George v. Mass. Mut. Life Ins. Co.
| Decision Date | 01 February 2018 |
| Docket Number | Civil Action No. ELH-17-1073 |
| Parties | NANCY F. GEORGE, Plaintiff, v. MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — District of Maryland |
Nancy F. George has filed suit against Massachusetts Mutual Life Insurance Company ("Mass Mutual"), alleging breach of her disability income insurance policy. ECF 2 (Complaint).1 In particular, Ms. George alleges that Mass Mutual owes her unpaid disability benefits of approximately $225,000. She also seeks a declaratory judgment that she was and is disabled under the terms of the policy; that Mass Mutual is obligated to make disability payments under the insurance policy; and that Mass Mutual is not entitled to recoup its disability payments to her in the sum of $152,865. Id. ¶¶ 27-28.
Ms. George is self-represented here. I note, however, that in the period preceding the litigation, she was represented by counsel.2
Now pending is defendant's motion for summary judgment under Fed. R. Civ. P. 56. ECF 16. The motion is supported by a memorandum of law (ECF 16-1) (collectively, "Motion"), and several exhibits. In the Motion, defendant asserts that plaintiff's claims are barred by Maryland's statute of limitations. ECF 16-1 at 1. Plaintiff opposes the Motion (ECF 22, "Opposition"), and she has submitted multiple exhibits. ECF 22-1 to ECF 22-8.3 Defendant replied. ECF 26.
No hearing is necessary to resolve the Motion. See Local Rule 105.6. For the reasons that follow, I shall grant the Motion.
On May 16, 1995, Mass Mutual issued a disability insurance policy ("Policy") to plaintiff, who worked as a "software regulatory consultant." ECF 2, ¶ 9. The Policy was set to expire on May 16, 2012. See ECF 16-2 (Policy); ECF 2, ¶ 10. Pursuant to the terms of the Policy, benefits would be payable upon the occurrence of a disability, which was defined to include a "mental infirmity" that would "reduce the Insured's ability to work." Id. at 5. The monthly benefit was $7,500, after a 90-day waiting period. Id. at 2. The Policy also included extended benefits, applicable under certain circumstances. ECF 2, ¶ 10; ECF 16-2 at 25-26.
On or about August 23, 2010, plaintiff submitted a claim stating that she became partially disabled in May 2009, and that she became totally disabled in June 2010, as a result of severe clinical depression. See ECF 16-4 (); ECF 16-7 at 9 (); seealso ECF 2, ¶¶ 11, 15.4 Defendant never paid benefits for plaintiff's period of partial disability. See ECF 16-6 at 5 (). However, according to plaintiff, defendant paid disability benefits to her totaling $152,865, under a reservation of rights, for the period from September 23, 2010 to May 22, 2012. ECF 16-5 (); see also ECF 16-7 at 9 (); ECF 16-6 at 5.
By letter of May 23, 2012, from defendant to plaintiff's lawyer, Mass Mutual stated that Ms. George did not meet the eligibility requirements under the Policy. ECF 16-7 at 9-12 ("Denial Letter"). Accordingly, Mass Mutual denied Ms. George's claim; advised that the Policy "terminated" as of May 16, 2012; and indicated that Ms. George's benefits ceased as of May 22, 2012. Id. Mass Mutual provided "a final payment" of $6,615.00, representing disability payments for the period of April 23, 2012 through May 22, 2012. Id. at 11. And, the Denial Letter advised plaintiff of her right to pursue Mass Mutual's optional internal appeals process. Id. at 12.
Following the Denial Letter, plaintiff received no further disability payments. See ECF 16-6 at 5. Notably, plaintiff received the Denial Letter and recognized it as such. See ECF 16-6 (excerpt of Maryland Insurance Administration hearing) at 5; ECF 16-7 at 3 (plaintiff's Maryland Insurance Administration complaint).
Plaintiff alleges that following receipt of the Denial Letter, her lawyer provided further information to Mass Mutual. ECF 2, ¶ 17. On October 26, 2012, Mass Mutual sent plaintiff'sattorney another letter denying plaintiff's claim. ECF 22-2 at 2 (letter from Mass Mutual). The letter again advised plaintiff of the company's appeals process. Id. Plaintiff states in her Opposition that on two more occasions she submitted supplemental information "which could well be considered an appeal." ECF 22 at 2. These submissions resulted in two more denial letters from defendant, one on March 28, 2013 (see ECF 22 at 2; ECF 22-3 at 6) and another on July 9, 2013. ECF 22-3 at 2-7. Plaintiff was again advised of defendant's appeals process, allowing for reevaluation of the claim. Id. at 7.
In August 2013, plaintiff, by counsel, formally requested "an appeal review" of the denial of her disability claim. See ECF 22-4; ECF 22-6. Of relevance here, the "appeal review" was conducted internally by a Mass Mutual Assistant Vice President for Benefits Policy & Strategy, and not by any government agency. See ECF 22-4 at 2, 4 (). In a letter dated December 5, 2013, Mass Mutual informed plaintiff, through her lawyer, that it had again determined that she was ineligible for disability benefits under the Policy. ECF 22-4 at 2-4. Notably, Mass Mutual said, id. at 4: "Mass Mutual would be pleased to review any additional information that you care to submit in support of Ms. George's claim."
In March of 2015, and on May 22, 2015, plaintiff submitted still more information to defendant to support her claim. See ECF 22-5 at 2. Defendant conducted another review (id.) and again denied the claim in a letter to plaintiff dated June 10, 2015. Id. at 2-3. The denial was reiterated in a letter from Mass Mutual to plaintiff, dated July 1, 2015. ECF 22-7.
It appears that in August 2015, plaintiff filed a complaint against Mass Mutual with the Maryland Insurance Administration ("MIA"), under the Maryland Unfair Claim Settlement Practices Act, Md. Code , §§ 27-301 -306 of the Insurance Article ("Ins."). SeeECF 16-7 at 1 (MIA Complaint Form); ECF 2, ¶ 22. Defendant has presented evidence that Ms. George testified before the MIA on February 27, 2017. ECF 16-6 at 2.5 There is no indication in either party's submissions as to whether, or how, the MIA ruled on Ms. George's complaint.
On December 2, 2016, plaintiff filed suit in the Circuit Court for Howard County, Maryland (ECF 2), seeking to recover benefits for her period of alleged partial disability, from May 2009 to June 2010 (see id. ¶ 26), and extended benefits, to which she alleges she is entitled from May 2012 onward. Id. ¶ 28. She also seeks a declaratory judgment that she was and is disabled within the meaning of the Policy, that defendant may not recoup the benefits already paid, and that defendant may not contest her disability. Id. at 9-10. As indicated, note 1, supra, defendant removed the case to this Court, based on diversity jurisdiction. See ECF 1 (notice of removal).
Under Rule 56(a) of the Federal Rules of Civil Procedure, summary judgment is appropriate only "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." See Celotex Corp. v. Catrett, 477 U.S. 317, 322-24 (1986); see also Iraq Middle Mkt. Dev. Found. v. Harmoosh, 848 F.3d 235, 238 (4th Cir. 2017) (). The nonmoving party must demonstrate that there are disputes of material fact so as to preclude the award of summary judgment as a matter of law. Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 585-86 (1986).
The Supreme Court has clarified that not every factual dispute will defeat the motion. "By its very terms, this standard provides that the mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986) (emphasis in original). A fact is "material" if it "might affect the outcome of the suit under the governing law." Id. at 248. There is a genuine issue as to material fact "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Id.; see Sharif v. United Airlines, Inc., 841 F.3d 199, 204 (4th Cir. 2016); Raynor v. Pugh, 817 F.3d 123, 130 (4th Cir. 2016).
"A party opposing a properly supported motion for summary judgment 'may not rest upon the mere allegations or denials of [its] pleadings,' but rather must 'set forth specific facts showing that there is a genuine issue for trial.'" Bouchat v. Baltimore Ravens Football Club, Inc., 346 F.3d 514, 522 (4th Cir. 2003) (quoting former Fed. R. Civ. P. 56(e)), cert. denied, 514 U.S. 1042 (2004); see also Celotex, 477 U.S. at 322-24. Moreover, in resolving a summary judgment motion, a court must view all of the facts, including reasonable inferences to be drawn from them, in the light most favorable to the nonmoving party. Matsushita Elec. Indus. Co. Ltd., 475 U.S. at 587; accord Roland v. United States Citizenship & Immigration Servs., 850 F.3d 625, 628 (4th Cir. 2017); FDIC v. Cashion, 720 F.3d 169, 173 (4th Cir. 2013). However, summary judgment is appropriate if the evidence "is so one-sided that one party must prevail as a matter of law." Anderson, 477 U.S. at 252. And, "the mere existence of a scintilla of evidence in support of the plaintiff's position will be insufficient;...
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