STEPHEN M. McNAMEE, Senior District Judge.
Before the Court is Defendant Lincoln National Life Insurance Company's ("Lincoln") fully briefed Motion for Summary Judgment. (Docs. 46; 50; 55.) For the reasons that follow, the motion is denied.
As a preliminary matter, the separate and controverting statements of fact provided for by Local Rule 56.1 are simply indices to evidence in the record that establish the existence or absence of genuine disputes.
Even though Plaintiff Neil Barnett ("Barnett") was granted leave to exceed presumptive page limits, he filed a controverting statement of facts that went beyond summarily stating objections and/or disputing Lincoln's factual assertions with conflicting evidence by raising substantive legal arguments (
It would be inequitable to penalize Barnett and excuse Lincoln for violating the same rule in virtually the same manner. Accordingly, the Court hereby vacates the part of its Order of January 23, 2014, striking Barnett's controverting statement of facts (Doc. 52 at 2:6-7, 12-14) but will not consider any arguments raised outside of either party's legal memoranda. Both parties are reminded that compliance with the Local and Federal Rules of Civil Procedure is paramount.
As to the parties' objections themselves, a court ruling on summary judgment may not consider evidence that would be inadmissible at trial.
Fed. R. Civ. P. 56(c)(2) advisory committee notes (2010). Like an objection at trial, the objecting party must "state[] the specific ground [therefor], unless it [is] apparent from the context." Fed. R. Evid. 103(a)(1)(B);
Barnett mostly raises specific objections (e.g. "Plaintiff objects . . . on the basis of hearsay"). (
Conversely, Lincoln exclusively raises unspecific objections ("Lincoln National objects . . ."). (
The following facts are not the subject of any genuine dispute. In February 1993, Third-Party Defendant Anthony Rogozinski ("Rogozinski") was a general agent for CHUBB Insurance Company. (Docs. 54 ¶¶ 1-3; 56 at 7 ¶ 2.) Barnett was a practicing orthopedic surgeon who was concerned about whether the disability policy he had at the time would provide coverage if he could no longer perform surgery. (Doc. 47 ¶ 8.) Barnett knew Rogozinski was a CHUBB agent and had purchased other CHUBB instruments from Rogozinski in the past. (Doc. 54 ¶¶ 39, 59.) Rogozinski met with Barnett at his home and, after a conversation that focused mostly on what constituted disability, recommended that a CHUBB policy with an "Own Occupation Rider" and an "Own Occupation Speciality Rider" would give Barnett better and more coverage.
Barnett's application was approved and when Rogozinski delivered the CHUBB disability policy (the "Policy") to Barnett, the two of them went through the Policy page by page discussing what the Policy terms meant. (
(Docs. 47 ¶¶ 19-20, 22; 59-11.)
Rogozinski's and Barnett's discussion generally concerned how the "Own Occupation Rider" (Doc. 59-11 at 12) and the "Own Occupation Specialty Rider" applied to benefits. (Doc. 54 ¶ 30.) If Barnett had a question about a Policy term, he would ask Rogozinski how CHUBB would apply the verbiage (
Rogozinski told Barnett that he was the local representative for CHUBB, that he spoke for CHUBB in clarifying questions about policy terms, and that he was CHUBB's mouthpiece. (
A few years later but before Barnett reached the age of 50, he filed a claim for disability benefits after developing osteoarthritis in his right shoulder. (
By August 4, 2008, well before his 65th birthday, Barnett informed a Lincoln representative that he was totally disabled and that he was entitled to lifetime benefits under the Policy. (Docs. 54 ¶ 52; 59-8 at 2; 60-1 at 69-70.) The representative responded that Barnett's benefits would expire on his 65th birthday. (Docs. 59-8 at 2; 60-1 at 69-70.) Barnett replied that if his benefits ended when he turned 65 then Rogozinski misrepresented the terms of the Policy and threatened legal action if it became necessary. (Docs. 47 ¶ 27; 60-1 at 70.) By April 2011, still before he turned 65, Barnett hired attorney an who inquired about the Policy's Total Presumptive Disability Benefits by mail (Docs. 54 ¶ 53; 54-9) and by phone (Docs. 54 ¶ 54; 54-10). Lincoln sent letters to the attorney in June, July, and November 2011 (Docs. 47 ¶¶ 39-41; 60-2 at 48-49, 51, 53), in January and February 2012 (Doc. 60-3 at 2-3, 5-6).
Lincoln took the position that neither Barnett nor his counsel ever provided evidence to support Barnett's claim of total disability.
On September 12, 2012, Barnett filed suit in Maricopa County Superior Court bringing claims for declaratory judgment, breach of contract, insurance bad faith, and negligent misrepresentation. (Doc. 1-1 at 5-15.) Lincoln timely removed on the basis of diversity (Doc. 1) and filed a Third-Party Complaint against Rogozinski, which was served by publication. (Docs. 20; 27.) Rogozinski has not answered. Barnett and Lincoln jointly moved to dismiss the insurance bad faith claim, which the Court granted. (Docs. 35; 36.) Thereafter, Lincoln filed for summary judgment on all of Barnett's remaining claims.
"The 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 judgment as a matter of law." Fed. R. Civ. P. 56(a). "[T]he substantive law will identify which facts are material[;] [o]nly disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment."
To prove the absence of a genuine dispute, the movant must demonstrate that "the evidence is such that [no] reasonable jury could return a verdict for the nonmoving party."
In determining whether either or both of these burdens have been carried, "[t]he evidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in [that party's] favor."
"[D]istrict courts are widely acknowledged to possess the power to enter summary judgments sua sponte, so long as the losing party was on notice that she had to come forward with all of her evidence."
Lincoln seeks summary judgment on all three of Barnett's remaining claims.
There are three elements to a breach of contract claim: (1) the existence of a contract; (2) breach; and (3) resultant damages.
At the heart of this case is the meaning of the operative clause in the Presumptive Total Disability provision: "You will be presumed to have a Total Disability if Injuries or Sickness results in the total loss of . . . the use of both hands." The parties disagree about the meaning of "total loss." Lincoln proposes that "total loss" means the loss of "all practical benefit." (Doc. 47 at 18.) Barnett proposes that "total loss" means the "loss of use of his hands to perform the material and substantial duties" of his occupational specialty—orthopedic surgery. (Doc. 50 at 16.) The Policy itself is silent on the matter.
Much of the parties' briefing focuses on the existence and nature of CHUBB's relationship with Rogozinski. Rightly so: Barnett's claim for breach can be disposed of on agency grounds. Specifically, if Rogozinski was an agent of CHUBB with authority to make true representations about the effect of policy riders on coverage, then Rogozinski's representation about the effect of the Own Occupation Rider is binding on CHUBB, even if the representation turned out to be false.
Generally, the question of agency is one of fact, but the question becomes one of law when the material facts are undisputed.
Actual authority extends beyond that expressly granted and includes the "implied" authority to (1) "do what is necessary, usual, and proper to accomplish or perform an agent's express responsibilities"; and/or (2) "act in a manner in which an agent believes the principal wishes the agent to act based on the agent's reasonable interpretation of the principal's manifestation in light of the principal's objectives and other facts known to the agent."
Barnett argues that because Rogozinski explained how the insurance policy worked while he was selling and delivering the Policy, Rogozinski was acting within the implied scope of his express authority. (Doc. 50 at 9.) The unstated premise of this argument is that interpreting policy terms and riders is necessary to and in the usual course of selling insurance. Lincoln does not argue—nor is there evidence to suggest—that Rogozinski lacked implied actual authority to correctly explain insurance coverage.
Both parties are correct. On the one hand, it would be all but impossible for Rogozinski to sell an insurance policy if he could not explain the coverage it provided, and neither the "General Agent's Contract" nor the insurance application make any mention of the agent's authority to explain the meaning of policy language. CHUBB could have withheld interpretive authority, but did not. There is no evidence capable of supporting a finding that Rogozinski lacked authority to correctly explain policy terms. On the other hand, Rogozinski's implied interpretive authority cannot conflict with clear and unambiguous policy language; such an interpretation would be tantamount to waiving or altering policy provisions. Both parties' positions are accommodated by framing the inquiry as whether Rogozinski's explanation of the Own Occupation Rider and the Presumptive Total Disability provision conflicts with the clear and unambiguous language of the Policy.
"The interpretation of an insurance contract is a question of law."
The Own Occupation Rider purports to "liberalize[] the policy definition of total disability to create the best definition available today" by changing the definition of "Total Disability or totally disabled" to mean the inability "to perform the substantial and material duties of [his or her] occupation," provided the insured is receiving appropriate medical care unless such care is futile. (Doc. 59-11 at 12.) The Presumptive Total Disability clause references "Total Disability" three different times and states that the insured "will be presumed to have a Total Disability if Injuries or Sickness results in the total loss of . . . the use of both hands." (
It is undisputed that Barnett asked Rogozinski to explain the coverage resulting from the interaction of the Own Occupation Rider and the Presumptive Total Disability provision. It is also undisputed that Rogozinski explained the Own Occupation Rider modified the Presumptive Total Disability provision so that Barnett would be presumed to be totally disabled if he lost the use of both his hands to perform the substantial and material duties of a practicing orthopedic surgeon. Further, it is undisputed that Barnett understood Rogozinski's explanation as clarifying, as opposed to amending, the Policy. Nothing in the Presumptive Total Disability provision plainly states that the definition of "total loss" is independent of the Own Occupation Rider and there is no evidence to suggest that Barnett knew or had reason to know Rogozinski's explanation was incorrect. The Court finds as a matter of contract interpretation that Barnett could have reasonably interpreted the "total loss" clause in more than one way and that Rogozinski's construction of the Own Occupation Rider vis-à-vis the Presumptive Total Disability provision was reasonable.
Given that Rogozinski had authority to correctly explain CHUBB's lines of coverage and that his explanation of Barnett's coverage does not conflict with plain and unambiguous language, Rogozinski's explanation is binding on CHUBB and its successors. This result is consistent with the well settled common law principle that the acts of the agent in the ordinary course of service to the principal are the acts of the principal.
The only evidence in the record is that Barnett indeed lost the use of both his hands for purposes of surgery before his 65th birthday. It is undisputed that CHUBB and its successors initially paid out benefits because Barnett lost the ability to perform surgery. It is also undisputed that Barnett, before his 65th Birthday, communicated to Lincoln that he had lost the use of both hands to perform surgery. It is undisputed that Barnett cannot now perform the duties of an orthopedic surgeon and that he will never regain the ability to perform those duties. There is no evidence capable of supporting a finding that Barnett did not lose the use of both hands to perform the substantial and material duties of surgery before his 65th birthday. Consequently, Lincoln's refusal to pay benefits past Barnett's 65th birthday breached the Policy and Barnett is entitled to summary judgment on both his claims for breach and for declaratory judgment.
It is true that this result is based principally upon Barnett's own recollection, but that does not mean that Lincoln is excused from having to come forward with evidence from which a jury could return a favorable verdict. Lincoln "must do more than simply show that there is some metaphysical doubt as to the material facts."
In Arizona, there is a two-year statute of limitations for negligent misrepresentation actions.
In the case at bar, Barnett may have had reason to believe that Rogozinski misrepresented the Policy terms by August 8, 2008, when a Lincoln Representative told Barnett that his benefits were set to expire on his 65th birthday. (Doc. 60-1 at 69-70.) However, after Barnett hired an attorney, Lincoln sent five letters requesting proof that Barnett lost the use of both his hands (Docs. 60-2 at 48-49, 51, 53; 60-3 at 2-3, 5-6), but Barnett had already submitted what he believed to be sufficient proof of loss (Doc. 54 ¶¶ 61-62). On the one hand, Barnett could have known injury was imminent if the Policy definition was what Lincoln said it was. On the other hand, Barnett may have believed—at least until benefit payments ceased—that Lincoln retreated from its August 8, 2008, interpretation and that Rogozinski may not have misrepresented the terms of the Policy. The evidence in the record permits inferences for both parties' positions on the matter of when Barnett discovered the negligent misrepresentation cause of action. It is therefore for the jury to "determine at what point Plaintiff's knowledge, understanding, and acceptance in the aggregate provided sufficient facts to constitute a cause of action."
Accordingly,
Regardless, it is undisputed that Barnett believed Rogozinski had apparent authority to correctly explain coverage because: (1) Barnett knew Rogozinski was CHUBB's agent; (2) Barnett had previously purchased CHUBB instruments through Rogozinski; (3) CHUBB and Barnett communicated predominantly through Rogozinski; and (4) Rogozinski claimed interpretive authority. Based on the entire record, a jury could conclude only that Barnett's belief was reasonable and traceable to "expressive conduct," such as an indirect route of communication and conformity with prior transactions,