Phillips v. Clark County School District

903 F. Supp. 2d 1094, 2012 WL 4604466, 2012 U.S. Dist. LEXIS 141633
CourtDistrict Court, D. Nevada
DecidedSeptember 30, 2012
DocketCase No. 2:10-cv-02068-GMN-GWF
StatusPublished
Cited by2 cases

This text of 903 F. Supp. 2d 1094 (Phillips v. Clark County School District) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phillips v. Clark County School District, 903 F. Supp. 2d 1094, 2012 WL 4604466, 2012 U.S. Dist. LEXIS 141633 (D. Nev. 2012).

Opinion

ORDER

GLORIA M. NAVARRO, District Judge.

Pending before the Court is the Motion for Partial Summary Judgment Regarding Breach of Contract (ECF No. 27), filed by Plaintiff LaQuan Phillips (“Plaintiff’). Defendant National Union Fire Insurance Company (“Defendant”) filed a Response (ECF No. 33) and Plaintiff filed a Reply (ECF No. 35). For the reasons discussed below, Plaintiffs Motion is DENIED.

Also pending before the Court is the Cross Motion for Summary Judgment (ECF No. 34) filed by Defendant. Plaintiff filed a Response (ECF No. 42) and Defendant filed a Reply (ECF No. 57). For the reasons discussed below, Defendant’s Motion is GRANTED in part and DENIED in part.

I. BACKGROUND

This case arises from a tragic injury suffered by Plaintiff, LaQuan Phillips (“Plaintiff’), during a high school football game on September 5, 2008. (Mot. for Partial Summ. J. 3:13-15, ECF No. 27.) Pursuant to an insurance policy purchased by Clark County School District, National Union Fire Insurance Company (“Defendant”) paid for Plaintiffs medical bills above the deductible stated in that insurance policy.1 (Id. at 3:20-23.) However, Defendant refused to pay the $500,000.00 catastrophe cash benefit (“Cash Benefit”) under the subject insurance policy. (Id. at 2:28-3:2.) Thus, Plaintiff filed this suit seeking payment of this Cash Benefit. (Id. at 3:4-9.)

A. Plaintiffs Injury

In 2008, Plaintiff was the captain of the Green Valley High School football team. (Compl. ¶ 11, ECF No. 1-2.) On September 5, 2008, Plaintiff was participating in a football game against Centennial High School when he was hit by another player. (Id.) As a result of injuries sustained from this hit, Plaintiff was “diagnosed as a C4 quadriplegic and immediately underwent a C3-4 anterior cervical discectomy and C3-C7 laminectomies for decompression.” (Mot. for Partial Summ. J. 3:17-19, ECF No. 27.)

B. The Insurance Policy

In April 2008, just prior to the Plaintiffs September 5, 2008 injury, the Clark County School District purchased an insurance policy for the benefit of the school district’s student athletes. (Pl.’s Mot. Partial Summ. J. 4:5-6, ECF No. 27.) Notably, this insurance policy included a Catastrophe Cash Benefit Rider (the “Rider”) that would provide a cash payment for those students who suffered sufficiently devastating injuries during interscholastic activities. (Id. at 2:23-26.) This provision provided that:

Catastrophe Cash Benefit. If Injury to the Insured results, within 180 days of the date of the accident that caused the Injury, in Paralysis or Coma, the Company will pay a benefit under the conditions described in this Rider. In order for a benefit to be payable under this Rider, the Paralysis or Coma must continue for a Waiting Period of 6 consecutive months, must be determined by a Physician to be permanent and irreversible at the end of that Waiting Period, and must result in Disability.

[1097]*1097(Id. at Ex. 2, ECF No. 27 (emphasis added).) Thus, the Rider requires “Paralysis” and “Disability” before a student is entitled to the $500,000.00 cash benefit. (Id.) To that end, the Rider also defines “Paralysis” as “the complete loss of function in a part of the body as a result of neurological damage, as determined by a Physician.” (Id.) Additionally, under the Rider, a student is “Disabled” when that student “is unable while under the regular care of a Physician, to engage in any of the usual activities of a person of like age and sex whose health is comparable to that of the [student] immediately prior to the accident.” (Id.) Finally, the determination that the student is paralyzed must come from a Physician, as defined by the Rider. (Id.) The Rider defines “Physician” as a “licensed practitioner of the healing arts acting within the scope of his or her license who is not 1) the Insured; 2) an Immediate Family Member; or 3) retained by the Policyholder.” (Id.)

C. Defendant’s Denial of the Catastrophe Cash Benefit

Since Plaintiff’s injury, he received regular treatment from Robert Voy, M.D. (“Dr. Voy”), who practices in general medicine and sports medicine. (Id. at 5:17-20.) As such, more than eight months after Plaintiffs injury, Defendant wrote to Dr. Voy requesting “additional medical records,” to be used in evaluating whether Plaintiff qualified for the cash benefit. (Id. at Ex. 5, ECF No. 27.) Defendant specifically informed Dr. Voy that awarding the cash benefit under the Rider required that “[a] physician must determine if the paralysis is complete, permanent and irreversible.” (Id. (alteration in original).) Dr. Voy responded that, in his medical opinion, Plaintiff was paralyzed and that paralysis was complete, permanent, and irreversible. (Id. at Ex. 6, ECF No. 27.) Specifically, on May 28, 2009, Dr. Voy informed Defendant that, although Plaintiff made improvements throughout his treatment, Plaintiff was “presently a quadriplegic from the neck down including total paralysis of both upper and lower extremities.” (Id.) Dr. Voy also informed Defendant that Plaintiff still faced substantial limitations and disabilities with his hands, arms, legs, and organs. (Id. at 6:22-24 (quoting Ex. 6, Letter of Dr. Voy.) Moreover, Dr. Voy opined that Plaintiffs “upper extremity status [was] permanent and irreversible,” and that “with a reasonable degree of medical certainty, after nine months of continued therapy, [Plaintiffs] disability is permanent.” (Id. at 6:25-27 (quoting Ex. 6, Letter of Dr. Voy).)

After Defendant received Dr. Voy’s response, Defendant arranged to have these records reviewed by its own retained expert, Leonid L. Topper, M.D. (“Dr. Topper”). (Def.’s Resp. to Pl.’s Mot. Partial Summ. J. 6:5-6, ECF No. 33.) Thereafter, Dr. Topper spent .7 hours, or 42 minutes, reviewing Plaintiffs medical records. (See Pl’s Resp. to Def.’s Mot. Summ. J., Ex. 13, ECF No. 42-13.) On June 19, 2009, Dr. Topper concluded that Plaintiff did not qualify for the Cash Benefit. (Def.’s Resp. to Pl.’s Mot. Partial Summ. J. Ex. 2 at 55-58, ECF No. 33-2.) Thus, despite Dr. Voy’s letter stating to the contrary, Defendant sent a letter to Plaintiffs legal guardian stating that “no benefits [were] payable at th[at] time.” (Mot. Partial Summ. J. Ex. 7, ECF No. 27.) Specifically, Plaintiff was denied payment of the Cash Benefit via a letter dated June 23, 2009 because his injuries failed to meet the Defendant’s definitions of “disability and paralysis.” (Id.)

D. Plaintiffs Current State of Health

Plaintiff began making progress before he was discharged from the hospital. First, in November 2008 — two months af[1098]*1098ter the injury, doctors noted that Plaintiff “managed a few steps with one person with moderate assist.” (Def.’s Resp. Mot. Summ. J. Ex. 1, at 2, ECF No. 33-1.) At the same time, however, doctors noted that Plaintiff was “lacking trunk and pelvic control in muscle activity.” (Id.) Additionally, the doctors observed that Plaintiff still suffered from “neurogenic bowel and bladder,” thus, requiring “4-6 hour catheterizations” and “bowel care ... every other day.” (Id.)

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903 F. Supp. 2d 1094, 2012 WL 4604466, 2012 U.S. Dist. LEXIS 141633, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phillips-v-clark-county-school-district-nvd-2012.