Zwerin v. Maccabees Mutual Life Insurance Company

111 F.3d 140
CourtCourt of Appeals for the Tenth Circuit
DecidedJuly 3, 1997
Docket96-8002
StatusPublished

This text of 111 F.3d 140 (Zwerin v. Maccabees Mutual Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zwerin v. Maccabees Mutual Life Insurance Company, 111 F.3d 140 (10th Cir. 1997).

Opinion

111 F.3d 140

97 CJ C.A.R. 625

NOTICE: Although citation of unpublished opinions remains unfavored, unpublished opinions may now be cited if the opinion has persuasive value on a material issue, and a copy is attached to the citing document or, if cited in oral argument, copies are furnished to the Court and all parties. See General Order of November 29, 1993, suspending 10th Cir. Rule 36.3 until December 31, 1995, or further order.

Mark J. ZWERIN, Plaintiff-Counter-Defendant-Appellant,
v.
MACCABEES MUTUAL LIFE INSURANCE COMPANY, Defendant-Appellee,
Northwestern Mutual Life Insurance Company,
Defendant-Counter-Claimant-Appellee.

No. 96-8002.

United States Court of Appeals, Tenth Circuit.

April 21, 1997.
As Modified on Denial of Rehearing July 3, 1997.

Before ANDERSON, McWILLIAMS, and BRISCOE, Circuit Judges.

ORDER AND JUDGMENT*

BRISCOE Circuit Judge.

Plaintiff Mark Zwerin brought this insurance bad faith action against defendants Maccabees Mutual Life Insurance Company (Maccabees) and Northwestern Mutual Life Insurance Company (Northwestern) based on the insurers' decisions to stop paying him disability benefits. Relying on theories of fraud and mistake, Northwestern counterclaimed for restitution of benefits paid and life insurance premiums it had waived between 1985 and 1993. Maccabees did not file a counterclaim. The jury found against Zwerin on all claims and awarded Northwestern restitution on all benefits paid, including waived premiums, for a total amount of $971,299.10. The district court later awarded prejudgment interest, which increased the judgment to $1,349,067.43.

I.

Zwerin purchased one disability insurance policy from Maccabees and two disability policies from Northwestern in 1982 while operating Spaulding Pharmacy in Inglewood, California. In early 1983, Zwerin also purchased six life insurance policies from Northwestern. The disability and life insurance policies contained clauses which waived premiums if Zwerin became disabled as a pharmacist. The disability policies contained incontestability clauses stating the policies could only be rescinded during the first two years following the application dates for misrepresentations in the applications.

Zwerin's pharmacy was initially successful, but profits dropped precipitously from 1981 to 1983. In addition, the pharmacy was robbed five times between 1978 and 1983, and Zwerin constructed a bulletproof glass work area in the store. Zwerin moved to Palm Springs, California, in 1984. As the commute to the pharmacy was approximately two hours, he started working only two to three days each week.

Zwerin filed his preliminary notice of disability with Northwestern on January 9, 1985, based on his alleged inability to stand because of artery blockage. In his application, which was supported by the medical opinion of Dr. Lowell Augustine, Zwerin did not assert any precipitating event leading to his disability, and he claimed he normally worked 50 hours per week. His notice of disability was filed shortly after the incontestability period on the Northwestern policies had expired. In March 1985, Zwerin submitted to Northwestern a signed request for disability benefits. Northwestern began paying Zwerin disability benefits in 1985, and also began waiving premiums on the life insurance policies. Maccabees began paying Zwerin benefits under its disability policy soon thereafter. By the time Zwerin's benefits were stopped in 1993, he was receiving benefits from both companies totaling about $10,000 per month.

Zwerin was required to submit monthly physician's verifications of disability. In February 1985, Dr. M. Williams reported Zwerin was disabled because of occlusive arterial disease and he projected a recovery period of three to six months. Zwerin's March request for benefits reported pain in standing and lower back and thigh pain. Dr. Augustine's report in April stated Zwerin was disabled because he could not stand, sit, or bend. In June, Dr. Orlando Pile found Zwerin disabled due to occlusive artery disease and osteoarthritis in the lumbar spine, with severe leg, back, and thigh pain.

In October 1985, Maccabees had Zwerin evaluated by Dr. Leon Levine, who determined Zwerin was not disabled. Zwerin sold his pharmacy in October 1985. In November 1985, Zwerin was denied social security disability benefits on his claim of having disabling varicose veins, although the agency noted, "We realize that your condition does prevent you from performing your job as a Pharmacist." Append. I at 141. In February 1986, on Zwerin's motion for reconsideration of social security disability benefits, the agency found he could work as a pharmacist.

By April 1986, Dr. Pile had added headaches and dizziness to the problems causing Zwerin's disability and he changed the projected recovery period to "indefinite." In June 1986, Dr. Raymond Baddour found Zwerin "apparently is unable to remain standing for more than 1 hour." Append. I at 161. At Maccabee's request, Dr. Lee Woolf and Dr. G. Stedman Huard examined Zwerin in October 1988. Dr. Woolf determined Dr. Augustine had not prepared an objective medical report and based his findings on Zwerin's subjective allegations. Dr. Woolf found Zwerin to be neither totally nor partially disabled. Dr. Huard found no evidence of vascular disease and found no clinical evidence of any disability. Following these reports, Dr. Pile began citing as causes of disability a torn ligament in Zwerin's knee, paranoia as a result of the robberies, and injuries from being kicked in the back during one of the robberies.

Maccabees terminated Zwerin's benefits in February 1989. Zwerin protested and procured the medical opinion of Dr. Antoine Roberts in March 1989, who concurred with previous diagnoses of total disability, and Maccabees reinstated the benefits.

By June 1989, Dr. Pile's reports omitted any reference to "painful varicosities" and cited back spasms from standing, headaches, and dizziness, and predicted Zwerin would not recover. In a letter dated October 16, 1989, Dr. Pile stated that despite an earlier diagnosis, there was no evidence of vascular disease. However, he noted that Zwerin still had lumbar sacral spinal strain and left knee strain.

Northwestern reviewed the medical reports in January 1991 and determined the circumstances surrounding Zwerin's disability were confusing and that it was "unclear as to both the cause and the degree of Mr. Zwerin's disability." Append. I at 206. In March 1991, Northwestern sent an investigator to interview Zwerin. Zwerin told the investigator he could only walk two blocks at a time, he had difficulty driving, he could stand for only twenty minutes, and he could not lift appreciable weight. At Northwestern's request, Dr. Leonard Kalfuss examined Zwerin in June 1991 and found him not to be disabled. In August 1991, Dr. R. Randolph Powell reviewed Dr. Kalfuss' findings and determined they were extremely thorough but that questions remained.

Zwerin moved to Jackson, Wyoming, in November 1991 and interviewed doctors to be sure they would go along with his disability. He eventually started seeing Dr.

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111 F.3d 140, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zwerin-v-maccabees-mutual-life-insurance-company-ca10-1997.