Gissendanner v. Riversource Life Ins. Co.
| Decision Date | 08 June 2022 |
| Docket Number | Case No. 2:21-cv-10731 |
| Citation | 606 F.Supp.3d 668 |
| Parties | Juana GISSENDANNER, Plaintiff, v. RIVERSOURCE LIFE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Eastern District of Michigan |
Ari W. Lehman, Lehman Law PLLC, Mount Clemens, MI, for Plaintiff.
Kristine R. Thomson, Miles D. Hart, Saretsky Hart Michaels & Gould PC, Birmingham, MI, for Defendant.
Plaintiff Juana Gissendanner alleged that Defendant RiverSource Life Insurance Company breached a policy for disability benefits and denied her disability claim in bad faith. ECF 1-2. Defendant moved for summary judgment on the claims. ECF 17. Plaintiff opposed the motion. ECF 21. The Court ordered supplemental briefing to address Sixth Circuit precedent involving similar terms in a different disability insurance policy, ECF 30, and the parties complied, ECF 31; 32. For the following reasons, the Court will grant the summary judgment motion.1
Plaintiff obtained disability income insurance from Defendant. ECF 21-2. The policy provided benefits based on "partial disability" and "total disability." Id. at 284–85. Partial disability applies "although you perform one or more important duties of your regular occupation." Id. at 283. Total disability applies if "you are ... [u]nable to perform the important duties of your regular occupation." Id. The policy included an "Occupational Protection Option." Id. at 284. The Option allowed Plaintiff to "qualify as totally disabled even if [she] work[s] outside of [her] regular occupation." Id. The policy provided an example about how the option works. Id. Id.
In Plaintiff's insurance application, she explained that she worked as a dental hygienist. ECF 17-3, PgID 165, 168. Her job duties involved: "dental xrays [sic]"; "exposure & development"; "dental education"; and "dental prophylaxis
." Id. at 168; see also ECF 17-4, PgID 189.
Plaintiff was later injured in a car accident. ECF 17-4, PgID 176. At the time, she was working as a dental hygienist. Id. She promptly made a claim under the disability policy. ECF 17-5. In her claim form, she detailed her job duties that included everything from cleanings (prophylaxis), preliminary examinations, dental radiographs
, and more besides. ECF 17-6, PgID 197.
Defendant then paid Plaintiff total disability benefits under the policy starting in 1997. ECF 17-4, PgID 190. Each year, Defendant reviewed Plaintiff's disability status and sought documents from Plaintiff to confirm that she was still qualified for the policy's total disability benefits. Id.
Since 1998, Plaintiff has worked as a volunteer in the same dentist office, but she kept the same title of "Dental Hygienist." ECF 17-4, PgID 177. Plaintiff has also maintained a dental-hygienist license. Id. While working in the dentist office, Plaintiff has done many of the same tasks she did before the accident. Id. at 178–79 (explaining that she performs dental prophylaxis
, x-rays, and radiographs ). Plaintiff explained that these tasks were part of her "occupational therapy." Id. at 178.
Plaintiff has also taught dental hygiene at various colleges. Id. at 177. As an instructor, she shows students how to perform dental procedures by doing them herself. Id. at 183 (). Plaintiff's profile on the University of Michigan's website represents that she "continue[s] to practice clinical dental hygiene part-time in Southfield, MI." ECF 17-5, PgID 226.
In the 2019 review of Plaintiff's disability, Defendant determined that she was no longer totally disabled under the policy and was only eligible for partial disability benefits. ECF 17-4, PgID 191; see also ECF 17-16, PgID 229–30. Defendant explained that the change occurred because Plaintiff had "been performing one or more of the important duties of [her] regular occupation as a dental hygienist." ECF 17-16, PgID 229.
The Court must grant a summary judgment motion "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." Fed. R. Civ. P. 56(a). A moving party must point to specific portions of the record that "it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett , 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Once the moving party has met its burden, the non-moving party may not simply rest on the pleadings but must present "specific facts showing that there is a genuine issue for trial." Matsushita Elec. Indus. Co. v. Zenith Radio Corp. , 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986) (emphasis omitted) (quoting Fed. R. Civ. P. 56(e) ).
A fact is material if proof of that fact would establish or refute an essential element of the cause of action or defense. Kendall v. Hoover Co. , 751 F.2d 171, 174 (6th Cir. 1984). A dispute over material facts is genuine "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). When considering a summary judgment motion, the Court must view the facts and draw all reasonable inferences "in the light most favorable to the non-moving party." 60 Ivy St. Corp. v. Alexander , 822 F.2d 1432, 1435 (6th Cir. 1987) (citations omitted).
The main issue for the breach of contract claim is whether Plaintiff is partially disabled under the policy. ECF 17, PgID 132–36. Defendant asserted that Plaintiff is partially disabled based on the policy's plain text. Id. But Plaintiff countered that the policy as a whole is ambiguous since the policy's partial disability and total disability terms conflict. ECF 21, PgID 263–69. Before resolving how to read the policy, the Court must first address Plaintiff's procedural arguments that Defendant is equitably estopped and has waived all claims that Plaintiff is partially disabled under the policy. Id. at 270–72.
"[I]n certain situations, estoppel or waiver may operate to hold a defendant liable for coverage which may differ from the express terms of the contract." Parmet Homes, Inc. v. Republic Ins. Co. , 111 Mich. App. 140, 148, 314 N.W.2d 453 (1981) (citations omitted). The party asserting either defense bears the burden of proof. Cadle Co. v. City of Kentwood , 285 Mich. App. 240, 255, 776 N.W.2d 145 (2009) (waiver); Mid-Century Ins. Co. v. Fish , 749 F. Supp. 2d 657, 677 (W.D. Mich. 2010) (estoppel).
The waiver argument here fails. Waiver is "the intentional and voluntary relinquishment of a known right." Moore v. First Sec. Cas. Co. , 224 Mich. App. 370, 376, 568 N.W.2d 841 (1997). "[A] valid waiver may be shown by express declarations or by declarations that manifest the parties’ intent and purpose, or be an implied waiver, evidenced by a party's decisive, unequivocal conduct reasonably inferring the intent to waive." Patel v. Patel , 324 Mich. App. 631, 634, 922 N.W.2d 647 (2018) (quotation marks and quotations omitted). "Mere knowing silence generally cannot constitute waiver." Quality Prod. & Concepts Co. v. Nagel Precision, Inc. , 469 Mich. 362, 365, 666 N.W.2d 251 (2003).
Plaintiff knew that Defendant annually reviewed whether she qualified for the disability payments. ECF 17-4, PgID 190. And the policy's plain terms provide that only a corporate officer for Defendant could "waive any of [Defendant's] rights or requirements under th[e] policy." ECF 17-2, PgID 157. But Plaintiff identified no evidence that Defendant, through its corporate officers, either expressly or impliedly waived any rights under the policy. See ECF 21, PgID 271. Rather, Plaintiff appeared to argue that Defendant's silence is enough for waiver. See id. (). Because "[m]ere knowing silence" cannot constitute waiver, Plaintiff has failed to meet her burden and the Court will reject the waiver argument. Quality Prod. & Concepts Co. , 469 Mich. at 365, 666 N.W.2d 251.
The Court will also bar the estoppel argument. "[E]stoppel is an equitable defense which prevents one party to a contract from enforcing a specific provision of the contract." Fish , 749 F. Supp. 2d at 677 (citing Morales v. Auto-Owners Ins. Co. , 458 Mich. 288, 295, 582 N.W.2d 776 (1998) ). But estoppel will not "broaden the coverage of a policy to protect the insured against risks that were not included in the policy or that were expressly excluded from the policy." Kirschner v. Process Design Assocs., Inc. , 459 Mich. 587, 594, 592 N.W.2d 707 (1999) (citations omitted).
"For equitable estoppel to apply against an insurer in favor of an insured, the party asserting estoppel must establish" three elements. Fish , 749 F. Supp. 2d at 677 (collecting cases). First, "the insurer's actions or representations induced the insured to believe that an otherwise applicable ... clause would not be invoked and that coverage would be provided." Id. (citations omitted). Second, "the insured justifiably relied on this belief." Id. (citations omitted). And third, "the insured was prejudiced by its reliance on this belief." Id. (citations omitted).
No evidence shows that the elements are satisfied, and Plaintiff pointed to no facts to suggest otherwise. See ECF 21, PgID 272. Defendant never told Plaintiff that it would not invoke a certain clause in the policy. Rather, Plaintiff testified that Defendant had requested she do occupational therapy to...
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