Carrington Estate Planning v. Reliance Standard

• Decision Date: 06 May 2002
• Docket Number: No. 00-17491.,00-17491.
• Parties: CARRINGTON ESTATE PLANNING SERVICES, a Nevada corporation individually and on behalf of Gerken Management Co., Inc. Money Purchase Plan, Plaintiff-Appellant, and Weisman Family Trust; Adams Family Trust; Larry Jones; Paula Jones; Dale Montgomery; Pamela Montgomery; ED Sandala, Plaintiffs, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, an Illinois corporation, Defendant-Appellee.
• Court: U.S. Court of Appeals — Ninth Circuit

289 F.3d 644

CARRINGTON ESTATE PLANNING SERVICES, a Nevada corporation individually and on behalf of Gerken Management Co., Inc. Money Purchase Plan, Plaintiff-Appellant, and Weisman Family Trust; Adams Family Trust; Larry Jones; Paula Jones; Dale Montgomery; Pamela Montgomery; ED Sandala, Plaintiffs, v. RELIANCE STANDARD LIFE INSURANCE COMPANY, an Illinois corporation, Defendant-Appellee.

No. 00-17491.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted February 14, 2002.

Filed May 6, 2002.

Richard M. Waugh, Phoenix, AZ, for the plaintiff-appellant.

Joshua Bachrach, Rawle & Henderson, Philadelphia, Pennsylvania; Mark W. Flory and Angela Lui Walsh, Harrington, Foxx, Dubrow & Canter, San Diego, CA; and David W. Davis, Turley, Swan & Childers, Phoenix, AZ, for the defendant-appellee.

Appeal from the United States District Court for the District of Arizona; Earl H. Carroll, District Judge, Presiding. D.C. No. CV-99-00616-EHC.

Before REINHARDT, MAGILL,^* and FISHER, Circuit Judges.

OPINION

FISHER, Circuit Judge.

Carrington Estate Planning Services ("Carrington") appeals the district court's summary adjudication of its claim for benefits under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. 1132(a)(1)(B). The district court based its grant of summary judgment on the finding that, as a matter of law, the notice-prejudice rule applicable to insurance policies under Rhode Island and Arizona law does not apply to a notice of disability requirement for extension of benefits under a life insurance contract's waiver of premium provision. We hold that, because the insurance policy at issue is a contract of adhesion, the notice provision is part of the conditions requiring proof of claim filed within a certain time limit and enforcement of the provision would result in a technical forfeiture unrelated to the merits of the claim, the notice-prejudice rule under Arizona and Rhode Island law is applicable to the notice of disability requirement in the waiver of premium provision. We therefore reverse and remand for further proceedings.

FACTUAL AND PROCEDURAL HISTORY

Pursuant to a "viatical agreement,"¹ Walter Zipoy assigned to Carrington the rights to receive benefits under an ERISA-regulated life insurance policy provided to the employees of Victoria Creations by Reliance Standard Life Insurance Company ("Reliance"). Soon after executing the viatical agreement with Carrington, Zipoy left work at Victoria Creations due to complications from the treatment of acquired immune deficiency syndrome ("AIDS"). He never returned to work in that or any other job and died from AIDS-related complications less than two years later. Victoria Creations continued to pay the premium on Zipoy's policy until after his death.

Upon Zipoy's death, Carrington submitted to Reliance a claim for the benefits due under the policy. Reliance rejected the claim because Zipoy was not an employee at the time of his death and neither he nor Carrington had submitted to Reliance notice of his total disability within one year of its onset as required for extension of benefits under the policy's Waiver of Premium in Event of Total Disability ("disability waiver") provision.²

Carrington brought this suit under 29 U.S.C. 1132(a)(1)(B), which provides: "a civil action may be brought — by a participant or beneficiary — to recover benefits due to him under the terms of his plan...." Carrington argues that, under the "notice-prejudice rule" applicable in Arizona and Rhode Island,³ the late filing of proof of disability cannot allow Reliance to avoid liability absent a showing of prejudice. The district court granted summary judgment to Reliance, finding that the notice-prejudice rule did not apply to the policy's proof of disability provision. We review this issue of law de novo, see In re Cybernetic Servs., Inc., 252 F.3d 1039, 1045 (9th Cir.2001), and reverse.

ANALYSIS

Under Rhode Island and Arizona law, an insurer may not "rely on any of the so-called `notice' provisions of its policy unless it ... demonstrate[s] that it ha[s] been prejudiced by the lack of notice." Siravo v. Great Am. Ins. Co., 122 R.I. 538, 410 A.2d 116, 117 (R.I.1980); accord Zuckerman v. Transamerica Ins. Co., 133 Ariz. 139, 650 P.2d 441, 445 (Ariz.1982) ("[I]n the absence of prejudice, policy conditions which require the giving of `notice of loss' or the filing of `proof of loss' within a specified time cannot be applied to work a forfeiture of the insured's claim."). The notice-prejudice rule recognizes that "[t]he primary and essential part of the contract [is] insurance coverage, not the procedure for determining liability," Donahue v. Associated Indem. Corp., 101 R.I. 741, 227 A.2d 187, 191 (R.I.1967); accord Zuckerman, 650 P.2d at 445 ("[I]t must not be forgotten that the primary function of insurance is to insure"), and that "the notice requirement serves to protect insurers from prejudice, ... not ... to shield them from their contractual obligations" through "a technical escape-hatch." Ins. Co. of Pennsylvania v. Associated Int'l Ins. Co., 922 F.2d 516, 523 (9th Cir.1991) (quoting Miller v. Marcantel, 221 So.2d 557, 559 (La.Ct.App.1969)); see also Zuckerman, 650 P.2d at 445 (explaining the purpose of the rule as "to prevent technical forfeitures such as would ensue from an unreasonable enforcement of a rule of procedure unrelated to the merits"). "Hence, it has been stated that when the late notice does not prejudice the insurer `the reason behind the notice condition in the policy is lacking, and it follows neither logic nor fairness to relieve the insurance company of its obligations under the policy in such a situation.'" Ins. Co. of Pennsylvania, 922 F.2d at 523 (quoting Trustees of the Univ. of Pennsylvania v. Lexington Ins. Co., 815 F.2d 890, 897-98 (3d Cir.1987)).

In both Arizona and Rhode Island, courts have applied the notice-prejudice rule broadly when (a) the insurance policy is a contract of adhesion, Zuckerman, 650 P.2d at 446; Siravo, 410 A.2d at 118, (b) "the clause in question forms part of the policy `conditions' which require that notice of loss and proof of claims be filed within certain time periods," Zuckerman, 650 P.2d at 445; accord Globe Indem. v. Blomfield, 115 Ariz. 5, 562 P.2d 1372, 1374 (Ariz.Ct.App.1977) ("An insurer cannot withdraw coverage on the ground that a condition such as notice has not been met unless the insurer can show that it was prejudiced by the act of the insured."), and (c) enforcement of the provision would result in a "technical forfeiture," Zuckerman, 650 P.2d at 445, or "technical breach," Siravo, 410 A.2d at 121, unrelated to the merits of the claim. Applying these factors to the case at hand, we conclude that the district court erred in finding that the notice-prejudice rule under Arizona and Rhode Island law has no application to the notice of disability requirement for the disability waiver.

There is no dispute that the policy is a contract of adhesion drafted entirely by Reliance.⁴ The "proof of Total Disability" requirement is similar in form and function to the kinds of "proof of claim" and "proof of loss" provisions to which the notice-prejudice rule is regularly applied. See Id. at 117; Zuckerman, 650 P.2d at 445; cf. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1089 (9th Cir.), cert. denied, 528 U.S. 964, 120 S.Ct. 398, 145 L.Ed.2d 310 (1999) (explaining that the phrase "satisfactory written proof" may be considered "a variant of the very old phrase `satisfactory proof of loss'"). For the purposes of summary judgment, viewing the facts in the light most favorable to Carrington, we assume that Zipoy became totally disabled while he was insured and therefore would have been entitled to an extension of coverage until the time of his death had he (or Carrington) given Reliance notice of Zipoy's disability within one year from the date it began.⁵ Thus, enforcement of the requirement that notice of disability be received within one year from the date it began would result in a technical forfeiture of the policy's benefits unrelated to the merits of Carrington's claim that the policy qualified for extension under the disability waiver. See J.C. Penney Life Ins. Co. v. Warren, 268 Ark. 1132, 599 S.W.2d 415, 417 (Ark.1980) (explaining that under a disability waiver provision, "[i]t is the existence of disability that fixes liability and not the proof thereof").

Reliance has not cited, and we have not found, any case in Arizona, Rhode Island or elsewhere refusing to apply the notice-prejudice rule...