Yahiro v. Northwestern Mutual Life Insurance

168 F. Supp. 2d 511, 2001 U.S. Dist. LEXIS 5864, 2001 WL 357303
CourtDistrict Court, D. Maryland
DecidedFebruary 6, 2001
DocketCIV. A. WMN-99-1621
StatusPublished
Cited by13 cases

This text of 168 F. Supp. 2d 511 (Yahiro v. Northwestern Mutual Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Yahiro v. Northwestern Mutual Life Insurance, 168 F. Supp. 2d 511, 2001 U.S. Dist. LEXIS 5864, 2001 WL 357303 (D. Md. 2001).

Opinion

MEMORANDUM

NICKERSON, District Judge.

Before the Court are cross motions for summary judgment. Paper Nos. 20 (Plaintiffs Motion for Partial Summary Judgment) and 22 (Defendant’s Motion for Summary Judgment). The motions are ripe for decision. Upon a review of the motions and the applicable case law, the Court determines that no hearing is necessary and that Defendant’s motion will be granted. 1

I. FACTUAL BACKGROUND

This case arises out of a dispute between Plaintiff Martin Yahiro, a board certified orthopaedic surgeon, and Defendant Northwestern Mutual Life Insurance Company over Plaintiffs entitlement to disability payments under three occupational policies issued to Plaintiff by Defendant. Plaintiff suffers from repeated and debilitating episodes of lightheadedness, diaphoresis, nausea, and vomiting that render him unable to safely perform surgery. While Defendant has made, and continues to make, partial disability payments under the policies, Plaintiff has filed this action seeking payments for total disability. The relevant facts are as follows.

Plaintiff began practicing orthopaedic surgery sometime around 1989. Beginning in June of 1995, Plaintiff was employed with the Greater Chesapeake Or-thopaedic Associates, LLC [GCOA]. While working at GCOA, Plaintiff treated patients both surgically and non-surgically. In his initial request for disability benefits, Plaintiff described his principal duties pri- or to his disability as follows: “office based practice, care of patients in office — 65% of time; hospital-based, care of in-patients, 10% of time; surgery, operative care of patients, 25% of time.” Def. Exh. 9, Plaintiffs Request for Disability Payments, January 20,1997.

Although Plaintiff has suffered from the “episodes” of which he now complains for most of his career as an orthopaedist, it was not until January 1997 that he ceased performing surgeries. 2 Once he could no longer perform surgery, Plaintiff continued in a “non-surgical office-based orthopedic practice” for over two years which included seeing non-operative referrals from the emergency room and patients that did not wish to wait as long as would be required to see other doctors in his practice. See *513 Def. Exh. 10, 3 Def. Exh 1, Plaintiffs Deposition, at 179-197. Although there is considerable dispute as to the amount of economic contribution Plaintiff was able to make to GCOA after he stopped operating, it is clear that he continued to generate significant income for the practice. See Def. Exh. 14. After March 1, 1997, Plaintiff salary was reduced to $30,000 per year.

While employed with GCOA, Plaintiff was also a member of the faculty for the orthopaedic residency program at Union Memorial Hospital with regular teaching and administrative responsibilities. As a member of the faculty, Plaintiff was “expected to participate in resident teaching conferences, x-ray rounds with residents in the emergency room during the weeks that [he was] on call, to attend in resident clinics and to assist the resident’s in surgery when indicated.” PI. Exh. 30. After January 1997, Plaintiff continued teaching but the allocation of his time was shifted to more clinical and non-surgical matters. His salary for the teaching position actually increased, from $28,000 to $36,000. Thus, Plaintiffs combined salary in 1998 from his positions with GCOA and Union Memorial was about $65,000.

Plaintiff resigned from his positions at GCOA and Union Memorial in March of 1999 and took a fall time position at the United States Food and Drug Administration, where he had been employed prior to coming to GCOA. Although Plaintiff speculates that he would have been terminated had he not resigned, there is no evidence that Plaintiff was forced, or even asked to resign.

Plaintiff had three disability policies with Defendant. The first two policies, D 485 359 and D1 024 436, with issue dates of August 30, 1986, and January 21, 1994, respectively, contain the following provisions, in relevant part:

Total Disability.... [T]he Insured is totally disabled when he is unable to perform the principal duties of his occupation.
Partial Disability. The Insured is partially disabled when:
a. he is unable:
— to perform one or more of the principal duties of his occupation; or
— to spend as much time at his occupation as he did before the disability started; and
b. he has at least a 20% Loss of Earned Income.
Occupation. The words “his occupation” mean the occupation of the Insured at the time he becomes disabled. If the Insured is regularly engaged in more than one occupation, all of the occupations of the insured at the time he becomes disabled will be combined together to be “his occupation.”

The third policy, D1 156 861, contains similar terms:

Total Disability.... [T]he Insured is totally disabled when he is unable to perform the principal duties of his occupation.
If the Insured can perform one or more of the principal duties of the regular occupation, the Insured is not totally disabled; however, the Insured may qualify as partially disabled.
Partial Disability. The Insured is partially disabled when:
a. The Insured is unable:
— to perform one or more but not all of the principal duties of the regular occupation; or
*514 — to spend as much time at the regular occupation as before the disability started; and
b. the Insured has at least a 20% Loss of Earned Income; and
c. the Insured is gainfully employed in an occupation.
Regular Occupation.
The words “regular occupation” mean the occupation of the Insured at the time the Insured becomes disabled. If the Insured is regularly engaged in more than one occupation, all of the occupations of the Insured at the time the disability starts will be combined together to be “the regular occupation.”
If the insured is exclusively engaged in:
— a medical or dental specialty of which board certification is available; or
— the specialty of trial law that specialty is the “regular occupation.”

Plaintiffs argument for summary judgment is straightforward. Because the terms “occupation” and “principal duties” are not defined in any of the policies, they are to be given their “common man” or dictionary definitions. Plaintiff argues that “the average layperson would agree that the principal duty of an orthopaedic surgeon is surgery.” Plaintiffs Reply at 12. As Plaintiff is no longer able to operate, “Northwestern therefore loses.” Id.

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Bluebook (online)
168 F. Supp. 2d 511, 2001 U.S. Dist. LEXIS 5864, 2001 WL 357303, Counsel Stack Legal Research, https://law.counselstack.com/opinion/yahiro-v-northwestern-mutual-life-insurance-mdd-2001.