ROBERT H. CLELAND, District Judge.
After a cervical spine disc herniation left Plaintiff Louis Leonor unable to continue working as a dentist, Defendants Provident Life and Accident Company ("Provident") and Paul Revere Life Insurance Company ("Paul Revere") paid him "Total Disability" benefits pursuant to three disability income insurance policies. Shortly
Plaintiff filed suit against Defendants alleging breach of contract and fraud. On March 20, 2013, 2013 WL 1163375, the court granted Defendants' motion to dismiss Plaintiff's fraud claim under Federal Rule of Civil Procedure 12(b)(6). The parties now cross-move for summary judgment on Plaintiff's remaining breach of contract claim. The motion has been fully briefed, and a hearing is unnecessary. See E.D. Mich. LR 7.1(f)(2). For the reasons that follow, the court will deny Defendants' motion for summary judgment and grant Plaintiff's motion for summary judgment.
Plaintiff, currently age 51, first became licensed to practice dentistry in 1987. (Pg. ID ## 542, 1269.) Shortly thereafter, he began to acquire various dental practices in Southeastern Michigan. Thus, in addition to practicing dentistry, Plaintiff sought out practices, interviewed the doctors and personnel in those practices, and performed due diligence with legal counsel and accountants. (Pg. ID # 400-02.) Between 1989 and 2008, Plaintiff became the sole proprietor of Oakcrest Dental Center, P.C., Flat Rock Dental Center, Stoneybrook Dental, P.C., and Romulus Family Dental Center. (Pg. ID # 1342-43.) Plaintiff "owned all of these practices ... and ... received income from all of them in various forms, whether it be W-2s for a practice where [he] performed dentistry or 1099 wages for the practices that [he] owned." (Pg. ID # 396.) In addition to owning dental practices, Plaintiff invested in and owned supply companies and various commercial and residential real estate. (Pg. ID ## 883, 543.)
In March 2009, Plaintiff had surgery to correct a cervical spine disc herniation. (Pg. ID # 1345.) Prior to surgery, Plaintiff performed dental procedures at Stoneybrook Dental 35 to 40 hours a week. (Pg. ID # 1282.) He also spent 15 to 25 hours per week "managing/overseeing all his businesses, both dental and non-dental." (Pg. ID # 542.) Since the surgery, Plaintiff has been unable to work as a dentist
Beginning in 1990, Plaintiff purchased three disability income insurance policies (the "Policies") from Defendants Provident and Paul Revere.
On April 24, 1990, Paul Revere issued policy number 0102450113 (the "0113 Policy") to Plaintiff. (Pg. ID # 906.) Regarding "Total Disability," the 0113 Policy states:
(Pg. ID # 920.) The monthly benefit amount for a period of "Total Disability" "is the Maximum Monthly Amount" which is $7,650.00 under the 0113 Policy.
(Pg. ID # 921.) "Your Occupation" is defined as "the occupation in which You are
On July 1, 1995, Paul Revere issued policy number 0102748090 (the "8090 Policy") to Plaintiff. (Pg. ID # 951.) Regarding "Total Disability," the 8090 Policy states:
(Pg. ID # 959.) The monthly benefit amount for a period of "Total Disability" "is the Maximum Monthly Amount" which is $1,850.00 under the 8090 Policy. (Pg. ID ## 961, 953.) As for "Residual Disability," the 8090 Policy states:
(Pg. ID # 960.) "Your Occupation" is defined as "the occupation or occupations in which You are regularly engaged at the time Disability begins." (Pg. ID # 959.)
On December 20, 2002, Provident issued policy number 06-7912074 (the "2074 Policy") to Plaintiff. (Pg. ID # 989.) With respect to "Total Disability," the 2074 Policy states:
(Id.) "Your Occupation" is defined as "the occupation or occupations, as performed in the national economy, rather than as performed for a specific employer or in a specific location, in which You are regularly engaged at the time You become Disabled." (Pg. ID # 998.)
After the March 2009 surgery that left Plaintiff unable to practice dentistry, he filed a "Total Disability" claim, and in July 2009 Defendants began paying Plaintiff "Total Disability" benefits under each Policy. (Pg. ID # 1286.) However, on September 27, 2010, Defendants informed Plaintiff by letter that "benefit payments have not been issued beyond August 9, 2010" under the 8090 and 2074 Policies because he was "engaging in another occupation which is gainful." (Pg. ID # 1189.) As for the 0013 Policy, Defendants' August 10, 2011 letter notified Plaintiff they were "unable to consider additional payable benefits beyond the paid-to-date of July 9, 2011."
On December 5, 2012, Plaintiff filed suit against Defendants alleging breach of contract (Count I) and fraud and misrepresentation (Count II). As relief, Plaintiff seeks "an amount equal to the Monthly Benefits due under the Policies less the amounts of the reduced Monthly Benefits paid" and an order declaring that Plaintiff is entitled to lifetime "Total Disability" benefits under the three policies. (Pg. ID # 6.) Additionally, Plaintiff seeks penalty interest of 12% per annum pursuant to Mich. Comp. Laws 500.2006(4). (Id.) Defendants counter-claimed
Summary judgment is proper only when "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). "In deciding a motion for summary judgment, the court must view the evidence in the light most favorable to the non-moving party, drawing all reasonable inferences in that party's favor." Sagan v. United States, 342 F.3d 493, 497 (6th Cir.2003).
The movant has the initial burden of showing the absence of a genuine dispute as to a material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The burden then shifts to the nonmovant, who must put forth enough evidence to show that there exists "a genuine issue for trial." Horton v. Potter, 369 F.3d 906, 909 (6th Cir.2004) (citing Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986)). Summary judgment, therefore, is not appropriate when "the evidence presents a sufficient disagreement to require submission to a jury." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251-52, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).
The existence of a factual dispute alone does not, however, defeat a properly supported motion for summary judgment — the disputed factual issue must be material. A fact is "material" for purposes of summary judgment when proof of that fact would establish or refute an essential element of the claim or a defense advanced by either party. Kendall v. Hoover Co., 751 F.2d 171, 174 (6th Cir.1984) (citation omitted).
This is a diversity action in which the court applies federal procedural law and state substantive law. See Legg v. Chopra, 286 F.3d 286, 289 (6th Cir.2002) (citing Erie R.R. Co. v. Tompkins, 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188 (1938)); see also Talley v. State Farm Fire & Cas. Co., 223 F.3d 323, 326 (6th Cir.2000) ("In a diversity action involving an insurance contract, a federal court applies the substantive law of the forum state.").
Construction and interpretation of an insurance contract is a question of law for the court. Ann Arbor Pub. Sch. v. Diamond State Ins. Co., 236 Fed.Appx 163, 165 (6th Cir.2007) (citing Henderson v. State Farm Fire & Cas. Co., 460 Mich. 348, 596 N.W.2d 190, 193 (1999)). In Michigan, a court "look[s] at the language of the insurance policy and interpret[s] its terms in accordance with the principles of contract construction." Allstate Ins. Co. v. Muszynski, 253 Mich.App. 138, 655 N.W.2d 260, 261-62 (2002). The commonly used meaning of the terms controls, unless the insurance contract expressly defines them. Grp. Ins. Co. v. Czopek, 440 Mich. 590, 489 N.W.2d 444, 447 (1992).
"An insurance contract is clear if it fairly admits of but one interpretation. An insurance contract is ambiguous if, after reading the entire contract, its language reasonably can be understood in differing ways." Farm Bureau Mut. Ins. Co. v. Blood, 230 Mich.App. 58, 583 N.W.2d 476, 478 (1998) (citations omitted). If a court determines that "the contractual language is unambiguous, [it] must interpret and enforce the contract as written, because an unambiguous contract reflects the parties' intent as a matter of law." In re Smith, 745 N.W.2d at 758. However, where a court determines that an insurance contract is ambiguous, Michigan law requires that, "[a]mbiguities and reasonable doubts ... [be] construed most favorably to the insured to maximize coverage." Carlyon v. Mut. of Omaha Ins. Co., 220 Mich.App. 444, 559 N.W.2d 407, 408 (1996) (citing American Bumper & Mfg. Co. v. Hartford Fire Ins. Co., 452 Mich. 440, 550 N.W.2d 475, 480 (1996); Erickson v. Citizens Ins. Co., 217 Mich.App. 52, 550 N.W.2d 606, 608 (1996)).
Plaintiff argues that he is entitled to "Total Disability" benefits under the 0113 Policy. Regarding "Total Disability," the 0113 Policy states:
(Pg. ID # 920.) Each part of the definition will be discussed, but the court will begin with the physician's care requirement.
For the first time, in their response to Plaintiff's motion for summary judgment, Defendants attempt to refute that Plaintiff is "under the regular and personal care of a Physician". This argument is absent from Defendants' answer, as well as its own motion for summary judgment and its reply in support of that motion.
To support their argument, Defendants point to two renewal applications for dental malpractice insurance with CNA Insurance Company signed by Plaintiff on July 1, 2009, and August 13, 2013. Defendants quote the following question from the first application, "[h]ave you been treated for... mental illness or physical impairment? If "yes" provide a letter from treating physician with complete details." (Pg. ID # 1331.) Plaintiff checked "[n]o." (Id.) Defendants
Plaintiff's affidavit does not mention the July 21, 2009 application renewal form, and therefore does not address Defendants' argument that Plaintiff "admitted" he was not "under the regular and personal care of a Physician" from March 2009 to July 21, 2009. However, when initially filing his claim for disability benefits, Plaintiff submitted to Defendants a June 6, 2009 Attending Physician Statement ("APS") completed by Dr. Seyfried of Henry Ford Hospital. (Pg. ID # 1012.) The APS lists March 10, 2009 under "date of first visit regarding current conditions" and June 4, 2009 under "date of last examination." (Pg. ID # 1021.) In addition to listing Plaintiff's "current treatment program" and "medication," it also indicates that Plaintiff was under the care of two other Henry Ford doctors, Dr. Crotty, a neurosurgeon, and Dr. Desilva, an orthopedist. (Pg. ID # 1012.) Plaintiff's disability claim form, dated June 11, 2009, lists six doctors under "[p]lease list ALL treatment providers with whom you are currently treating" including Dr. Seyfreid and Dr. Crotty. (Pg. ID # 1123-24.) The list details each doctor's specialty and the date of Plaintiff's last visit. (Id.) Finally, the court observes that Defendants' July 2, 2009 letter initiating payment of "Total Disability" benefits states, "[b]ased on review of the available information which accompanied your claim form, there is reasonable support for you meeting your policies' definitions of Total Disability beginning on March 11, 2009." (Pg. ID # 1146.) If Plaintiff met the definition of "Total Disability" then Defendants would have had to have determined that he was "under the regular and personal care of a Physician." The overwhelming evidence confirms that Plaintiff was "under the regular and personal care of a Physician" from March 2009 to July 21, 2009.
Moreover, the record establishes that Plaintiff remains "under the regular and personal care of a Physician." In his August 17, 2013, deposition Plaintiff testified that he sees Dr. Emmer, Dr. Shuker, and Dr. Pierce for nerve damage. (Pg. ID # 885.) Plaintiff testified that he sees Dr. Shuker, an internist, once a year. (Id.) During Plaintiff's last visit, Dr. Shuker reviewed Plaintiff's medications, conducted blood work, examined Plaintiff's gastrointestinal tract, and referred him to Dr. Emmer. (Id.) Dr. Emmer, a neurologist, has been treating Plaintiff for "several years, two years, three years" and Plaintiff sees him every three to four months where Dr. Emmer reviews Plaintiff's medication and
Defendants have not set forth sufficient evidence to create a genuine issue of material fact on the question of whether Plaintiff is "under the regular and personal care of a Physician." The nonmovant "must do more than raise some doubt as to the existence of a fact; the non-moving party must produce evidence that would be sufficient to require submission of the issue to the jury." Kerwin v. Paul Revere Life Ins. Co., 6 Fed.Appx. 233, 240 (6th Cir. 2001); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249-50, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986) ("If the [nonmovant's] evidence is merely colorable, or is not significantly probative, summary judgment may be granted."). The court concludes that, as a matter of law, Plaintiff has been "under the regular and personal care of a Physician" since his March 2009 surgery. No reasonable jury could find differently based on the evidence presented in the record.
To decide if Plaintiff is "unable to perform the important duties of [his] Occupation" the court must first determine Plaintiff's occupation. "Your Occupation" is defined as "the occupation in which You are regularly engaged at the time You become Disabled." (Pg. ID # 920.) Prior to Plaintiff's 2009 cervical disc herniation surgery, he performed dental procedures at Stoneybrook Dental 35 to 40 hours a week. (Pg. ID ## 1282.) At that time, he also spent 15 to 25 hours per week "managing/overseeing all his businesses, both dental and non-dental." (Pg. ID # 542.) Put differently, Plaintiff spent roughly two thirds of his time performing dental procedures and the other third of his time managing and overseeing his dental practices and other businesses. However, Plaintiff's management and oversight duties generated approximately half of his income.
Courts appear to take one of two approaches when interpreting disability insurance policies with similar, and in many cases the same, language. Under the first approach, upon which Defendants rely, courts have interpreted similar language to mean that an insured must be unable to perform "all" of his important duties to be considered "Totally Disabled." These courts have held that an insured's ability to perform just one important duty precludes a determination of total disability. The logic of the first approach is that where a policy provides for total and residual/partial disability, an insured cannot be "Totally Disabled" if the insured is able to perform some of the important duties of his "Occupation" because any other construction would render the residual/partial disability provision meaningless. For example, in Canu v. Nat'l Life Ins. Co., 12-12838, 2013 WL 1883534, at *6 (E.D.Mich. May 6, 2013), Judge Cohn explained:
However, the policy language in Miller, upon which Canu partially relies, differed
Under the second approach, which Plaintiff endorses, courts find the definitions of "Total Disability" and "Residual Disability" ambiguous. Using this approach, courts explain that just because an insured is able to continue in "some" of his pre-disability duties, he is not precluded from "Total Disability" benefits. For example, in Giddens v. Equitable Life Assur. Soc. of U.S., 445 F.3d 1286, 1298 (11th Cir.2006), the Eleventh Circuit Court of Appeals concluded that ambiguity existed in a similar "Total Disability" provision, explaining: "[w]e do not suggest that `all' is an unreasonable interpretation of the policy language, but we do say that `most' or the `majority' of the substantial and material duties is also a reasonable interpretation if an insured is unable to engage in his regular occupation as a result of his inability to perform most or the majority of those duties." Giddens held that the plaintiff-insured was not precluded from showing a "Total Disability" despite retaining an ability to "perform a few substantial and material duties — including ... selecting house plans, materials, and subcontractors —" because "his ability to perform those tasks in isolation still would not allow [plaintiff] to continue in his real estate development occupation [where] he is unable to perform his entrepreneurial, financial, planning, coordinating, and administrative duties, which were the heart of his real estate occupation." Id. In interpreting similar policy provisions, the Eighth Circuit Court of Appeals reached the same result as the Eleventh Circuit: "[t]he policies' definitions of `total disability' are susceptible to differing interpretations, because the policies do not speak in terms of "any," "all," "some," or "the most important part" of [the insured's] duties." Dowdle v. Nat'l Life Ins. Co., 407 F.3d 967, 970 (8th Cir.2005). Dowdle held that a surgeon who could no longer stand long enough to perform orthopedic surgery but who could conduct office visits, see patients, read x-rays, perform independent medical examinations, interpret data, and promote referrals was totally — not residually — disabled because he could not perform "the most important substantial and material duty" of his pre-disability occupation. Id. at 972. Dowdle emphasized that it was relying on Minnesota law, which requires an interpretation in favor of coverage when a contract is ambiguous. As noted previously, like Minnesota, under Michigan law, "[a]mbiguities and reasonable doubts in insurance contracts are construed most favorably to the insured to maximize coverage." Carlyon, 559 N.W.2d at 408.
The court finds the latter view more convincing. Under Michigan law,
Raska v. Farm Bureau Mut. Ins. Co. of Mich., 412 Mich. 355, 314 N.W.2d 440, 441 (1982). Because "unable to perform the important duties of Your Occupation" could reasonably be interpreted as inability to perform "all" of the important duties or "some" of the important duties of one's "Occupation," the provision is ambiguous. A recent Eastern District of Michigan case, Stoneman, 2013 WL 6768616, at *14, followed the second approach and concluded that the Policy at issue, containing identical language to that of the 0113 Policy, was ambiguous because the language is susceptible to more than one reasonable interpretation. Stoneman also noted that its finding of ambiguity "is bolstered by Michigan case law providing that when `a conflict of opinion' regarding interpretation of insurance contract language arises among courts both in and out of state, the language is at least `of doubtful meaning and requires construction.'" Id. (citing C. & J. Commercial Driveway v. Fid. & Guar. Fire Corp., 258 Mich. 624, 242 N.W. 789, 790-91 (1932)); see also Mich. Millers Mut. Ins. Co. v. Bronson Plating Co., 445 Mich. 558, 519 N.W.2d 864, 869 n. 8 (1994) (finding "the division of authority" over interpretation of insurance contract language "to be instructive and to at least lend credence to the position that more than one reasonable interpretation of the term exists"), overruled on other grounds by Wilkie v. Auto — Owners Ins. Co., 469 Mich. 41, 664 N.W.2d 776 (2003). The court finds the reasoning of Stoneman persuasive.
Finally, the court notes that a finding of ambiguity does not nullify the "Residual Disability" provision. Instead, reading the "Total Disability" and "Residual Disability" provisions together "creates a continuum of disability." Oliver v. Nat'l Life Ins. Co., 09-11040, 2011 WL 5904651, at *7 (E.D.Mich. Nov. 22, 2011) (Zatkoff, J.) (citations omitted). In reference to the concept of a "continuum of disability," the Eleventh Circuit explained,
Giddens, 445 F.3d at 1300-01. The court agrees that "Total Disability" and "Residual Disability" are not mutually exclusive categories. "Had Defendant[s] meant `all' `[important]' duties, [they] could have expressly stated such." Oliver, 2011 WL 5904651, at *7; see also Stoneman, 2013 WL 6768616, at *13 ("If [Defendant] means `all' in its Total Disability clause, then it may amend its policies to make that simple change.").
In summary, Plaintiff's reading that "the important duties" does not mean "all important
Plaintiff argues that he is entitled to "Total Disability" benefits under the 8090 and 2074 Policies. Unlike the 0113 Policy's two-part formulation, the 8090 and 2074 Policies use a three-part formulation to define "Total Disability." The 8090 Policy states:
(Pg. ID # 959.) The 2074 Policy states:
(Pg. ID # 998.) The first part in the 8090 Policy definition of "Total Disability" — "You are unable to perform the important duties of Your Occupation," is identical to the first part of the 0113 Policy discussed in the previous section. That language is also substantially similar to the first part in the 2074 Policy — "You are unable to perform the material and substantial duties of Your Occupation." "Important" has simply been replaced with "material and substantial" and connotes the same meaning and effect.
The "Residual Disability" provision is also similar, or the same, in the three Polices. The 0113 Policy and the 8090 Policies both include, "You are unable to perform one or more of the important
Defendants attempt to distinguish the 8090 and 2074 Policies from the 0113 Policy because of the three-part definition of "Total Disability" in the 8090 and 2074 Policies. As noted above, the second part of the definition of "Total Disability" in the 8090 and 2074 Policies states, "[y]ou are not engaged in any other gainful occupation" and "[y]ou are not engaged in any other occupation," respectively. Under the 8090 Policy, "Your Occupation" is defined as "the occupation or occupations in which You are regularly engaged at the time Disability begins." (Pg. ID # 959.) Under the 2074 Policy, "Your Occupation" is defined as "the occupation or occupations, as performed in the national economy, rather than as performed for a specific employer or in a specific location, in which You are regularly engaged at the time You become Disabled." (Pg. ID # 998.)
As established in the preceding section, prior to Plaintiff's surgery, he performed dental procedures at Stoneybrook Dental 35 to 40 hours a week and also spent 15 to 25 hours per week "managing/overseeing all his businesses, both dental and non-dental." (Pg. ID ## 1282, 397, 542.) A June 23, 2009, "action plan" written shortly after Plaintiff's surgery by Jodie Duval, Defendants' Disability Benefits Specialist, verified Plaintiff's primary occupational duties as performing general dentistry:
(Pg. ID # 1143.) However, approximately two years after Plaintiff's surgery, on September 8, 2011, Defendants' unilaterally modified Plaintiff's "Occupation" from "Dentist" to "Dentist and Owner/Operator." (Pg. ID # 1233.) Consistent with their modification of Plaintiff's "Occupation," when discussing the 0113 Policy, Defendants emphasized that "Plaintiff's occupation at the time of disability as of March 2009 was not merely a practicing dentist, but included owning, managing and purchasing several other dental practices, all of which he continued to do after March 2009." (Pg. ID # 282.) As stated earlier, "Total Disability" under the 0113 Policy is defined using a two-part formulation:
(Pg. ID # 920.) Thus, according to Defendants, if Plaintiff's former "Occupation" was exclusively a "dentist" and he could no longer perform dentistry he would be "Totally Disabled" because he would be "unable
However, Defendants reformulation of Plaintiff's title bolsters Plaintiff's argument that he is "Totally Disabled" under the 8090 and 2074 Polices's three-part definition of "Total Disability." To reiterate, the 8090 Policy states:
(Pg. ID # 959.) The 2074 Policy states:
(Pg. ID # 998.) The second part in each, "You are not engaged in any other gainful occupation" and "You are not engaged in any other occupation" respectively, is absent from the 0113 Policy which uses only a two-part definition of "Total Disability." Before the modification, when Plaintiff's title was "Dentist," Defendants might have argued that under the 8090 or 2074 Policies Plaintiff was no longer a "dentist" post-disability but that he was engaged in an "other occupation" or "other gainful occupation" — that of an "Owner/Operator." However, due to their modification of Plaintiff's "Occupation" from "Dentist" to "Dentist and Owner/Operator" that argument is now unavailable to Defendants; Plaintiff is not engaged in an "other occupation" or "other gainful occupation."
Accordingly, the court concludes that the 8090 and 2074 Policies are ambiguous and coverage will be construed to maximize coverage to the insured, Plaintiff.
With respect to the 2074 Policy only, Defendants argue that Plaintiff is not entitled to summary judgment because of that Policy's "Mental Disorder" exclusion. The 2074 Policy states: "[i]f your disability is contributed to or caused by a Mental Disorder, We will pay benefits according to the provisions of this Policy, except as limited by the Maximum Benefit Period for Mental Disorders." (Pg. ID # 1007.) The Policy states that the "Maximum Benefit Period for Mental Disorders" is "24 months over the life of Your Policy." (Pg. ID # 993.) The Policy defines "Mental Disorders":
(Pg. ID # 996.)
On December 3, 2010, Defendants exercised their contractual right under each Policy and arranged for an independent medical examination of Plaintiff. (Pg. ID # 1293.) Dr. Carol E. Holden, who performed the examination stated in her report, "[t]he pain Dr. Leonor experiences when he attempts to do dental procedures is real; and it is exacerbated by, for example, his anxious anticipation of pain, lack, of confidence that he will be able to succeed, muscle tension, depression, and other psychological factors." (Pg. ID # 1211.) Dr. Holden concluded, "in my opinion, [Plaintiff] cannot return to full-time dentistry at this point." (Id.) At Defendants request, Dr. Holden answered additional questions in an addendum. In response to the question, "[i]s your opinion ... that the insured cannot return to full time dentistry based on physical or behavioral health complaint/symptoms?" Dr. Holden wrote:
(Pg. ID # 1215.) Plaintiff's deposition testimony confirms that in addition to his physical limitations, he suffers from depression. In response to the question "what condition or conditions, Doctor, do you believe prevent you from practicing dentistry? Plaintiff answered "physical and psychological." (Pg. ID # 885.) Later, Plaintiff testified that his Psychiatrist Dr. Omar diagnosed him with "major depression and something else." (Pg. ID # 887.) Given that Plaintiff's disability "is contributed to ... by a Mental Disorder" the 2074 Policy limits his benefit period to 24 months.
In Guo v. Reliance Standard Life Ins. Co., 08-11027, 2009 WL 2386084 (E.D.Mich. July 30, 2009) (Cleland, J.), the court reached the same result in interpreting the plan language of an insurance Policy. In Guo an ERISA plan provided that "Monthly Benefits for Total Disability caused by or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months." Id. at *2. Initially diagnosed with the physical medical condition of Vertigo, Guo's anxiety contributed to that condition and the defendant
In the instant case, Plaintiff filed his "Total Disability" claim shortly after his surgery, and in July 2009 Defendants began paying Plaintiff "Total Disability" benefits under each of the Policies.
In summary, Plaintiff is "Totally Disabled" under the 8090 and 2074 Policies. As explained in the background section, under the 8090 Policy, the monthly benefit amount for a period of "Total Disability," is $1,850.00. (Pg. ID ## 961, 953.) Because his "Total Disability" began before he turned 61, Plaintiff is entitled to benefits "to age 65" under the 8090 Policy. (Pg. ID # 957.) As noted in the background section, under the 2074 Policy, the monthly benefit amount for a period of "Total Disability," is $400.00. (Pg. ID ## 1002, 993.) Under the 2074 Policy, because Plaintiff's disability "is contributed to ... by a Mental Disorder" his benefit period is limited to 24 months and he is owed benefits for 9 months. With respect to the 8090 and 2074 Policies, Defendants' motion for summary judgment will be denied and Plaintiff's motion for summary judgment will be granted.
In answering Plaintiff's complaint, Defendants counterclaimed stating that "Plaintiff was paid benefits under the Policies to which he was not entitled" and, as such, Defendants seek repayment of the alleged overpayment. (Pg. ID # 26.) Defendants do not mention their counterclaim in their motion for summary judgment. Regardless, as the court has found that Plaintiff is entitled to "Total Disability" benefits under the Policies, the court will deny Defendants' counterclaim as moot.
Plaintiff includes a claim in his complaint seeking penalty interest of 12% per annum pursuant to Mich. Comp. Laws. 500.2006(4). (Pg. ID # 6.) Mich. Comp. Laws § 500.2006(4) requires an insurer to pay an insured interest when benefits are
IT IS ORDERED that Defendant's motion for summary judgment [Dkt. # 29] is DENIED and Plaintiff's motion for summary judgment is GRANTED [Dkt. # 31].
IT IS FURTHER ORDERED that Defendants pay Plaintiff "Total Disability" benefits under the 0113 Policy for the remainder of his lifetime, "Total Disability" benefits under the 8090 Policy until he turns 65, and "Total Disability" benefits under the 2074 Policy for an additional 9 months.
Finally, IT IS ORDERED that Plaintiff's claim for penalty interest is denied under M.C.L. § 500.2006(4).
A separate judgment will issue.