Karnofsky v. Mass. Mut. Life Ins. Co.
| Decision Date | 07 December 2015 |
| Docket Number | C.A. No.: 2:14-cv-949-PMD |
| Court | U.S. District Court — District of South Carolina |
| Parties | Roberta Karnofsky, Plaintiff, v. Massachusetts Mutual Life Insurance Company, Defendant. |
This matter is before the Court on cross-motions for summary judgment filed by Plaintiff (ECF No. 33) and Defendant (ECF No. 34). For the reasons set forth herein, Defendant's Motion is granted in part and denied in part, and Plaintiff's Motion is denied.
This action arises out of a dispute over disability insurance benefits. Plaintiff "is a physician who has specialized and was Board certified in Anesthesiology since 1993." (Pl.'s Mem. Supp. Mot. Partial Summ. J., ECF No. 33-1, at 3.) In 1994, Plaintiff "purchased a disability policy with an 'Own Occupation Rider' from Connecticut Mutual Life Insurance Company now known as Massachusetts Mutual Life Insurance Company." (Id. at 1.) Plaintiff was subsequently injured in a serious automobile accident.1 Plaintiff's injuries have prevented her from performing anesthesia in the operating room. However, she is still able to treat pain management patients as she did before she became disabled. Before the accident, Plaintiff derived approximately fifty percent of her income from operating room procedures and the other fifty percent from pain management procedures.
In 2011, Plaintiff filed for total disability benefits pursuant to her disability insurance policy. From July 12, 2011, to March 9, 2012, Defendant paid Plaintiff total disability benefits while Plaintiff underwent two surgeries, but did not make any total disability payments thereafter. Defendant did pay Plaintiff partial disability benefits for a brief period from March 10, 2012, to June 9, 2012. After a lengthy period of correspondence, Plaintiff filed suit on February 6, 2014.
Plaintiff moved for partial summary judgment on the grounds that she is totally disabled under the terms of the policy. Her policy states:
The insured is Totally Disabled if he/she cannot perform the main duties of his/her Occupation due to Sickness or Injury. The insured must be under a Doctor's Care.
(Def.'s Mot. Summ. J., Exh. A, ECF No. 34-2, at 11.) (emphasis added). In contrast, the policy defines partial disability as follows:
(Id.) (emphasis added). Defendant asserts it is entitled to summary judgment on several grounds. First, Defendant argues because Plaintiff can still perform some of the duties of her occupation, she does not qualify for total disability. Second, Defendant asserts "Plaintiff was not entitled to disability benefits from April 2007 to September 10, 2011 because Plaintiff did not comply with the Notice of Claim provision of her policy" or "the Proof of Disability provision of her policy." (Def.'s Mot. Summ. J., ECF No. 34, at 1-2.) Third, Defendant claims "Plaintiff is not entitled to 'Partial Disability' benefits after June 2012 because Plaintiff failed to establish that there was a'Demonstrated Relationship' between any alleged 'Loss of Income' and her claimed disability." (Id. at 2.) Fourth, Defendant states Plaintiff's claims for bad faith, punitive damages, and future disability benefits fail as a matter of law. Finally, Defendant asserts Plaintiff has not shown sufficient evidence to support a claim for emotional distress.
On July 6, 2015, Plaintiff filed her Motion for Partial Summary Judgment. That same day, Defendant also filed its Motion for Summary Judgment. The parties both filed responses to the respective motions on July 23, and each filed a reply on August 3. This matter is now ripe for consideration.
To grant a motion for summary judgment, a court must find that "there is no genuine dispute as to any material fact." Fed. R. Civ. P. 56(a). The judge is not to weigh the evidence but rather must determine if there is a genuine issue for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). All evidence should be viewed in the light most favorable to the nonmoving party. Perini Corp. v. Perini Constr., Inc., 915 F.2d 121, 124 (4th Cir. 1990). CoreTel Va., LLC v. Verizon Va., LLC, 752 F.3d 364, 370 (4th Cir. 2014) (citations omitted). "[W]here the record taken as a whole could not lead a rational trier of fact to find for the non-moving party, disposition by summary judgment is appropriate." Teamsters Joint Council No. 83 v. Centra, Inc., 947 F.2d 115, 119 (4th Cir. 1991). Summary judgment is not "a disfavored proceduralshortcut," but an important mechanism for weeding out "claims and defenses [that] have no factual basis." Celotex Corp. v. Catrett, 477 U.S. 317, 327 (1986).
When opposing parties file motions for summary judgment, the trial court applies the same standard of review to both motions. See Northfield Ins. Co. v. Boxley, 215 F. Supp. 2d 656, 657 (D. Md. 2002). "The role of the court is to 'rule on each party's motion on an individual and separate basis, determining, in each case, whether a judgment may be entered in accordance with the Rule 56 standard.'" Id. at 658 (quoting Towne Mgmt. Corp. v. Hartford Acc. & Indem. Co., 627 F. Supp. 170, 172 (D. Md. 1985)); see also Mingus Constructors, Inc. v. United States, 812 F.2d 1387, 1391 (Fed. Cir. 1987) (). The mere fact that both parties seek summary judgment "does not 'establish that there is no issue of fact and require that summary judgment be granted to one side or another.'" World-Wide Rights Ltd. P'ship v. Combe Inc., 955 F.2d 242, 244 (4th Cir. 1992) (quoting Am. Fid. & Cas. Co. v. London & Edinburgh Ins. Co., 354 F.2d 214 (4th Cir. 1965)); see also ITCO Corp. v. Michelin Tire Corp., 722 F.2d 42, 45 n.3 (4th Cir. 1983) (); Lac Courte Oreilles Band of Lake Superior Chippewa Indians v. Voigt, 700 F.2d 341, 349 (7th Cir. 1983) (). Nevertheless, dueling motions for summary judgment "may be probative of the nonexistence of a factual dispute," because "when both parties proceed on the same legal theory and rely on the same material facts the court is signaled that the case is ripe for summary judgment." Shook v. UnitedStates, 713 F.2d 662, 665 (11th Cir. 1983) (citing Bricklayers, Masons & Plasterers Int'l Union v. Stuart Plastering Co., 512 F.2d 1017, 1023 (5th Cir. 1975)); see also Nafco Oil & Gas, Inc. v. Appleman, 380 F.2d 323, 325 (10th Cir. 1967) ().
The parties have both moved for summary judgment on the question of whether Plaintiff is totally disabled pursuant to the terms of her policy. Accordingly, the Court will address that issue first and then proceed to the remainder of Defendant's Motion.
Plaintiff moves for Partial Summary Judgment on the ground that she is totally disabled under the terms of her policy. She asserts several arguments to support her claim. As the Court has jurisdiction pursuant to 28 U.S.C. § 1332,2 the Court must apply South Carolina law and, where necessary, predict how the Supreme Court of South Carolina would decide a particular issue. See Nationwide Mut. Ins. Co. v. Powell, 292 F.3d 201, 203 (4th Cir. 2002); Hartsock v. Am. Auto. Ins. Co., 788 F. Supp. 2d 447, 450-51 (D.S.C. 2011).
"The cardinal rule of contract interpretation is to ascertain and give effect to the intention of the parties." Chan v. Thompson, 395 S.E.2d 731, 734 (S.C. Ct. App. 1990) (). "The rights of the parties must be measured by the contract which the parties themselves made, regardless of its wisdom, reasonableness, or failure of the parties to guard their rights carefully." Id. (citing Conner v. Alvarez, 328 S.E.2d 334, 336 (S.C. 1985)). "When a contract is perfectly plain andcapable of legal construction the language of the contract determines the full force and effect of the document." Id. (citing Conner, 328 S.E.2d at 336). "Under South Carolina law the interpretation of an insurance policy is a matter of law." Graf v. Allstate Ins. Co., No. 2:06-cv-1045-CWH, 2007 WL 221244, at *1 (D.S.C. Jan. 25, 2007) (citing TCX, Inc. v. Commonwealth Land Title Ins. Co., 928 F. Supp. 2d 618, 624 (D.S.C. 1995).
The crux of the parties' disagreement over the contract language is the meaning of "main duties." The policy provides that in order for Plaintiff to be eligible for total disability benefits, she must be unable to perform the main duties of her occupation. Regrettably, the parties chose not to define "main duties" in their agreement. Nonetheless, the Court need not define that term as it finds that the plain meaning of the total disability provision requires that Plaintiff be unable to perform more than one main duty. The parties' use of the...
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