Temple v. Mut. of Omaha Ins. Co.
| Decision Date | 28 January 2013 |
| Docket Number | Civil Action No.: 4:11-cv-00128-RBH |
| Parties | E. Hood Temple, as Personal Representative of the Estate of Genie H. Temple, Plaintiff, v. Mutual of Omaha Insurance Company, Defendant. |
| Court | U.S. District Court — District of South Carolina |
Plaintiff E. Hood Temple, as Personal Representative of the Estate of Genie H. Temple ("Plaintiff") filed this lawsuit alleging breach of contract and bad faith on the part of Defendant Mutual of Omaha Insurance Company ("Defendant") regarding a claim made by Genie H. Temple pursuant to a long-term care insurance policy. This matter is before the Court on Defendant's Motion for Summary Judgment [Doc. # 41]. On December 10, 2012, the Court heard from the parties regarding Defendant's Motion. For the reasons discussed below, Defendant's Motion is granted.
In 1988, Genie Temple purchased a long-term care policy with Aetna Long-Term Care, which was ultimately assigned to Defendant. [Pl.'s Resp., Doc. # 62, at 1; Long-Term Care Policy, Doc. # 41-1.] This Policy, which entitled Ms. Temple to long-term care payments from Defendant after an authorized stay, remained in force through the circumstances giving rise to this case. [See id.]
In a letter dated September 28, 2009, and stamped received on October 2, 2009, E. Hood Temple first advised Defendant that his mother, Ms. Temple, had become ill and would require long-term care sometime in the future. [9/28/2009 Temple Letter, Doc. # 41-6.] The letter also requested claim forms and explained that Mr. Temple, an attorney, was representing Ms. Temple. [Id.]
On October 15, 2009, Ms. Temple checked into Methodist Manor in Florence, South Carolina, to begin receiving long-term care. [See Def. Mot., Doc. # 41, at 16; Pl.'s Resp. at 2.] Pursuant to an elimination period under the Long-Term Care Policy, coverage under the Policy began only after Ms. Temple stayed at Methodist Manor for twenty days. [See Pl.'s Expert1 Dep., Doc. # 41-3, at 68:1-24, 77:6-13.] Thus, it is undisputed that Ms. Temple became eligible for coverage on November 5, 2009. [See id.; Def. Mot. at 5.] It is further undisputed that because the Policy paid benefits in arrears, no payment could have been due to Ms. Temple until sometime in December. [Id.]
On November 5, 2009, the same day Ms. Temple became eligible for coverage, a representative from Defendant sent claim forms to Mr. Temple at his law firm's address,2 andrequested nursing home bills from him. [Pl.'s Resp. at 3.] The representative also contacted Methodist Manor, a third party, and requested a facility evaluation, medical records, medical bills, cognitive test results, and a plan of care. [See 11/5/2009 Omaha Fax, Doc. # 41-11; Facility Evaluation, Doc. # 41-12.] Although Methodist Manor submitted a facility evaluation, it did not include the other requested items at that time. [See Facility Evaluation.]
On November 18, 2009, Mr. Temple contacted Defendant asking what it needed to complete the claim. [Omaha Activity Logs, Doc. # 41-8, at 5.] A representative from Defendant explained that it had not received the completed claim forms from Mr. Temple, which had been sent thirteen days previously. [Id.] Mr. Temple completed the claim forms by November 19, 2009, and they were stamped as received by Defendant on November 24, 2009. [See Completed Claim Forms, Doc. # 41-13.]
On December 2, 2009, early in the first month Ms. Temple could have received any payment, a representative from Defendant again contacted third-party Methodist Manor to follow-up on the items it had yet to receive. [Omaha Activity Logs at 4.] The representative also followed up with Mr. Temple by calling his office and leaving a message to inform him of the status of the claim. [Id.; 12/2/2009 Temple Email, Doc. # 41-14, at 2] On December 7, 2009, Methodist Manor transmitted the plan of care and medical records to Defendant. [Plan of Care, Doc. #41-15.] The previously requested medical bills were still not included in this transmission. [Id.] Although the parties appear to dispute the importance of the medical bills in processing the claim,3 Plaintiff agreed at the hearingand in his brief that, at a minimum, it was not until December 7, 2009, that Defendant had the information it needed to process Ms. Temple's claim. [See Pl.'s Resp. at 4; Pl.'s Expert Dep. at 79:20-82:9.]
On December 22, 2009, having still not received the medical bills, a representative from Defendant again contacted third-party Methodist Manor. [Omaha Activity Logs at 4.] In response to this call, Methodist Manor provided the requested medical bills. [Medical Bills, Doc. # 41-16.] The representative called Mr. Temple to inform him Defendant had received the bills, and that she would be out of the office during the holidays and return January 4, 2010. [Omaha Activity Logs at 5; 12/22/2009 Temple Email, Doc. # 41-17, at 2.]
On January 5, 2010, Mr. Temple contacted Defendant's representative. [Pl.'s Resp. at 4.] The parties dispute what occurred on that day. According to Plaintiff, the representative first called to say that the claim was payable, only to call later that day to explain that the claim required further review. [Id.] Defendant, however, claims that the representative spoke with Mr. Temple only once that day. [Def.'s Mot. at 8; Petrie Dep., Doc. # 62-5, at 124:1-13.] According to Defendant, during that call4 the representative explained that benefits were payable, but that a care coordinator nurse would need to review the file to determine which level of benefits were payable based upon the level of care Ms. Temple received. [Def.'s Mot. at 8; Omaha Activity Logs at 3-4.]
The parties do not dispute that based upon the review of the care coordinator nurse, Defendant concluded on January 12, 2010, that benefits were payable to Ms. Temple at the highest level under the Policy. [Claim Acceptance, Doc. # 41-8; Omaha Activity Logs at 3.] Defendant's representative also called Mr. Temple the same day to inform him that benefits had been fully approved and were payable, and to determine where he wished for Defendant to send the check. [Omaha Activity Logs at 3.] In fact, an email from Mr. Temple's law office verifies he was asked to [1/12/10 Temple Email, Doc. # 41-9, at 2.] Plaintiff does not dispute Defendant's claim that Mr. Temple did not return this call or otherwise respond to Defendant, and there is nothing in the record indicating any response by Mr. Temple.
On January 14, 2010, having received no call back from Mr. Temple, Defendant issued a check for $7,105.00, which represented payment due under the Policy, and mailed that check to Ms. Temple's last known address5 prior to her admission into Methodist Manor. [Benefits Check, Doc. # 41-21; Omaha Activity Logs at 3.] Ms. Temple passed away seven days later, on January 21, 2010.[Pl.'s Resp. at 4.] Although it is unclear when Mr. Temple himself received the check, the check indicates that he deposited the check on February 3, 2010, and the parties do not dispute that Mr. Temple deposited the check on this date. [See Benefits Check at 3.]
Although it is undisputed that Defendant issued the check on January 14, 2010, Plaintiff filed suit alleging breach of contract on January 20, 2010, nearly a week later.6 It is also undisputed that all monetary benefits due under the Policy have been paid, and at no point did Defendant ever deny payment or refuse coverage. [See Def.'s Mot. at 10; Pl.'s Resp. at 5.]
A court shall grant summary judgment "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(a). The movant bears the initial burden of demonstrating that summary judgment is appropriate; if the movant carries its burden, then the burden shifts to the non-movant to set forth specific facts showing that there is a genuine issue for trial. See Celotex Corp. v. Catrett, 477 U.S. 317, 322 23 (1986). Summary judgment is not "a disfavored procedural shortcut;" rather, it is an important mechanism for weeding out "claims and defenses [that] have no factual bases." Id. Further, "[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." Ricci v. DeStefano, 557 U.S. 557, 586 (2009) (quoting Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986); see also Hill Holliday Connors Cosmopulos, Inc. v. Greenfield, 433 Fed. App'x 207, 213 (4th Cir. 2011) ( that under the facts of the case "no reasonable finder of fact would conclude" thatjudgment for the non-movant was appropriate).
If a movant asserts that a fact cannot be disputed, it must support that assertion either by "citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations (including those made for purposes of the motion only), admissions, interrogatory answers, or other materials;" or by "showing . . . that an adverse party cannot produce admissible evidence to support the fact." Fed. R. Civ. P. 56(c)(1).
Accordingly, to prevail on a motion for summary judgment, the movant must demonstrate that: (1) there is no genuine issue as to any material fact; and (2) that he is entitled to judgment as a matter of law. As to the first of these determinations, a fact is deemed "material" if proof of its existence or non-existence would affect disposition of the case under applicable law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). An issue of material fact is "genuine" if the evidence offered is such that a reasonable jury might return a verdict for the non-movant. Id. at 257. In determining whether a genuine issue has been...
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