Sims v. Clarendon National Insurance

336 F. Supp. 2d 1311, 2004 U.S. Dist. LEXIS 19545
CourtDistrict Court, S.D. Florida
DecidedSeptember 22, 2004
Docket04-60401
StatusPublished
Cited by41 cases

This text of 336 F. Supp. 2d 1311 (Sims v. Clarendon National Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sims v. Clarendon National Insurance, 336 F. Supp. 2d 1311, 2004 U.S. Dist. LEXIS 19545 (S.D. Fla. 2004).

Opinion

ORDER ON PENDING MOTIONS

ALTONAGA, District Judge.

THIS CAUSE came before the Court upon Defendant, Clarendon National Insurance Company’s Motion to Dismiss or Alternatively, to Stay Litigation and Compel Binding Arbitration (D.E. 4-1, 4-2 & 4-3); and Plaintiff, Iris Sims’ Motion for Leave to File Affidavit of Iris Sims in Support of her Response to Clarendon’s Motion to Dismiss, or Alternatively to Compel Binding Arbitration (D.E.15). The Court has carefully considered the Motions, the written submissions of the parties, the pertinent portions of the record, and applicable law.

I. Sims’ Motion for Leave to File Affidavit of Iris Sims

Plaintiff, Iris Sims (“Sims”), seeks leave to file her Affidavit in response to Defendant, Clarendon National Insurance Company’s (“Clarendon”) Motion to Dismiss, or Alternatively to Stay Litigation and Com *1314 pel Binding Arbitration (“Clarendon’s Motion”).

The party opposing a motion to compel arbitration or to stay litigation pending arbitration “has the affirmative duty of coming forward by way of affidavit or allegation of fact to show cause why the court should not compel arbitration.” Aronson v. Dean Witter Reynolds, Inc., 675 F.Supp. 1324, 1325 (S.D.Fla.1987). “This burden is not unlike that of a party seeking summary judgment.” Id. (citing Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986)). Therefore, “[t]he party opposing arbitration should identify those portions of ‘the pleadings, depositions, answers to interrogatories, and ... ’ affidavits which support its contention.” Id. See also Bertram v. Beneficial Consumer Discount Co., 286 F.Supp.2d 453, 456 (M.D.Pa.2003) (in the context of a motion to compel arbitration, or to stay pending arbitration, “the court may consider the pleadings, documents of uncontested validity, and affidavits or depositions submitted by either party”).

Sims is granted leave based on good cause shown, and the Court has considered Sims’ Affidavit in resolving Clarendon’s Motion, as well as the Complaint and the documents attached as exhibits to the Complaint, the validity of which is uncontested.

II. Clarendon’s Motion to Dismiss, or to Stay Litigation and Compel Arbitration

A. Factual and Procedural Background

Sims, a resident of the State of Florida at all relevant times, applied for and purchased health insurance coverage under a Group Short Term (one year) Major Medical Expense Insurance Policy issued to her by Clarendon. The policy is entitled “The Competitor 12X3 Flex Term Major Medical Short Term Medical Plan, Policy Number 027-40-9679” (the “Policy”), with an effective date of coverage of May 25, 2003.

There are several relevant provisions in the Policy and other governing documents. The Certificate of Insurance issued to Sims has the following provision:

30 DAY RIGHT TO RETURN THE GROUP POLICY
If for any reason You are not satisfied with this Certificate, You may return it to Clarendon within 30 days after You receive it. We will refund any premium paid and the Certificates issued under the Group Policy will be deemed void, just as though it had not been issued.

(Compl.Ex. A, p. 4). Moreover, the Certificate of Insurance states that “the Policyholder ... may be inspected at any reasonable time on request.” (Id.). The Policy states in section GP-20, that “[t]he Certificate [of Insurance provided to the Policyholder] describes the main features of the Group Policy.... In the event of any conflict, the terms of the Group Policy will govern.” (Id. at p. 17 (numbered 14)).

Section GP-20, entitled “General Provisions,” contains an arbitration agreement (the “Arbitration Agreement”), which provides:

Arbitration: Any disputes which You may have under the Group Policy or otherwise with Us or Our authorized Administrator must be arbitrated in accordance with the commercial arbitration rules of the American Arbitration Association [“AAA”]. The right of arbitration may be invoked by either You or Us or both. Judgment upon any arbitration award may be entered in a court of proper jurisdiction. Judicial review is limited in accordance with applicable law.

*1315 (Id. at p. 17 (numbered 14)) (emphasis added). Another clause in Section GP-20 provides:

Legal Proceedings: No proceedings to obtain benefits under the Group Policy-may be brought against Us until the expiration of 60 days after proper written proof of loss and any other documentation necessary to establish what benefits are due under the provisions of the Group Policy have been received by Us. No proceedings may be brought more than 3 years after proof is required to be filed.

(Id. at p. 18 (numbered 15)). Additionally, the Policy contains a merger or integration clause that reads as follows:

Entire Contract: The entire contract consists of the Group Policy, the Application of the Association, Your application form and any other documents requested and accepted by Us. No change in the Group Policy or Your Certificate is valid unless approved by Our executive officer. Such approval must be signed by the officer and attached to the Group Policy and Certificate. No broker, agent or producer can change or waive any provision of the entire contract or any of Our requirements.

(Id.). Finally, the Policy includes the following provision:

Conformity with Statutes: Any provision of the Group Policy that is in conflict with the statutes of the jurisdiction in which the Policyholder is located on such date is hereby amended to conform to the minimum requirements of such statutes.

(Id. Ex. A, p. 18 (numbered 15)) (emphasis added). 1

On or about June 3, 2003, Sims was first informed that she had acute leukemia and began to undergo treatment for this condition soon thereafter, including hospitalization. It is alleged that since June 3, 2003, Sims has incurred and continues to incur medical expenses in connection with the treatment of her leukemia in an amount exceeding $350,000. Sims further alleges that she paid her monthly premiums for coverage under the Policy in a timely manner on the fifteenth day of each month via an automatic deduction from her credit card account. Sims filed a claim with Clarendon for benefits under the Policy to pay the cost of her treatment for leukemia. Sims alleges that Clarendon breached its contract of insurance with Sims by refusing to pay benefits under the Policy to cover the cost of the treatment of her leukemia.

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Bluebook (online)
336 F. Supp. 2d 1311, 2004 U.S. Dist. LEXIS 19545, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sims-v-clarendon-national-insurance-flsd-2004.