Radecki v. Mutual of Omaha Insurance

583 N.W.2d 320, 255 Neb. 224, 1998 Neb. LEXIS 197
CourtNebraska Supreme Court
DecidedAugust 21, 1998
DocketS-96-1294
StatusPublished
Cited by26 cases

This text of 583 N.W.2d 320 (Radecki v. Mutual of Omaha Insurance) is published on Counsel Stack Legal Research, covering Nebraska Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Radecki v. Mutual of Omaha Insurance, 583 N.W.2d 320, 255 Neb. 224, 1998 Neb. LEXIS 197 (Neb. 1998).

Opinion

Gerrard, J.

I. INTRODUCTION

Tadeusz Radecki submitted an application to Mutual of Omaha Insurance Company (Mutual of Omaha) for long-term disability benefits, claiming that he was totally disabled due to a major depressive episode. Mutual of Omaha denied Radecki’s claim for benefits because it disputed whether he became totally disabled while covered by the policy and because it contended that Radecki’s claim was not timely made. Radecki then brought an action against Mutual of Omaha for bad faith and breach of contract, and the case was ultimately tried to a jury. At the close of Radecki’s case in chief, the trial court sustained Mutual of Omaha’s motion for a directed verdict on the bad faith cause of action because it found that Mutual of Omaha had a reasonable basis for denying the claim as being untimely. The jury returned a verdict in favor of Radecki on the breach of contract cause of action and awarded Radecki damages equal to 24 months of disability benefits. The district court entered judgment on the verdict.

On appeal, Radecki asserts that the trial court erred by, inter alia, directing a verdict in favor of Mutual of Omaha on the bad *226 faith cause of action. On cross-appeal, Mutual of Omaha argues that the trial court erred in overruling its motions for a directed verdict and judgment notwithstanding the verdict on the breach of contract cause of action. Because we determine that Mutual of Omaha did not engage in bad faith as a matter of law and that there was a factual dispute with respect to the breach of contract action which was properly submitted to the jury, we affirm the judgment of the district court.

II. FACTS

Radecki was employed as an associate professor in the department of computer science at the University of Nebraska at Lincoln (UNL) beginning on August 19, 1985. During Radecki’s employment at UNL, he was covered by a long-term disability insurance policy issued by Mutual of Omaha. Beginning in April 1989, Radecki was treated by internist James A. Fosnaugh, M.D. Radecki’s chief complaints were fatigue and an inability to concentrate. In January 1990, Fosnaugh prescribed an antidepressant for Radecki.

On February 13, 1990, the chairman of the computer science department at UNL recommended to the dean of the college of arts and sciences that Radecki not be reappointed for the 1991-92 academic year. The report noted concerns with Radecki’s ability to communicate with students and general teaching ability. The dean of the college of arts and sciences adopted the recommendation, and Radecki was informed of the decision. During the spring of 1991, Radecki devoted himself exclusively to research projects. Radecki testified that he continued to work on research projects for UNL during the summer of 1991.

Radecki saw Fosnaugh again on April 2, 1992. At that time, Fosnaugh indicated that Radecki was as depressed as ever but wished to stop taking the antidepressant medication. At this point, Fosnaugh referred Radecki to a psychiatrist, J. Bastani, M.D. Radecki was first seen by Bastani on April 14 when he was no longer an insured under the policy.

On December 3, 1992, one of the attorneys that previously represented Radecki requested an application for long-term disability benefits from Mutual of Omaha. Radecki ultimately submitted his application to Mutual of Omaha on March 17, 1993. *227 In the application, Radecki indicated that he first became disabled on May 18, 1991, which was the day after UNL’s spring semester ended. UNL stated on part B of the application that Radecki was covered by the long-term disability policy through August 31, 1991. Bastani, who completed part C of the application, stated that he did not begin seeing Radecki until April 14, 1992.

On July 2, 1993, Mutual of Omaha denied Radecki’s claim. The denial letter stated that because Radecki’s appointment with UNL ended on August 31,1991, his coverage would have ended on midnight as of that date. The letter further stated that the information that Mutual of Omaha had received certified disability only beginning on April 14,1992. Since disability began after the termination of coverage, Mutual of Omaha declined to approve benefits. The letter went on to quote the policy language regarding proof of loss requirements, as follows:

The claim form is due:
a. Within 90 days after the end of the period for which we are liable; and
b. At least once every 90 days after that period as long as you are totally disabled.
If you do not send us the claim form when due, we will still honor the claim if you send us the claim form as soon as reasonably possible. However, unless you are legally incapable, the claim form must be sent to us no later than one year after items stated in a and b above.

The letter then informed Radecki that he could appeal the decision by providing additional information within 60 days.

Mutual of Omaha received Radecki’s appeal on November 10,1993. Two claims supervisors at Mutual of Omaha independently evaluated Radecki’s appeal, and both agreed the denial should be upheld. On November 15, Mutual of Omaha informed Radecki that it was upholding the denial. Mutual of Omaha stated that (1) Radecki did not meet the definition of total disability and did not have verification of total disability and verified treatment by a physician prior to the date his insurance coverage ended and (2) Radecki had not complied with the filing requirement. Mutual of Omaha changed its position from its first denial letter and stated that Radecki last worked on May *228 17, 1991, rather than August 31, and therefore, that the claim form should have been submitted by February 18, 1992, and in no event after February 18, 1993.

Radecki then filed the instant lawsuit against Mutual of Omaha, claiming breach of contract and bad faith. Both parties obtained further medical reports from various psychiatrists. The medical reports obtained by Radecki reveal that he was totally disabled by at least May 18,1991. The medical reports obtained by Mutual of Omaha, on the other hand, do not indicate total disability at that time.

At trial, the court granted Mutual of Omaha’s motion for a directed verdict on the issue of bad faith, and the breach of contract theory was submitted to the jury. The jury found for Radecki and awarded him $78,916.80, which is equal to 24 months of benefits. The trial judge then reduced the award by $15,955.20, the amount of Social Security benefits Radecki received over 24 months, pursuant to a coordination of benefits provision in the policy, and awarded Radecki attorney fees.

III. ASSIGNMENTS OF ERROR

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Bluebook (online)
583 N.W.2d 320, 255 Neb. 224, 1998 Neb. LEXIS 197, Counsel Stack Legal Research, https://law.counselstack.com/opinion/radecki-v-mutual-of-omaha-insurance-neb-1998.