia County and hit the vehicle in which plaintiff Shannon Nichols was a passenger. Plaintiff was seriously injured in the accident and was hospitalized from June 5, 2004 until July 28, 2004. On July 13, 2005, plaintiffs treating physician concluded that plaintiff was permanently disabled under paragraphs (2) and (3) of the policy definition of permanent total disability. On September 7, 2006, another physician concluded that plaintiff was still permanently disabled under paragraphs (2) and (3). Plaintiff continues to undergo treatment for injuries caused by the accident.

After the accident, plaintiffs filed a claim for in-hospital indemnity and permanent total disability benefits. On February 17, 2005, defendant wrote to plaintiffs regarding the claims. In this letter, defendant included the definition for “permanent total disability,” reworded to include the word “and” between the first and second paragraphs.

Defendant paid the $100,000 in-hospital indemnity benefits, but denied permanent total disability coverage, maintaining that plaintiff had to meet all three paragraphs of the policy definition of “permanent total disability.”

The parties have stipulated that plaintiff Shannon Nichols does not meet the requirements of the first paragraph contained in the definition of permanent total disability.

OPINION

A. Defendant’s Untimely Filing

As a preliminary matter, plaintiffs have argued that this court should not consider defendant’s response brief because it was filed three days after the deadline set by the court. Defendant argues that it should be entitled to three additional days under Rule 6(e) of the Federal Rules of Civil Procedure for serving plaintiffs electronically.

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Cite This Page — Counsel Stack

Bluebook (online)
509 F. Supp. 2d 752, 2007 U.S. Dist. LEXIS 67103, 2007 WL 2609816, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nichols-v-national-union-fire-ins-of-pittsburgh-wiwd-2007.