Zander v. Continental Casualty Co.

61 F. App'x 963
CourtCourt of Appeals for the Seventh Circuit
DecidedMarch 24, 2003
DocketNo. 02-2696
StatusPublished
Cited by1 cases

This text of 61 F. App'x 963 (Zander v. Continental Casualty Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zander v. Continental Casualty Co., 61 F. App'x 963 (7th Cir. 2003).

Opinion

ORDER

The district court granted summary judgment in John Zander’s favor, holding as a matter of law that Continental Casualty Company was obliged to pay Zander partial disability benefits under its policy of disability insurance. Continental appeals, arguing that the court below erred in concluding that Zander became disabled after the effective date of Continental’s policy and that a pre-existing conditions clause applied to Zander. Continental also claims that the district court erred by concluding that Continental had conceded that Zander was disabled. We affirm.

I.

John Zander was a colorectal surgeon and partner in the Springfield Clinic, located in Springfield, Illinois. In August 1996, he developed “posterior interosseus neuropathy,” which caused pain in his right arm and hands. On the advice of his doctor, Zander decreased his working hours in November 1996. At first, Zander did not experience a significant decrease in pay: under a complex system of compensation at the clinic, a partner’s bi-monthly compensation was based at least partly on his history of productivity. Zander’s pay remained relatively steady between when he cut back his working hours in November 1996 until he received his paycheck of January 30, 1998. At that point, his bi-monthly salary decreased to less than 60% of what it had been before his disability.

Prudential Insurance Company was the clinic’s insurance carrier when Zander first applied for partial disability benefits in December 1996. Prudential approved his claim and began paying benefits. On February 1, 1997, the clinic switched carriers to Continental and the Continental coverage became active. Continental’s policy, like Prudential’s before it, was an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001, et seq. Zander continued to receive benefits until Prudential withdrew its approval on September 24, 1998, claiming that Zander’s loss did not occur until after the effective date of the Continental policy. Zander then filed a claim with Continental, which denied benefits on the ground that Zander’s disability and corresponding drop in earnings began before February 1,1997, when Prudential’s policy was in effect.

Thus whipsawed, Zander filed suit in the district court against Prudential, Continental, the clinic, and his partners. In relevant part, the district court granted Prudential’s motion for summary judgment against Zander and Zander’s motion for summary judgment against Continental.1 The district court reasoned that Continental had to provide benefits because: (1) under the policy, coverage was triggered when “Zander’s earnings fell below 80% of his predisability earnings” because of disability; (2) Continental admitted that Zander was disabled; and (3) it was undisputed that Zander’s earnings did not drop below the 80% level until after February 1, 1997. The district court also predicated its ruling on the alternate ground that Continental’s Pre-Existing Condition Continuity of Coverage Guarantee (“Guaran[965]*965tee”) mandated coverage. Continental appeals.

II.

Because this is a case involving a benefits determination under ERISA, and because the Continental policy contains no language granting the plan administrator discretionary authority to interpret policy language or determine eligibility for benefits, the district court’s review of Continental’s decision to deny coverage was plenary. Herzberger v. Standard Ins. Co., 205 F.3d 327, 330-33 (7th Cir.2000). Our review, in turn, of the district court’s grant of summary judgment is de novo, construing all facts in favor of Continental, the nonmoving party. Commercial Underwriters Ins. Co. v. Aires Envtl. Servs., Ltd., 259 F.3d 792, 795 (7th Cir.2001). Summary judgment is proper when the “pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Fed. R.Civ.P. 56(c). Thus, “[s]ummary judgment is appropriate if, on the record as a whole, a rational trier of fact could not find for the non-moving party.” Commercial Underwriters, 259 F.3d at 795.

We first address Continental’s contention that the district court erred in concluding that Continental stipulated to Zander’s disability. The district court held that Continental stipulated to Zander’s disability on the basis of paragraph 19 of Continental’s Statement of Undisputed Facts. Paragraph 19 states: “On January 14, 1999, Continental Casualty sent a letter to Plaintiff denying his application for disability benefits on the basis that he became disabled prior to the February 1, 1997 effective date of the Continental Casualty policy” (emphasis added). Although Continental concedes that it worded this stipulation “inartfully,” it argues that the district court erred because Continental “never determined whether Zander’s condition was disabling.” We reject Continental’s position because paragraph 19 says, without qualification, that Zander had a disability. Continental may now regret that judicial admission, but an admission it was, and Continental it is not entitled to controvert it on appeal. Keller v. United States, 58 F.3d 1194, 1198 n. 8 (7th Cir.1995). There is no dispute that Zander is disabled now, so the purpose of the “admission” was to insist that Zander’s disability occurred on Prudential’s watch and not later, when Continental was on the hook.

We now turn to Continental’s argument that the district court erred as a matter of law in construing the policy to trigger coverage when Zander’s pay decreased below 80%, as opposed to when Zander suffered the injury that eventually caused his pay to drop. The relevant language in the policy states that eligibility for partial benefits begins when the participant is “currently earning less than 80% per month of [his] pre-disability earnings due to ... injury or sickness.” The “currently earning less than 80%” proviso is the bone of contention; if Zander met that element before February 1, 1997, Continental would not be liable. The district court reasoned, and Zander argues, that he did not meet that criterion until after February 1, 1997, when, more than one year after his work level decreased, Zander first began to get paid less than 80% of his pre-disability earnings. Continental contends that this position is wrong because it conflates “earnings” and “income.” In Continental’s view, Zander was “earning” less than 80% of his predisability amount in December 1996, when the Prudential coverage was in effect and Zander [966]*966began the reduced work-schedule that led his income to drop beginning with the paycheck of January 30,1998.

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61 F. App'x 963, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zander-v-continental-casualty-co-ca7-2003.