Zaloga v. Provident Life & Accident Insurance Co. of America

671 F. Supp. 2d 623, 2009 U.S. Dist. LEXIS 109648, 2009 WL 4110320
CourtDistrict Court, M.D. Pennsylvania
DecidedNovember 24, 2009
DocketCase 3:09-CV-635
StatusPublished
Cited by49 cases

This text of 671 F. Supp. 2d 623 (Zaloga v. Provident Life & Accident Insurance Co. of America) is published on Counsel Stack Legal Research, covering District Court, M.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zaloga v. Provident Life & Accident Insurance Co. of America, 671 F. Supp. 2d 623, 2009 U.S. Dist. LEXIS 109648, 2009 WL 4110320 (M.D. Pa. 2009).

Opinion

MEMORANDUM

EDWIN M. KOSIK, District Judge.

Plaintiff, Edward J. Zaloga, D.O. (“Zaloga”), filed on December 24, 2008 a Complaint regarding the denial of disability insurance benefits in the Court of Common Pleas for Lackawanna County. (Doc. 1, Ex. 3.) On April 7, 2009, Defendants Provident Life and Accident Insurance Company (“Provident Life”) and Unum Group (“Unum”) removed the case to this court on the basis of diversity jurisdiction. (Doc. 1.) We have subject-matter jurisdiction of this case under 28 U.S.C. § 1332(a), as the diversity and amount-in-controversy *626 requirements are met. 1 Because the parties entered into the insurance contract in the Commonwealth of Pennsylvania, we will apply Pennsylvania law to this action. 2

Defendants filed a Motion to Dismiss and Strike and a supporting brief on April 14, 2009. (Doc. 4.) Plaintiff filed a Brief in Opposition on April 29, 2009. (Doc. 5.) After requesting leave of court to file a reply brief (see Doc. 7, ¶ 4), Defendants filed a Reply Brief on November 17, 2009 (Doc. 8.)

Defendants’ Motion to Dismiss and Strike (Doc. 4) is presently before us and ripe for adjudication. For the reasons that follow, we will deny the Motion.

Factual Background

A brief recitation of the facts alleged in the Complaint are as follows:

Zaloga, an osteopathic physician and surgeon certified in internal medicine and nephrology, applied to Defendant Provident Life for a private disability insurance policy. As a result of his application, Provident Life issued Policy No. 06-338-6102937 (the “Policy”). The Policy is described as non-cancellable and guaranteed at pre-determined premiums until the later of Zaloga’s sixty-fifth birthday or five years. The policy provides for a graduated monthly disability insurance benefit starting with $5,000 a month and increasing annually to $6,400 by July 13, 2004. The benefits are payable after ninety days from the onset of disability, and if the disability was caused by an injury and before Zaloga’s sixty-fifth birthday, the benefits continue for life. The policy defines “total disability,” “your occupation,” and “monthly income.” Zaloga’s own occupation is that of board certified nephrologist.

On June 17, 2002, Dr. Zaloga was injured in a motor vehicle accident from which he suffered orthopedic and neurological injuries to his neck, left arm, and left hand. By July 13, 2004, Zaloga’s injuries had progressively worsened to the point that he was determined to be incapacitated and unable to work as a board certified nephrologist. At the time, Zaloga was involved in numerous ventures, including an affiliation with a medical practice, serving as a locum tenens nephrologist, planning to open his own nephrology practice, and forming a corporation to provide medical services to the Lackawanna County Prison. The timing and overlap of these ventures is immaterial at this stage.

On November 29, and December 15, 2005, Zaloga notified Defendants that he would be filing a claim for disability benefits. Defendants conducted an investiga *627 tion of Zaloga’s claim, which included researching Zaloga’s own occupation and ventures. After the completion of the investigation, Defendants approved Zaloga’s claim, finding as follows: the date of disability was July 13, 2004; Zaloga’s own occupation was a nephrologist; and that Zaloga was unable to perform the duties of a nephrologist. Without any reservation of rights, Defendants approved Zaloga’s disability benefits retroactive to July 13, 2004 after tolling for the ninety day elimination period. Defendants stated that Zaloga would receive monthly $6,400 from that point forward. Defendants also agreed to waive premiums pursuant to the policy, retroactive to July 13, 2004.

From August 15, 2006 to February 15, 2008, neither Zaloga’s medical condition nor his occupational activities changed. During this time, however, Zaloga provided Defendants with monthly supplemental claim forms, which were a prerequisite to receiving his monthly benefit payment. Also during this period, Defendants assigned a new disability benefits specialist to Zaloga’s claim. After reviewing Zaloga’s claim file, the new benefits specialist drafted a letter alleging that Zaloga was not actively working as a nephrologist on the date of his disability and that Zaloga had acted as Chief Medical Officer of a medical services provider from June 1, 2004 forward. The benefits specialist also questioned Zaloga’s earnings prior to his disability. Defendants reevaluated Zaloga’s claim, specifically considering Zaloga’s occupation and whether he had a “dual occupation” prior to the date of his disability. After a review of the internal file but without consulting external sources, Defendants terminated Zaloga’s disability benefits. The details of the basis for the termination are immaterial at this point of the litigation.

Discussion

Defendants argue that we should (1) dismiss Count II of the Complaint for failure to state a claim upon which relief can be granted; (2) dismiss Count IV as a matter of law because Zaloga has not alleged facts sufficient to support such a claim; (3) dismiss and strike Paragraphs 11-17, 37-49, and 81-85 of the Complaint as scandalous, impertinent, irrelevant, and collateral to the issues in the case; and (4) strike from the caption of the Complaint “d/b/a Provident Life and Accident Insurance Company, a Tennessee insurer, The Paul Revere Life Insurance Company, a Massachusetts insurer, And Unum Life Insurance Company, a Maine insurer.”

We will discuss each of these motions in turn.

I. Rule 12(b)(6) IMotion to Dismiss

Defendants argue that Count II of the Complaint, breach of the covenant of utmost fair dealing, should be dismissed for failure to state a claim upon which relief may be granted because the Pennsylvania bad faith statute, 42 Pa. Cons.Stat. Ann. § 8371, is the only remedy for extra-contractual damages. Defendants also argue that Count IV, violations of the Pennsylvania Unfair Trade Practices and Consumer Protection Law (the “UTPCPL”), 73 Pa. Stat. Ann. §§ 201-1 to 201-9.3, should be dismissed because Zaloga has not alleged sufficient facts to survive a Rule 12(b)(6) Motion to Dismiss.

A. Standard of Review

Rule 8 of the Federal Rules of Civil Procedure provides that a pleading must set forth a claim for relief which contains a short and plain statement of the claim showing that the pleader is entitled to relief; the complaint must provide the defendant with fair notice of the claim. See Bell Atl. Corp. v. Twombly, 550 U.S. 544, *628 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
671 F. Supp. 2d 623, 2009 U.S. Dist. LEXIS 109648, 2009 WL 4110320, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zaloga-v-provident-life-accident-insurance-co-of-america-pamd-2009.