Wickboldt v. Mass. Mut. Life Ins. Co.

• Decision Date: 05 September 2019
• Docket Number: Case No: 6:17-cv-2208-Orl-28EJK
• Citation: 409 F.Supp.3d 1312
• Parties: Lloyd WICKBOLDT, Plaintiff, v. MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Middle District of Florida

409 F.Supp.3d 1312

Lloyd WICKBOLDT, Plaintiff,

v.MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, Defendant.

Case No: 6:17-cv-2208-Orl-28EJK

United States District Court, M.D. Florida, Orlando Division.

Signed September 5, 2019

Henry Clay Parker, IV, Parker & Associates, PA, Orlando, FL, for Plaintiff.

Allison Paige Gallagher, Megan Costa DeVault, Akerman LLP, Orlando, FL, Daniel B. Rotko, Pro Hac Vice, Katherine L. Villanueva, Pro Hac Vice, Drinker, Biddle & Reath, LLP, Philadelphia, PA, for Defendant.

ORDER

JOHN ANTOON II, United States District Judge In this dispute over interpretation of a disability insurance policy,¹ Dr. Lloyd Wickboldt moves for summary judgment on his claims for a declaratory judgment and for damages for breach of contract against Massachusetts Mutual Life Insurance Company (MassMutual). (Mot. Summ. J., Doc. 34). And although Mass Mutual did not file a motion of its own, the parties agree that there are no disputed material facts and that denial of Dr. Wickboldt's motion "should result in the entry of judgment in favor of MassMutual." (Doc. 44 at 2 & n.1). After review of the record and the parties' submissions on Dr. Wickboldt's motion, the Court concludes that Dr. Wickboldt's motion must be denied and that judgment must be entered for MassMutual.

I. Background

A. Factual History

In 1985, Dr. Wickboldt—then a 33-year-old practicing dermatologist—applied for and obtained a policy of disability insurance² from MassMutual's predecessor.³ In addition to the Basic Policy (Doc. 34-1 at 3 through 7), Dr. Wickboldt also purchased a Cost of Living Rider (COLA Rider) (Doc. 34-1 at 8 & 9) at the same time.⁴ A year later, he purchased another rider—the Lifetime Total Disability Benefits Rider (Lifetime Rider). (Doc. 34-1 at 10). The Basic Policy and COLA Rider had an effective date of September 1, 1985; the Lifetime Rider, September 1, 1986. (Coverage Page, Doc. 34-1 at 17). And under the policy's terms, "[a]n Anniversary falls each year on the same month and day as the effective date," (Doc. 34-1 at 4)—in other words, every September 1.

In 2000, at the age of forty-eight, Dr. Wickboldt became totally disabled—defined in the policy as unable, "because of sickness or injury," to "do the main duties of [his] occupation," (Doc. 34-1 at 4)—and he has remained totally disabled since then. MassMutual began paying monthly benefits shortly after Dr. Wickboldt became totally disabled and continues to pay benefits to him. But the parties dispute the amount of benefits to which Dr. Wickboldt is and has been entitled since September 1, 2017—the policy Anniversary following his sixty-fifth birthday.

B. Pertinent Policy Provisions

The Basic Policy provides for payment of benefits for "total disability"⁵ beginning one month after an elimination period. (Doc. 34-1 at 4). The amount of the monthly benefit is described as the "basic monthly benefit shown on the Coverage Page"⁶ —$8,000—"multiplied by the ratio of [Dr. Wickboldt's] loss of income to [his] predisability income." (Doc. 34-1 at 4). Dr. Wickboldt began receiving disability benefits of $8,000 per month in mid-2000.

The COLA Rider provides for the payment of monthly "benefit increases"—the amount of which adjusts each year based on the Consumer Price Index⁷ —starting after one year of disability. The COLA Rider states in part:

This rider provides monthly benefit increases while you're totally or residually disabled....

....

When We'll Pay Monthly Benefit Increases. We'll pay monthly benefit increases while you're receiving total or residual disability benefits. The benefit increases will start after you've been totally and/or partially disabled for 12 months, or the full elimination period, if longer. We'll make the first payment one month later.

....

How Long We'll Pay Benefit Increases. While you're totally or residually disabled, we'll pay benefit increases until the earliest of:

• the date your total or residual disability ends;

• the date the maximum benefit period under this rider ends;

• the anniversary on or after your 65th birthday.

(Doc. 34-1 at 8 (emphasis in original)). Pursuant to this rider, after twelve months of receiving $8,000 in monthly benefits under the Basic Policy, in 2001 Dr. Wickboldt continued to receive those benefits each month and also began to receive monthly benefit increases. By June 2015, Dr. Wickboldt was apparently receiving a total of approximately $16,000 per month in combined benefits—that is, $8,000 per month under the Basic Policy plus an additional $8,000 or so⁸ per month in "benefit increases" under the COLA Rider.

Finally, the Lifetime Rider provides:

This rider provides monthly total disability benefits to be paid beyond the Anniversary on or after your 65th birthday. Benefits will be paid for life....

....

Eligibility. To qualify for monthly total disability benefits under this rider you must meet three conditions:

• you must be totally disabled.

• you must have become totally disabled before the Anniversary on or after your 65th birthday and remained totally disabled since. A recurring disability will not affect your eligibility.

• the Anniversary on or after your 65th birthday must have occurred.

When We'll Pay Monthly Total Disability Benefits. If you're eligible, your monthly benefits under this rider will start after the Anniversary on or after your 65th birthday. We'll make the first payment 1 month after that Anniversary. We'll continue to make monthly payments as long as you remain totally disabled.

Monthly Total Disability Benefit. The largest amount of monthly benefit you will receive under this rider is shown on the current Coverage Page of your policy....

(Doc. 34-1 at 10 (emphasis in original)). After September 1, 2017, MassMutual began paying Dr. Wickboldt $8,000 per month under the Lifetime Rider, without benefit increases under the COLA rider—a total of $8,000 per month.

There is no dispute that MassMutual paid Dr. Wickboldt the correct amount of benefits under both the Basic Policy and the COLA Rider until September 1, 2017—the Anniversary after his 65th birthday.⁹ The parties' disagreement is about the amount of monthly benefits that MassMutual is obligated to pay since that date—specifically, whether the COLA Rider applies to the benefits Dr. Wickboldt receives under the Lifetime Rider.¹⁰ Dr. Wickboldt explains that he "reads the documents to mean that he will continue to receive both the base monthly benefit and the increased benefits resulting from the [COLA Rider] for so long as he remains disabled and is receiving benefits under the [Lifetime Rider]." (Doc. 34 at 3). MassMutual, on the other hand, maintains that entitlement to benefit increases under the COLA Rider ended on September 1, 2017, and that since then Dr. Wickboldt has been entitled only to benefits under the Lifetime Rider—a constant $8,000 per month. (Doc. 37 at 2).

II. Discussion

A. Legal Standards

The parties agree that Florida substantive law governs this diversity case. Interpretation of an insurance policy is a question of law for the court. Kattoum v. N.H. Indem. Co., 968 So. 2d 602, 604 (Fla. 2d DCA 2007). And under Florida law, "[e]very insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy and as amplified, extended, or modified by any application therefor or any rider or endorsement thereto." § 627.419(1), Fla. Stat.

"[I]nsurance contracts are construed in accordance with the[ir] plain language as bargained for by the parties." Auto-Owners Ins. Co. v. Anderson, 756 So. 2d 29, 34 (Fla. 2000). "Ambiguities in insurance contracts are interpreted against the insurer and in favor of the insured." Garcia v. Fed. Ins. Co., 969 So. 2d 288, 291 (Fla. 2007). But "[t]o allow for such a construction ... the provision must actually be ambiguous." Id.

B. Application

Applying these principles to the terms of Dr. Wickboldt's disability insurance policy, there is no ambiguity regarding whether Dr. Wickboldt is entitled to benefit increases beyond September 1, 2017. Under the plain language of the policy documents, after September 1, 2017, Dr. Wickboldt is entitled to receive $8,000 in benefits under the Lifetime Rider but is not entitled benefits under the Basic Policy or to past or future benefit increases under the COLA Rider.

The Coverage Page explains that benefits under the Basic Policy are payable only until September 1, 2017. It indicates that the "maximum benefit period" under the Basic Policy is "to 65" and explains that the "benefit period for disability is [the insured's] specified benefit period, but not beyond Sep 01 2017," with the caveat that the benefit period might extend beyond that date "if [the insured] qualif[ies] for benefits under the [Lifetime Rider]." (Doc. 34-1 at 17). The COLA Rider also expressly states that MassMutual will "pay benefit increases until the earliest of : the date ... total or residual disability ends; the date the maximum benefit period under this rider ends; [or] the anniversary on or after [the insured's] 65th birthday." (Doc. 34-1 at 8 (emphasis added)). Regardless of which of these dates ended up being the latest, it is clear that benefit increases would not be paid beyond September 1, 2017—the policy Anniversary on or after Dr. Wickboldt's 65th birthday.

Additionally, the Lifetime Rider plainly states that "[t]he largest amount of monthly benefit you will receive under this rider is shown on the current Coverage Page of your policy." (Doc. 34-1 at 10). The Coverage Page lists the "monthly benefit" under the Lifetime Rider as $8,000 and states that "Your Maximum Monthly Benefit is $8,000." (Doc. 34-1 at 17). Moreover, $8,000 is the largest amount listed anywhere on the Coverage Page. (Id. ).

Dr. Wickboldt repeatedly concedes in his filings that both disability benefits under the Basic Policy and benefit increases under the COLA Rider ceased at age 65. (See, e.g., Compl. ¶ 30 ("Both the Bas[ic] Policy and the [COLA] Rider ... provide[ ] a benefit that...