Pogue v. Principal Life Insurance Company

CourtDistrict Court, W.D. Kentucky
DecidedAugust 2, 2021
Docket3:14-cv-00599
StatusUnknown

This text of Pogue v. Principal Life Insurance Company (Pogue v. Principal Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, W.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pogue v. Principal Life Insurance Company, (W.D. Ky. 2021).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION

JAMES H. POGUE, ) ) Plaintiff, ) Civil Action No. 3:14-CV-599-CHB ) v. ) ) PRINCIPAL LIFE INSURANCE ) MEMORANDUM OPINION AND COMPANY, ) ORDER ) Defendant. ) )

*** *** *** *** This matter is before the Court on Defendant Principal Life Insurance Company’s Motion for Summary Judgment. [R. 156] Plaintiff James H. Pogue filed a response, [R. 157], Principal filed its reply, [R. 158], both parties filed supplemental briefs, [R. 159; 160], and Principal filed a reply to Pogue’s supplemental response [R. 164].1 The matter is now ripe for resolution. For the following reasons, the Court grants Principal’s Motion for Summary Judgment. I. Factual and Procedural Background The factual background to Pogue’s lawsuits against his disability insurance companies has been previously explained in multiple opinions from this Court and the Sixth Circuit. See Pogue v. Nw. Mut. Life Ins. Co., No. 3:14-CV-00598-CRS, 2018 WL 1189415 (W.D. Ky. Mar. 7, 2018) (Northwestern); Pogue v. Nw. Mut. Life Ins. Co., No. 18-5291, 2019 WL 1376032, at *1 (6th Cir. Feb. 7, 2019) (Northwestern II); Pogue v. Principal Life Ins. Co., No. 3:14-CV-599-CHB, 2019 WL

1 The parties originally filed their summary judgment briefing in 2018 [R. 89; 99; 109], and following remand from the Sixth Circuit, the briefing was re-docketed at R. 156, R. 157, and R. 158. The parties’ briefs cite to the record entries from the original summary judgment briefing; however, the Court’s citation to the record will refer to docket entries for the re- docketed briefs. 1427554, at *1 (W.D. Ky. Mar. 29, 2019) (Principal Life); Pogue v. Principal Life Ins. Co., 979 F.3d 534, 535 (6th Cir. 2020) (Principal Life II). In short, Pogue is a physician who formerly practiced medicine in Nashville, Tennessee. [R. 156-1] In November 2012, he stopped practicing medicine and

in spring of 2013, he filed claims for benefits under his disability insurance policies with Northwestern Mutual Life Insurance Company and Principal Life Insurance Company (the defendant in this matter). [R. 156-10]; Northwestern, 2018 WL 1189415 at *1. In his request for benefits with Northwestern, he claimed that he suffered from a “severe anxiety disorder” and that on “Nov. 9, 2012 [he] had a total nervous breakdown and could no longer think clearly enough to continue practicing medicine.” Northwestern II, 2019 WL 1376032, at *1. He further stated that he voluntarily chose to surrender his medical license “due to a feeling of personal incompetence to handle work stresses.” Id. What he failed to mention was that the Tennessee Board of Medical Examiners had suspended his medical license in November 2012. [R. 156-5]; Principal Life II, 979 F.3d at 535. In an agreed order, the Board suspended Pogue’s license for conduct that amounted to “[g]ross malpractice, or a pattern

of continued or repeated malpractice, ignorance, negligence or incompetence in the course of medical practice” for prescribing or distributing painkiller narcotics to numerous patients without performing the appropriate medical examination or tests and prescribing these narcotics in such quantities and duration that such patients “would likely become addicted,” as well as many other ethical failings and inappropriate conduct in his medical practice. [R. 156-5 p. 39] With this decision in hand, his insurance company (Northwestern) denied Pogue’s claim for benefits because his policy did not cover disability or loss caused by the suspension of a professional license, and Pogue could not show that he was unable to practice medicine due to an actual disability rather than because he lost his medical license. Northwestern, 2018 WL 1189415, at *1. Similarly, in his request for benefits with Principal, Pogue claimed a “nervous breakdown” on November 9, 2012, as well as anxiety and a few other medical issues. [R. 156-10 pp. 2-3] Principal denied Pogue’s claim for benefits because he did “not meet the contractual definition of Total

Disability or Residual Disability under the terms of [his] policy” with Principal. [R. 156-14] Principal’s policy specifically excluded “benefits for any Injury or Sickness which in whole or in part is caused by, contributed to by, or which results from the suspension, revocation, or surrender of [an insured’s] professional or occupational license or certification.” [Id. at pp. 13-14] Like Northwestern, Principal explained in its decision letter that Pogue’s “inability to perform [his] job duties is due to [his] medical license being suspended,” and that even though he has documented medical concerns for several years prior to his license suspension, “it was not until [he] knew there was an ongoing investigation, that eventually resulted in the suspension of [his] medical license, that [he] stopped working,” and claimed to be disabled. [R. 154-14 pp. 14-15] Pogue proceeded to sue both insurers in Jefferson County Circuit Court alleging breach of

contract, common law bad faith, violation of the Kentucky Unfair Claims Settlement Practices Act, and violation of the Kentucky Consumer Protection Act. Northwestern, 2018 WL 1189415, at *1; [R. 1-2]. Both suits were removed to federal court by each defendant. His suit against Northwestern reached summary judgment first, and the district court granted summary judgment to Northwestern. Northwestern, 2018 WL 1189415. The district court found that the suspension of Pogue’s medical license caused or contributed to his alleged disability. Id. at *4-5. Because Pogue’s policy with Northwestern unambiguously excluded benefits for a disability that was caused or contributed to by the suspension of a professional or occupational license, Pogue could not recover under the policy. Id. at *3-4. In the alternative, the district court also concluded that Pogue’s “legal disability” (his license suspension) preceded his alleged “factual disability” (his disabling mental health issues). Id. at *5. The court explained that because disability insurance policies cover factual disabilities and not legal disabilities, if a claimant becomes legally disabled before becoming factually disabled, then the claimant is not entitled to disability benefits. Id. On appeal, the Sixth Circuit held that “the district

court correctly determined that Pogue’s legal disability preceded his factual disability and granted summary judgment in favor of Northwestern Mutual on Pogue’s breach-of-contract claim,” and the Court declined to address whether the suspension of his medical license caused or contributed to his disability. Northwestern II, 2019 WL 1376032, at *4. On March 29, 2019, this Court granted summary judgment to Principal. [R. 139] The Court held that Pogue was barred by issue preclusion from relitigating the issue of whether his license suspension had contributed to his disability because that issue had been raised and actually litigated in a prior proceeding (in Northwestern), the issue had been necessary to the outcome, it had resulted in a final judgment on the merits, and Pogue had a full and fair opportunity to litigate it. [Id.] Pogue appealed, and the Sixth Circuit reversed this Court’s decision. Principal Life II, 979 F.3d at 535. The

Court’s error was that it had given preclusive effect to the district court’s primary ground for summary judgment in Northwestern (the contribution issue), but Pogue had appealed that decision and the Sixth Circuit had affirmed on the district court’s alternative ground (the legal disability preceding factual disability issue), the appellate court having declined to consider the contribution issue. Id. In those situations, as the Sixth Circuit explained, “issue preclusion does not apply to issues an appellate court declines to consider on appeal, even when the appellate court affirms the overall judgment.” Id. at 536.

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Pogue v. Principal Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pogue-v-principal-life-insurance-company-kywd-2021.