Hunter v. Mass. Mut. Life Ins. Co.
| Decision Date | 01 July 2014 |
| Docket Number | Civ. Action No. 12–1144 EGS |
| Citation | 53 F.Supp.3d 86 |
| Court | U.S. District Court — District of Columbia |
| Parties | John S. Hunter, Plaintiff, v. Massachusetts Mutual Life Insurance Company, Defendant. |
Daniel S. Crowley, J. Michael Hannon, Hannon Law Group, Washington, DC, for Plaintiff.
Bryan D. Bolton, Michael Edward McCabe, Jr., Funk & Bolton, PA, Baltimore, MD, for Defendant.
UNDER SEAL
John Hunter brings this lawsuit alleging that Massachusetts Mutual Life Insurance Company (“MassMutual”) breached an insurance contract by failing to pay him the correct amount of monthly disability benefits and commencing payment on the wrong date. Pending before the Court is defendant's motion for summary judgment. Upon consideration of the motion, the responses and replies thereto, the applicable law, the oral argument, and the entire record, the Court GRANTS defendant's motion.
Dr. Hunter, a dentist, has practiced in Washington, D.C. since 1985. Def.'s Statement of Material Facts (“Def.'s SMF”), ECF No. 22–1 ¶¶ 1–2. On October 5, 1992, he obtained a disability-insurance policy (“the Policy”) from MassMutual. Id. ¶ 3. The Policy provides a maximum monthly benefit of $3,000 and an additional $1,000 monthly maximum if Dr. Hunter does not receive other disability benefits. See Ex. 1 to Def.'s Mot. for Summ. J. (“Mot.”), ECF No. 24 at 3, 23.1 The amount of benefits to be paid each month is tied to Dr. Hunter's “loss of earned income,” which is the difference between his average monthly income during the twelve months preceding the onset of his disability and his income during the current month. See id. at 7–8.
Benefits may be paid only after a waiting period, which lasts for sixty days after the onset of the disability. Id. at 3–4, 9. Benefits are then available “subject to certain notice and proof of disability requirements.” Id. at 13. The insured must provide “notice” by indicating in writing that he “is disabled and that a claim may be made,” and must do so “before the end of 20 days after the Waiting Period, or as soon afterwards as it is reasonably possible to do so.” Id. He must also submit “proof of claim ... before the end of 90 days after the end of each monthly period” for which he claims benefits. Id. “[I]f it is not reasonably possible to give ... proof within this time limit, then proof may be given as soon thereafter as it is reasonably possible to do so.” Id. This extension is limited to one year, “[u]nless the delay is due to legal incapacity.” Id.
On July 17, 2004, Dr. Hunter was involved in a motorcycle accident. See Pl.'s Opp. to Mot. for Summ. J. (“Opp.”), ECF No. 27 at 2. He did not contact MassMutual about the accident until March 4, 2011, when he provided notice of a claim. See Ex. 2 to Mot., ECF No. 22–5 at 1–2. That day, MassMutual sent him a claim package and asked him to complete certain forms. Ex. 3 to Mot., ECF No. 22–6 at 1. On April 12, 2011, Dr. Hunter submitted his forms and listed various medical conditions as resulting from the accident. See Ex. 4 to Mot., ECF No. 24–1 at 5.
MassMutual wrote Dr. Hunter on April 21, 2011 to request that he “explain, in detail, why he filed a claim more than 6 years after the date on which he is claiming Partial Disability.” Ex. 5 to Mot., ECF No. 22–8 at 2. Dr. Hunter replied on June 3, 2011, and attached a letter from a doctor stating that the conditions resulting from the accident “caused [Dr. Hunter] to not pursue or understand the option of pursuing disability coverage since 2004.” Ex. 2 to Opp., ECF No. 28–1 at 3.
On October 20, 2011, MassMutual approved Dr. Hunter's claim for disability benefits and assigned him a “temporary disability date of January 3, 2011.” Ex. 6 to Mot., ECF No. 22–9 at 1. On February 14, 2012, MassMutual wrote to Dr. Hunter to inform him of its conclusion that his “permanent date of disability” for the purpose of calculating his entitlement to benefits would be January 3, 2011. See Ex. 7 to Mot., ECF No. 22–10. Among other reasons for this decision, MassMutual stated:
[W]e did not receive notice of claim from Dr. Hunter until March 4, 2011 and we did not receive the initial Proof of Loss until April 6, 2011. It is important to note that this is more than 6 ½ years after Dr. Hunter's reported date of disability. As a result of the late notice of claim and proof of loss submission, MassMutual's rights have been severely prejudiced .... As such, we are unable to make an accurate assessment of any benefits to which Dr. Hunter may be eligible for prior to January 3, 2011.
Id. at 3 (emphasis added).
Dr. Hunter filed this lawsuit on July 9, 2012, alleging that MassMutual breached the insurance contract by failing to pay disability benefits to cover the period from July 17, 2004 to January 2, 2011, and by calculating his prospective benefits based on his average monthly income from the twelve months preceding January 3, 2011, rather than July 17, 2004. See Compl., ECF No. 3 ¶¶ 23–29. He was initially granted leave to proceed under the pseudonym John Doe. See Order, ECF No. 2.
On September 10, 2012, MassMutual filed two motions to dismiss. The first claimed that Dr. Hunter violated Federal Rule of Civil Procedure 10(a) by filing his complaint under a pseudonym. See Mem. in Supp. of Mot. to Dismiss, ECF No. 4–1. The second motion sought dismissal of various claims and forms of relief. See Mem. in Supp. of Mot. to Dismiss, ECF No. 5–1. After a hearing, the Court ordered Dr. Hunter to proceed under his real name, and dismissed certain of his claims and requests for relief. See Minute Order of May 2, 2013.
On September 9, 2013, MassMutual moved for summary judgment. See Mem. in Supp. of Mot. (“Mem.”), ECF No. 22–2. Dr. Hunter filed his opposition on November 18, 2013. See Opp. MassMutual filed its reply on December 6, 2013. See Def.'s Reply (“Reply”), ECF No. 29. The Court held a hearing on May 21, 2014, and subsequently ordered the parties to file supplemental briefs. See Pl.'s Suppl. Br., ECF No. 33; Def.'s Suppl. Br., ECF No. 35. The motion for summary judgment is now ripe for decision.
Pursuant to Federal Rule of Civil Procedure 56, summary judgment should be granted only if the moving party has shown that there are no genuine issues of material fact and that it is entitled to judgment as a matter of law. See Fed. R. Civ. P. 56 ; Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). A material fact is one that is capable of affecting the outcome of the litigation.
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A genuine issue exists where the “evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Id. A court considering a motion for summary judgment must draw all “justifiable inferences” from the evidence in favor of the nonmovant. Id. at 255, 106 S.Ct. 2505. To survive a motion for summary judgment, however, the requester “must do more than simply show that there is some metaphysical doubt as to the material facts”; instead, the nonmoving party must come forward with “ ‘specific facts showing that there is a genuine issue for trial.’ ” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586–87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986) (quoting Fed. R. Civ. P. 56(e) ).
Federal courts sitting in diversity must apply the choice-of-law rules of the state in which they sit. Klaxon Co. v. Stentor Elec. Mfg. Co., 313 U.S. 487, 496–97, 61 S.Ct. 1020, 85 L.Ed. 1477 (1941). Therefore, the District of Columbia's choice-of-law analysis applies. In insurance cases, where the insured is a D.C. resident and the insured risk is located in D.C., courts have held that D.C. law applies.See, e.g., Potomac Elec. Power Co. v. Cal. Union Ins. Co., 777 F.Supp. 968, 973 (D.D.C.1991). Defendant argues that D.C. law applies to this case because Dr. Hunter was a D.C. resident when the Policy was issued and at the time he submitted his claim for benefits. See Mem. at 4 n.1. Dr. Hunter does not dispute this. Accordingly, the Court will apply D.C. law.
MassMutual claims that Dr. Hunter is not entitled to benefits prior to January 3, 2011 because he did not provide timely notice and proof of his claim. See Mem. at 4–7; Def.'s Suppl. Br. at 2. MassMutual also argues that Dr. Hunter did not submit evidence from which a jury could conclude that it was not reasonably possible to submit timely notice and proof. See Reply at 1–5. In any event, MassMutual asserts, Dr. Hunter's failure to provide timely proof dooms his claim because the Policy limits the extension for delayed proof to one year, absent legal incapacity. See id. at 1–2. Dr. Hunter responds that MassMutual waived this argument and that the Court should ignore the one-year limit. See Pl.'s Suppl. Br. at 1–9.
Dr. Hunter argues that MassMutual waived the notice and proof requirements, but provides no legal authority for this argument. See Pl.'s Suppl. Br. at 1–3. He asserts that “MassMutual did not deny the claim, nor any portion of the claim, on account of Dr. Hunter's failure to provide timely notice or proof.” Id. at 1. He believes that MassMutual's February 14, 2012 denial of his claim for benefits prior to January 3, 2011 “was based on the sufficiency of medical evidence, not the timing of his notice or proof.” Id. at 2. The Court disagrees.
The Policy makes the payment of benefits “subject to certain notice and proof of disability requirements.” Ex. 1 to Mot., ECF No. 24 at 13. As a result, compliance with the notice and proof provisions are conditions precedent to coverage. See, e.g., Travelers Indem. Co. v. United Food & Comm. Workers Int'l Union, 770 A.2d 978, 991 (D.C.2001). When “compliance with notice provisions is a contractual...
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