Zwerin v. Northwestern Mutual

CourtCourt of Appeals for the Tenth Circuit
DecidedApril 21, 1997
Docket96-8002
StatusUnpublished

This text of Zwerin v. Northwestern Mutual (Zwerin v. Northwestern Mutual) 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. Northwestern Mutual, (10th Cir. 1997).

Opinion

UNITED STATES COURT OF APPEALS

FOR THE TENTH CIRCUIT

MARK J. ZWERIN,

Plaintiff-Counter-Defendant- Appellant,

v. No. 96-8002

MACCABEES MUTUAL LIFE INSURANCE COMPANY,

Defendant-Appellee,

NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY,

Defendant-Counter-Claimant- Appellee.

ORDER

Filed July 3, 1997

Before ANDERSON, McWILLIAMS, and BRISCOE, Circuit Judges.

This matter is before the court on appellant’s petition for rehearing. The petition is

denied. The order and judgment entered on April 21, 1997, is modified, however, to delete the last sentence in the first full paragraph on page 11. The modified order and

judgment is attached.

Entered for the Court PATRICK FISHER, Clerk of Court

by: Deputy Clerk

2 F I L E D United States Court of Appeals Tenth Circuit UNITED STATES COURT OF APPEALS APR 21 1997 TENTH CIRCUIT PATRICK FISHER Clerk

v. No. 96-8002 (D.C. No. 94-CV-90-B) MACCABEES MUTUAL LIFE (D. Wyo.) INSURANCE COMPANY,

ORDER AND JUDGMENT*

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

* This order and judgment is not binding precedent, except under the doctrines of law of the case, res judicata, and collateral estoppel. The court generally disfavors the citation of orders and judgments; nevertheless, an order and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3. 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,

-2- 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.

-3- 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

-4- 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.

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