Pediatricians, Inc. v. Provident Life & Accident Insurance Co., Pediatricians, Inc. v. Provident Life & Accident Insurance Co.

965 F.2d 1164, 1992 WL 101662
CourtCourt of Appeals for the First Circuit
DecidedJune 12, 1992
Docket91-2103, 91-2129
StatusPublished
Cited by18 cases

This text of 965 F.2d 1164 (Pediatricians, Inc. v. Provident Life & Accident Insurance Co., Pediatricians, Inc. v. Provident Life & Accident Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pediatricians, Inc. v. Provident Life & Accident Insurance Co., Pediatricians, Inc. v. Provident Life & Accident Insurance Co., 965 F.2d 1164, 1992 WL 101662 (1st Cir. 1992).

Opinion

KEETON, District Judge.

The present cross-appeals involve a dispute over life insurance coverage. Pursuant to a Certificate of Insurance on the life of Dr. Thomas A. Flaherty under a group insurance policy issued to the American Medical Association Group Insurance Trust by defendant Provident Life & Accident Insurance Company (“Provident”), Provident paid insurance proceeds to Flaherty’s beneficiary, plaintiff Pediatricians, Inc. (“Pediatricians”), in the amount of $100,-000.00.

Pediatricians sued to recover an additional $100,000.00, claiming that the coverage amount at the time of Flaherty’s death was $200,000.00. The court below entered summary judgment for Pediatricians on its coverage claim.

Pediatricians also contends that it is entitled to attorney’s fees, costs, and double or treble damages under Mass.Gen.L. c. 176D *1166 and 93A. After a hearing conducted September 17, 1991, the district court denied plaintiffs claim for relief on that count of its complaint. Final Judgment was entered September 20, 1991.

Provident now appeals the award of additional death benefits; Pediatricians cross-appeals the denial of attorney’s fees, costs, and multiple damages. We affirm.

I.Background

The material historical facts are not in dispute. We summarize them briefly and for context identify uncertainties about the timing of some events.

In 1973, Flaherty obtained life insurance from Provident in the amount of $25,-000.00, naming his wife as beneficiary. During the next fifteen years he amended his coverage several times. Of significance to this litigation, he eventually increased the amount to $200,000.00 and changed his beneficiary to Pediatricians (a corporation operating a medical clinic), of which he was president and 50% shareholder. A semiannual premium came due on September 1, 1988. The amount of this premium was $598.50 (the “semi-annual renewal premium” of $855 less a “premium credit” under the terms of the Group Policy of $256.50).

It is undisputed that in 1988 Marsh and McLennan Group Associates (“Marsh”) regularly issued renewal premium notices to AMA members who were certificate holders and also received payments from them. The record before us does not specify either when this practice commenced or how it was authorized. (An application in the record, however, signed by Flaherty on March 2, 1973, has a printed statement, “The program is Administered by [Marsh].”)

In the period August 1988 — February 1989, nine events (or sets of events) of interest in this litigation occurred. As the following description discloses, however, the precise timing is not certain in all instances. Some overlapping in time among some of these events is probable.

1. Notice of Renewal Premium due September 1, 1988. In or before August 1988, Marsh sent to Flaherty a notice that a renewal premium of $598.50 for $200,000 of coverage under the Flaherty Certificate was due September 1, 1988.

2. Tender of $299.25 payment. A Pediatricians’ check, signed by Donald J. Anni-no, dated August 31, 1988, and payable to Marsh was mailed in a Pediatricians’ envelope, postmarked September 3, 1988 and addressed to Marsh and McLennan Group Associates, 222 So. Riverside, Chicago, ILL, 60606. Also in the envelope was a note in the handwriting of Flaherty and signed by him, stating,

To Whom It May Concern:

Please reduce my coverage on Term Life Insurance from $200,000 to $100,-000. The enclosed premium for $299.25 is forwarded herewith.
/s/ Thomas A. Flaherty, M.D.
Plan 1104 AMA
Certificate No. 503722

Marsh received the envelope and enclosures on September 7, 1988.

3. Dr. Flaherty’s entry to hospital. At some time on September 19 or 20, 1988, Flaherty was admitted to New England Medical Center with a diagnosis of “sepsis” and “septic arthritis.” He remained there until his death.

4. Tender of $598.50 payment. A check of $598.50, signed by Donald J. Anni-no, dated September 23, 1988, and payable to Marsh was mailed to Marsh on an undetermined date and received on an undetermined date.

5. Dr. Flaherty’s death. Dr. Flaherty died at 4:21 a.m., September 29, 1988, from “cardiac arrest” incident to “sepsis” and “septic arthritis.”

6. Reminder Notice. A machine-generated Reminder Notice, not dated, addressed to Flaherty at 955 Main Street, Winchester, MA 01840 was sent by Marsh and delivered by mail to that address. The Reminder Notice states, “Make check payable to: Marsh and McLennan Group Associates, P.O. Box 2204, Bedford Park, IL 60499-2204,” “Total Amount Due $299.25,” and “Coverage description: $200,000 Member Life Insurance.” The Reminder Notice *1167 carries the legend “Final Notice” and declares, “Your coverage will lapse unless we receive your payment in our office postmarked no later than October 7, 1988.” At the bottom is the following additional information:

Semi-annual Renewal Premium $855.00
Less credit balance 299.25
Premium credit 256.50
Total premium due 299.25

The top line of this notice reads: “REMINDER NOTICE. IF PAYMENT HAS BEEN MADE, PLEASE DISREGARD.” The record is silent as to precisely when the Notice was mailed and when delivered.

7. Notice of Reduction of Coverage to $100,000. In an envelope postmarked October 5, 1988, Marsh sent a machine-generated notice bearing a date of 09/29/88, addressed to Thomas A. Flaherty, M.D., 955 Main St., Winchester, MA 01890, and saying, “Please be advised that as requested we have reduced your benefit to $100,000. Your check for $299.25 has been applied to your account and you are currently paid to 3-1-89....”

8. Refund. By check dated November 15, 1988, payable to “Thomas A. Flaherty, M.D., 955 Main St., Winchester, MA 01840,” Marsh attempted to tender a refund in the amount of $799.56, together with an attachment showing the word “deceased” under the printed heading, “Explanation of Refund.” Marsh’s address, printed on the check, is 222 S. Riverside Plaza, Chicago, Illinois 60606.

9. Provident’s Tender of $100,000. Provident tendered a payment of $100,000 by check dated February 24, 1989, payable to “Pediatricians, Inc., 175 Washington Street, Winchester, MA 01840.” The check was enclosed in an envelope with a letter reciting that it represented “Group Life Benefits due ... for the death of Thomas Anthony Flaherty, which occurred on December 29, 1988,” and that “Dr. Flaherty reduced his Life Insurance to $100,000 on September 1, 1988.” The voucher attached to the check, however, stated the “DATE OF LOSS” as “September 29, 1988.”

After these events, several exchanges took place between Provident and Pediatricians.

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Bluebook (online)
965 F.2d 1164, 1992 WL 101662, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pediatricians-inc-v-provident-life-accident-insurance-co-ca1-1992.