Crumbliss v. Nw. Mut. Life Ins. Co.

• Decision Date: 17 April 2020
• Docket Number: CIVIL ACTION FILE NO. 1:19-CV-892-TWT
• Parties: Sandra CRUMBLISS, Plaintiff, v. NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Northern District of Georgia

455 F.Supp.3d 1376

Sandra CRUMBLISS, Plaintiff,
v.
NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY, Defendant.

CIVIL ACTION FILE NO. 1:19-CV-892-TWT

United States District Court, N.D. Georgia, Atlanta Division.

Signed April 17, 2020

455 F.Supp.3d 1377

Brent J. Savage, Savage, Turner, Durham Pinckney & Savage, Savannah, GA, Carl Foster Lindberg, Mark D. Johnson, Gilbert, Harrell, Sumerford & Martin, P.C., Brunswick, GA, for Plaintiff.

Andrea K. Cataland, Kenton Jones Coppage, H. Sanders Carter, Jr., Fox Rothschild, LLP, Atlanta, GA, for Defendant.

OPINION AND ORDER

THOMAS W. THRASH, JR., United States District Judge

This is an action to recover benefits. It is before the Court on Defendant Northwestern Mutual Life Insurance Company's Motion for Summary Judgment [Doc. 18]. For the reasons that follow, Defendant Northwestern Mutual Life Insurance Company's Motion for Summary Judgment [Doc. 18] is GRANTED.

I. Background

Plaintiff Sandra Crumbliss filed this lawsuit to recover benefits under two term life insurance policies issued to the Plaintiff's deceased husband, Thomas Crumbliss, by Defendant Northwestern Mutual in 2005. Mr. Crumbliss paid the annual premiums for the policies at issue without incident for several years. Def.'s Statement of Material Facts ¶ 9 [Doc. 18-1]. The policies lapsed, however, when Mr. Crumbliss failed to pay the premiums in 2016. Id. ¶¶ 10-11. Mr. Crumbliss passed away on October 11, 2017. Id. ¶ 12. On November 4, 2017, the Plaintiff requested that the Defendant waive the unpaid premiums on the grounds that Mr. Crumbliss was totally disabled due to alcoholism from April of 2016 until his death. Id. ¶ 30. The Defendant denied the Plaintiff's waiver request, and the Plaintiff sued for breach of contract and attorneys' fees. The Defendant now moves for summary judgment.

A. The Policies

Mr. Crumbliss was insured under two term life insurance policies numbered 17008814 and 17086138. Id. ¶ 1. Both policies provide for death benefits of $500,000 to the Plaintiff as the direct beneficiary. Id. The annual premium for Policy No. 17008814 was due each year on July 11 or within a thirty-one-day grace period. Id. ¶ 10. The annual premium for Policy No. 17086138 was due each year on December 11 or within a thirty-one-day grace period. Id. ¶ 11. Both policies stipulate that failure to pay premiums results in termination of coverage. Id. ¶ 4.

Both policies allow the insured party to request waiver of the annual premiums due to total disability. The waiver provisions define "total disability" as:

one which prevents the Insured from engaging in an occupation. For the first 24 months of total disability, an occupation is the one that the Insured had at the time he became disabled. After 24 months, an occupation is one for which the Insured is qualified by education, training or experience. Due regard will be given to his vocation and earnings before he became disabled.

Id. ¶ 6. The insured is entitled to a waiver of his premiums "only if":

• the Insured becomes disabled while this Benefit is in force;

• the disability results from an accident or sickness;

455 F.Supp.3d 1378

• the disability lasts for at least six months.

Id. The insured must provide "proof" of total disability within one year of the start of the disability or, in the alternative, "as soon as reasonably possible." Id. ¶ 7.

B. The Parties' Dispute

The Plaintiff requested that the Defendant waive the unpaid premiums on the grounds that Mr. Crumbliss's debilitating alcoholism prevented him from adequately performing his job as a sales representative for American Family Life Assurance Company of Columbus ("Aflac") from April 2016 until his death. Id. ¶ 30. Medical records that the Plaintiff submitted as part of the waiver request establish that Mr. Crumbliss was admitted to a substance abuse facility called the "The Treehouse" on April 20, 2016. Id. ¶ 32. Mr. Crumbliss's treating physician at the facility, Dr. Sullivan Bryant, identified Mr. Crumbliss's "presenting problem" as "[ethyl alcohol] dependence/withdrawal." Id. ¶ 33. At intake, counselors at the facility described Mr. Crumbliss as having a "serious" and "cooperative" manner; "appropriate" thought processes, speech, and affect; proper orientation to "time, person, place, [and] situation;" and no hallucinations or delusions. Id. ¶ 34. Dr. Bryant indicated that he expected Mr. Crumbliss to return to pre-morbid functioning following discharge. Id. ¶ 32. He did not identify any work-related restrictions. Id.

Mr. Crumbliss was discharged from The Treehouse on May 26, 2016. Id. ¶ 32. Mr. Crumbliss's former supervisor, Lara Carlson, submitted a letter in support of the Plaintiff's waiver request documenting a decline in Mr. Crumbliss's productivity after he returned to work following discharge. Id. ¶ 37. According to Ms. Carlson, Mr. Crumbliss's duties had primarily consisted of field work, but after...