EDUARDO C. ROBRENO, District Judge.
Presently before the Court is the motion for summary judgment filed by Defendant, Provident Life and Accident Insurance Company ("Provident"). Plaintiff, Satya Bandhu Arya ("Arya"), alleges that Provident, in bad faith, breached the individual disability income insurance policy ("the Policy") it issued to him by failing to provide him with various increases to his benefits. For the reasons set forth below, the Court will grant Provident's motion.
On August 27, 1994, Provident issued Arya the Policy which provided him with benefits in the event that he became disabled. The Policy has an effective date of September 6, 1994.
Three Policy provisions are especially relevant here:
First, the Policy provides for yearly 5% increases in Arya's monthly benefit should he become disabled. These "Update Increases" become automatically effective on the anniversary of the Policy's effective date.
Second, the Policy provides that Arya has the right to request an increase in the maximum cost of living adjustment ("COLA") percentage. Similar to the Update Increases, the Policy states "[y]ou can request [a maximum COLA percentage] increase during any Option Period even if you are disabled, but the increase will apply only to a Period of Disability which starts after the effective date of the increase. It must qualify as a separate Period of Disability."
Third, the Policy provides a formula for calculating Arya's monthly benefit adjusted for COLA (or "Adjusted Monthly Benefit for Total Disability"). The Adjusted Monthly Benefit for Total Disability is calculated by multiplying Arya's "Monthly Benefit for Total Disability" by the "Benefit Factor."
Arya made his first claim for benefits due to major depression in 1998. Provident paid monthly benefits on this claim from June 21, 1998 to November 21, 1999. Arya later made a second claim for benefits based on complications from surgery. Provident paid benefits for this period of disability from January 24, 2000 to December 2, 2000. After Arya made a third claim for benefits, due to depression, Provident paid benefits from September 20, 2002 to October 20, 2003. In all instances, Provident discontinued Arya's benefits after determining that he could return to work and was, therefore, no longer disabled. During the "gap" periods when Arya was not considered disabled, he paid the Policy premiums and did not receive any benefits.
In 2004, Arya was diagnosed with multiple sclerosis ("MS"). As a result of the diagnosis, Arya made a fourth claim for benefits. On December 1, 2004, Provident determined that Arya was permanently disabled due to MS and began making payments on February 27, 2004.
On March 31, 2006, Arya sent a letter to Provident requesting that his MS-related claim be treated as a single period of disability dating back to 1997, rather than a period separate from his other three periods of disability. Mot. Ex. 5, ECF No. 46-2. After reviewing the records, Provident concluded that all of Arya's periods of disability were related to his MS. As a result, by letter dated June 20, 2006, Provident assented to Arya's request, considered Arya to have had one continuous period of disability due to MS, and retroactively issued benefits starting from 1997.
While the additional benefits and refund of premiums were obvious boons to Arya, there were negative consequences to the retroactive onset date as well. Because Arya was now considered to have been continuously disabled under one period of disability since 1997, Provident removed the last two 5% Update Increases that became effective after Arya's new onset date. Similarly, Provident refused to apply the maximum COLA percentage increase that Ayra sought in 2000, but that Provident did not acknowledge until 2009, for the same reason. As discussed above, both of the governing Policy provisions indicate that the increases to which Arya became eligible after his onset date would only apply to a new period of disability. In that Ayra is now considered permanently disabled since 1997, it is highly unlikely that he will ever recoup those increases as he will probably never start a new period of disability.
Arya filed an action against Provident in the Philadelphia Court of Common Pleas on June 29, 2015 which was removed to this Court on August 7, 2015 based on diversity of citizenship. The December 9, 2016 amended complaint asserts two counts against Provident: (1) breach of contract; and (2) common law bad faith. Currently, Arya claims that, in bad faith, Provident breached the Policy by: (1) taking away the two 5% Update Increases; (2) failing to apply the 2% increase to the maximum COLA percentage that he requested; and (3) failing to compound his COLA benefits when his Adjusted Monthly Benefit for Total Disability was calculated each year.
Provident raises two main arguments in its motion for summary judgment: (1) that Arya's claims are barred by the applicable statutes of limitations; and (2) that Arya's claims have no merit in light of the clear language of the Policy. The Court held oral argument on September 5, 2018.
Summary judgment is appropriate if there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). "A motion for summary judgment will not be defeated by `the mere existence' of some disputed facts, but will be denied when there is a genuine issue of material fact."
The Court will view the facts in the light most favorable to the nonmoving party. "After making all reasonable inferences in the nonmoving party's favor, there is a genuine issue of material fact if a reasonable jury could find for the nonmoving party."
Provident argues that Delaware law should apply to the claims while Arya asserts that the law of Ontario, Canada controls. Provident bases its argument on the facts that Arya lived in Delaware when Provident determined he had been suffering from one continuous period of disability and that he received almost all of his benefits in Delaware. Arya's position is primarily premised on the fact that, when he applied for and purchased the Policy in 1994, he was a resident of Ontario.
However, a choice of law analysis is only necessary if the laws of the relevant jurisdictions differ.
All three of Arya's remaining contentions rest on the plain language of the Policy. "The proper construction of any contract, including an insurance contract, is purely a question of law."
Regarding Arya's first two arguments, the Policy clearly provides that both the 5% Update Increases and any increases to the maximum COLA percentage apply only to periods of disability that begin after the effective date of the increases. Mot. Ex. 1 at 8 & 17, ECF No. 46-2. "It must qualify as a separate Period of Disability."
Instead, Arya contends that while he was retroactively paid for one continuous claim going back to 1997, he did not waive his rights to the increases that accrued between 1997 and 2006 during the periods of time when he originally had been found not to be disabled. Arya essentially contends that once his rights to the various updates accrued, Provident could not take them away, even though he sought and received a declaration that, instead of being periodically disabled through 2006, he was under a single period of disability starting in 1997. Arya seeks retroactive effect when it benefits him but does not want to accept any changes that negatively affect his benefits. However, when the parties agreed to a new disability onset date under the Policy, changes were necessarily made to the benefit amounts to conform them to what he was entitled. Arya is now considered to have been under one continuous period of disability since 1997. As a result, by the clear and unambiguous terms of the Policy, he is not entitled to any increases that occurred after that date as they would only affect a separate period of disability.
Therefore, Provident did not breach the Policy by removing the two Update Increases or by refusing to apply the maximum COLA percentage increase after it changed Arya's disability onset date per his request.
Regarding Arya's third argument, Arya contends that he had a reasonable expectation that his COLA benefits would be compounded under the Policy, even though there is no language in the Policy supporting that proposition. He argues that his expectation was based on: (1) the assertion that he was told by the selling agent in 1994 that his COLA benefits would be compounded each year; and (2) his understanding of how the CPI-U is used to calculate COLA benefits. Provident contends that in light of the clear Policy language, Arya's subjective belief is immaterial. Moreover, it argues that a belief based on a misunderstanding of the CPI-U and an unsupported hearsay statement allegedly uttered twenty years before the suit is not a "reasonable" belief.
Regardless of Arya's expectation, the Policy language is not ambiguous and clearly indicates that his COLA benefits are not compounded. Both the Supreme Courts of Delaware and Canada have confirmed that a reasonable expectation analysis is only performed when the court determines that the provisions at issue are ambiguous.
The Policy provides that the "Adjusted Monthly Benefit for Total Disability," which includes Arya's COLA, is determined by multiplying the "Monthly Benefit for Total Disability" by the "Benefit Factor." The Monthly Benefit for Total Disability is a fixed number listed on page three of the Policy. The Benefit Factor is determined by dividing the CPI-U for the latest Index Month by the CPI-U applicable in the first Index Month. Mot. Ex. 1 at 15, ECF No. 46-2. On its face, this fairly simple calculation does not include factoring in previous COLA awards. In order for Arya to be entitled to compounded COLA benefits, the Policy would have to provide that the Adjusted Monthly Benefit for Total Disability is calculated by multiplying the previous year's Adjusted Monthly Benefit for Total Disability by the Benefit Factor. This is not what the Policy provides. Instead, Arya's Adjusted Monthly Benefit for Total Disability is largely dependent on a fixed number: the Monthly Benefit for Total Disability listed in the Policy.
In light of the clear language of the Policy, Provident did not breach the contract by failing to compound Arya's COLA benefits.
For the reasons set forth above, the Court will grant Provident's motion for summary judgment, entering judgment in its favor and against Arya.
An appropriate order follows.
Below, the Court will discuss Arya's first two remaining claims together before separately addressing the third claim.