Sterling v. Provident Life & Accident Insurance

619 F. Supp. 2d 1242, 2009 U.S. Dist. LEXIS 26154, 2009 WL 811621
CourtDistrict Court, M.D. Florida
DecidedMarch 27, 2009
DocketCase 8:06-CV-2334-T-TGW
StatusPublished
Cited by1 cases

This text of 619 F. Supp. 2d 1242 (Sterling v. Provident Life & Accident Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sterling v. Provident Life & Accident Insurance, 619 F. Supp. 2d 1242, 2009 U.S. Dist. LEXIS 26154, 2009 WL 811621 (M.D. Fla. 2009).

Opinion

ORDER

THOMAS G. WILSON, United States Magistrate Judge.

The plaintiff asserts several claims against the defendants arising from the discontinuation of his disability insurance benefits. Defendant UnumProvident (“Unum”) has filed a Motion for Summary Judgment on all of the plaintiffs claims and defendant Provident Life and Accident Insurance Company (“Provident”) seeks *1244 summary judgment in its favor on all but the plaintiffs breach of contract claim (Doc. 59). The plaintiff has filed an opposition memorandum (Doc. 68).

Summary judgment will be granted for the defendants on the plaintiffs claims that the defendants violated the Connecticut Unfair Trade Practices Act and the Connecticut Unfair Insurance Practices Act (Counts Five and Six), and the plaintiffs contention in Count Two that the defendants’ conduct prior to May 15, 2006, breached Connecticut’s common law duty of good faith and fair dealing, because the plaintiff has failed to create a genuine issue of material fact on these claims and the defendants are entitled to judgment as a matter of law. Further, the plaintiffs allegation of repudiation (contained in Count One) and his claim for punitive damages (contained in Count Two) will be stricken because the plaintiff has failed to create a triable issue on these contentions. However, the motion will be denied as to the plaintiffs claims of negligent infliction of emotional distress and breach of common law duty of good faith and fair dealing on, and after, May 15, 2006, because genuine issues of material fact exist as to these claims. Furthermore, Unum’s Motion for Partial Summa r y Judgment on the claims of breach of contract and breach of common law duty of good faith and fair dealing on the ground that it was not a party to the insurance contract will be denied because further development of this contention is warranted.

I.

The plaintiff, Dr. Anthony Sterling, was an orthopedic surgeon who practiced medicine in Connecticut. In 1983, defendant Provident issued to the plaintiff disability income policy no. 6-334-550334 (“the policy”), which provided monthly benefits of $9,000 in the event of total disability (Doc. 59-3). The benefits were for the plaintiffs lifetime for a disabling “accidental bodily injury” occurring before age 65, or until age 65 for a disabling sickness commencing between ages 50-65 (id., pp. 3, 5).

In the summer of 1998, the plaintiff, who has a history of cervical spine disease, began experiencing neck pain, cramping in his left hand, and spasms in his left wrist and fingers (see Doc. 59-4). An MRI scan showed that the plaintiff had a large osteophyte (bone spur) in his cervical spine causing canal stenosis and marked impingement upon his spinal cord (id.). Surgery to remove the spur and decompress the spinal cord was recommended (id.). The plaintiff was forewarned that, even after a successful operation, he may not be able to continue as a surgeon (id.; Doc. 59-7).

Prior to the surgery, the plaintiff completed a disability claim form because he expected to be temporarily disabled while he recuperated from the surgery (see Doc. 59-6). In response to the question, “When did sickness commence (if applicable),” he wrote, “past month,” and identified “severe spinal stenosis cervical spine” as the impairment (id.). 2 He indicated that he expected to be disabled for approximately six months (see id.). The plaintiff was 57 years old at the time of the surgery.

On September 8, 1998, Dr. Gary M. Bloomgarden performed cervical surgery on the plaintiff (see Doc. 59-8). The operative report indicates that “the calcifications were molded into the dura [the outermost membrane of the spinal cord] and firmly poking into the spinal cord” (id., p. 3). Dr. Bloomgarden noted that they “were able to drill off the calcified liga *1245 ment on the right side, but along with it went the dura to the point that we could actually visualize the anterior aspect of the spinal cord bowing into our decompression .... Unfortunately, on the inferior aspect, we were unable to remove the entire osteophyte ...” (id.). No surgical complications were identified in the operative report (id., p. 1). However, when the plaintiff awoke from surgery, his left arm was paralyzed (Doc. 68-14, p. 48). 3

On September 21, 1998, Provident received the plaintiffs disability claim form that he had previously completed (see Doc. 59-6). In October 1998, the plaintiff spoke with claims representative, Nancy Smith, and Carolyn Craig, a nurse employed by the defendants (see Doc. 57, PLACL00375, 00385). The plaintiff informed them that his left arm was paralyzed due to a leak in his spinal column during surgery (id.). The plaintiff estimated that it would be five to eighteen months before he could return to work (id., PLACL00385-86).

In a letter dated January 9, 1999, Provident informed the plaintiff that he would be receiving disability payments “as a result of [hisj sickness” (Doc. 59, Ex. 10). Howard Kantrovitz, the plaintiffs attorney at the time, was sent a copy of this correspondence (see id.).

In March 1999, A1 Baldassarri, an employee of the defendants, met with the plaintiff in Kantrovitz’s presence regarding the status of the plaintiffs arm and his plans for returning to work (Doc. 68-6, p. 26; Doc. 57, PLACL00142-46). The plaintiff told Baldassarri that he continued to experience paralysis in his left hand as a result of a spinal fluid leak during surgery and that he was informed that he may regain additional use of his hand over the next two to three years (Doc. 57, PLACL00143).

The plaintiffs disability persisted and he continued to receive monthly disability payments of $9,000 under this policy for approximately seven and one-half years, totaling more than $823,000 (see Doc. 59-12, p. 3). The plaintiff stated that he did not have any complaints with the company’s handling of this policy “as long as they were sending [him] what [he] was entitled to” (Doc. 59-21, p. 1).

In correspondence dated March 30, 2006, Provident informed the plaintiff that the benefit period for the policy was scheduled to expire on July 17, 2006 (Doc. 57, PLACL00489). This is consistent with the policy provision that benefits payable for disability grounded in sickness end at age 65, as Dr. Sterling reached age 65 on June 23, 2006 (see Doc. 59-3).

The plaintiffs disability claim was closed on May 11, 2006 (Doc. 68-2, pp. 16-17). On May 15, 2006, the plaintiff told Añila Skende, a disability benefits coordinator, that his disability was not due to sickness, but was caused by an injury to his spinal cord during surgery (Doc. 68-9, pp. 9, 13; Doc. 57, PLACL00577-78). Skende referred the plaintiffs file to her manager, who advised Skende that day to tell the plaintiff that his claim is for sickness, but that he could file an appeal (Doc. 68-9, pp. 13-15; Doc. 57, PLACL00577).

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Bluebook (online)
619 F. Supp. 2d 1242, 2009 U.S. Dist. LEXIS 26154, 2009 WL 811621, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sterling-v-provident-life-accident-insurance-flmd-2009.