PER CURIAM.
Defendants Dr. David C. Maffei and his wife Leona Maffei, appeal from an order granting summary judgment and dismissing their counterclaim, which alleged professional negligence by their accountant, third-party defendants Esmond S. Druker, C.P.A., and the accounting firm employing Druker, plaintiff the Mercadien Group (Mercadien).
Dr. Maffei, a New Jersey licensed chiropractor, owned and operated two businesses: a chiropractic practice, formed as a professional corporation, and another entity known as Leige Corporation. Druker was Dr. Maffei's friend and the managing director of Mercadien; he performed accounting services for Dr. Maffei individually and for his businesses. From 1998 to 2004, Leona Maffei completed worksheets provided by Druker, gathered the necessary documentation, and transmitted it to Mercadien, along with payment of approximately $27,500 for the preparation of personal and business, state and federal income tax returns. However, from 1999 to 2004, no income tax returns were completed. Consequently, no returns were filed for defendants individually, for Dr. Maffei's chiropractic office, or for Leige Corporation. At some point, defendants contacted Druker and their personal tax returns were completed in September 2006.
Defendants' professional negligence claims relate to damages allegedly suffered by Dr. Maffei caused by the late filing of his tax returns. Specifically, Dr. Maffei maintains his inability to produce timely filed tax returns caused him to voluntarily dismiss separate litigation seeking disability benefits. Additional facts are necessary to understand the context of this assertion.
From 1993 through 1996, Dr. Maffei's chiropractic practice flourished. He reported working 55-65 hours and treating as many as 320 patients per week. The practice was comprised of as many as seven employees, including one other doctor, massage therapists, and a billing clerk.
When performing adjustments, Dr. Maffei employed the Applied Kinesiology Technique (AKT), which requires utilization of pressure to various parts of the back to reduce stresses, relax the muscles, and adjust the vertebrae. In addition to performing chiropractic adjustments, Dr. Maffei "screened and adjusted all massage patients"; "performed modalities" such as "ultrasound, heat, electric stimulation, G5 massage"; "took all x-rays"; "created and actively participated in several health fairs"; and performed "house calls" as necessary for patients.
In the late 1990s, Dr. Maffei began experiencing pain and swelling in his hands and arms. His ability to treat patients began to diminish because he "was only able to treat and adjust massage patients four hours, three days a week." He also stated he ceased making house calls, no longer participated in health fairs, and allowed his wife to perform all modalities.
By 2001, Dr. Maffei experienced great difficulty implementing AKT because his hands "began to swell daily . . . especially during the evening appointments. [His] upper body discomfort became more pronounced and [he] was unable to sleep [except] for only a few hours at a time." He continued to work and treat patients, explaining he was working in "consistent" "pain and discomfort" until 2002. From January 2002 through August 2002, Dr. Maffei stopped working because of his "inability to maintain finger contact" and need to "give [his hands] time to rest and heal." He hired another chiropractor, Steve Horowitz, to treat patients.
In February 2002, Dr. Maffei sought treatment by Brian J. Sennett, M.D. An EMG revealed "bilateral median nerve and ulnar nerve neuropathies[,]" resulting in Dr. Sennett's diagnosis that Dr. Maffei suffered from "[b]ilateral cubital tunnel syndrome, with ulnar nerve entrapment" and "[a]symptomatic carpal tunnel syndrome, bilateral hands." Dr. Sennett recommended Dr. Maffei avoid flexion and compression positions and continue his use of anti-inflammatory medications.
In April 2002, Dr. Maffei filed a total disability claim under the provisions of a Lincoln National Life Insurance Company (Lincoln National) disability insurance policy (the policy). In his claim, Dr. Maffei listed his occupational duties to include twenty-five to thirty hours of patient treatment along with twenty hours of paperwork each week. He described his disabling condition this way: "[a]rms, hands, and fingers have muscle fatigue, weak, painful, spasms, tingling sensation and atrophy of the forearms, numbness in fingers, fingers lock and wakes me up at night. Occasional swelling of the joints and hands, wrists, and arms[.]" Further, he stated pain in his hands occurred when he was treating patients, which caused him to reduce the number of patients he treated each hour.
The terms of the policy stated:
The policy also provided benefits for "residual disability":
MetLife served as the administrative agent for the disability income insurance business of Lincoln National. On June 13, 2002, MetLife wrote to Dr. Maffei explaining his submission contained "insufficient information as to the severity and extent that [his] conditions would restrict and limit [his] ability [to] perform the activities associated with being a self employed chiropractor at this time." MetLife sought additional medical records and arranged for a Field Claims Representative's observation of Dr. Maffei while working in his practice. The correspondence also noted the policy included coverage for residual disability benefits and sought copies of Dr. Maffei's 2000 and 2001 income tax returns.
Dr. Maffei returned to work in September 2002. He also underwent additional medical testing.
On August 9, 2002, Dr. Sennett requested "a functional capacity evaluation[,]" which was performed by Elizabeth Sweetland. The test revealed Dr. Maffei was "able to work at a light level of physical demand[,]" which included up to "20 pounds of occasional lifting, 10 pounds of frequent lifting, and no constant lifting." Dr. Sennett concluded "[i]t is within a reasonable degree of medical certainty that Dr. Maffei had limitations as a result of his bilateral upper extremity condition[,]" which was later described as "bilateral upper extremity pain and tightness[.]"
Following MetLife's subsequent review of additional medical reports and testing results, it informed Dr. Maffei its expert concurred with Dr. Sennett, and concluded his condition failed to qualify for "total disability" benefits under the terms of the policy. In an effort to "verify [Dr. Maffei's] occupation and business status leading up to and at the time [his] reported disability commenced and to determine [his] pre-disability income[,]" MetLife again requested copies of the chiropractic business tax returns for 1998 through 2001, and Dr. Maffei's personal income tax returns for 2000 and 2001.
Dr. Maffei continued to treat patients throughout 2003 and 2004. He explained his symptoms returned, impacting his ability to provide treatment because of pain and swelling in his fingers, hands, and arms. He also began experiencing pain in his cervical spine, which radiated to his elbows. His condition required a longer time interval to treat patients and additional days off for recovery following days he worked. Consequently, Dr. Maffei treated fewer patients, such that his patient load dropped to thirty-three per month in 2003, and just under thirty in 2004. He also found it necessary to refer patients with long-term problems to other chiropractors. As of March 7, 2005, Dr. Maffei permanently ceased working.
On August 11, 2004, Dr. Maffei initiated a coverage action against Lincoln National and MetLife, which was removed to federal court (the disability action). Ultimately, Dr. Maffei voluntarily dismissed the disability action, fearing possible ramifications regarding the late filed tax returns. Although all returns were filed in September 2006, Dr. Maffei declined to resubmit a disability benefit claim as he had canceled the disability policy in June 2006.
On July 27, 2007, Mercadien filed separate complaints seeking the balance of fees owed for accounting services provided to Dr. Maffei, his professional chiropractic corporation, and the Leige Corporation. Dr. Maffei answered and filed a counterclaim against Druker and Mercadien. Relevant to the issues raised on appeal are the allegations contained in the second count of the counterclaim alleging professional negligence by Druker and Mercadien in handling defendants' tax affairs, which caused Dr. Maffei to dismiss the disability action.
Mercadien moved for partial summary judgment seeking to dismiss the counterclaim, including count two pertaining to his necessary abandonment of the disability action. Mercadien asserted no proof of causation was presented as there was no relationship between the failure to complete the tax returns, MetLife's denial of total disability benefits, and Dr. Maffei's decision to dismiss his disability complaint.
Defendants admitted almost all statements of material fact presented in Mercadien's motion for partial summary judgment; however, they clarified certain facts, such as the actual hours Dr. Maffei worked pending his total disability claim. Further, defendants cross-moved for summary judgment on the same issue.
The motion judge determined the record contained no genuine disputes of fact. She found the unequivocal evidence revealed Dr. Maffei continued to treat patients from 2002 until 2005, the period for which he claimed total disability. Therefore, he was performing the main duties of his occupation and, as a matter of law, could not satisfy the requisites for total disability benefits under the plain language of the policy. Regarding defendants' cross-motion for partial summary judgment, the motion judge found Dr. Maffei had submitted proof of total disability from March 2005 through August 2010; however, he was not denied disability benefits for that period because he had never submitted a claim.
On May 27, 2011, the judge granted Mercadien's motion for partial summary judgment, dismissing any claims "arising out of Dr. David Maffei's allegations that he was forced to abandon his action seeking disability payments under [the disability policy,]" which effectively dismissed count two of the counterclaim. The motion judge also denied defendants' cross-motion for summary judgment. Thereafter, an order was entered disposing of all remaining claims in plaintiff's complaint and defendants' cross-claim.
On appeal, defendants limit their arguments to a challenge of the May 27, 2011 summary judgment dismissal of count two, arguing the motion judge erred in determining "Dr. Maffei was not totally disabled under the [disability] policy." Defendants maintain a determination of whether Dr. Maffei could perform the duties of his occupation should have been submitted to the factfinder. We reject defendants' contention that unresolved factual issues precluded entry of summary judgment.
Pursuant to
While a motion judge does not engage in the typical weighing of evidence that a factfinder would, the judge does not abstain from all balancing of evidence. The judge is required to analyze and sift through evidential materials and "determine `the range of permissible conclusions that might be drawn'",
In our review of a summary judgment determination, we employ the same standards used by the motion judge.
It is also important to note, a professional malpractice matter is based on negligence.
One method of proving proximately caused damages is "by attempting to prove the `suit within a suit.'"
In the Law Division, Mercadien successfully argued Dr. Maffei's inability to present sufficient proof he was totally disabled and, therefore, entitled to benefits under the disability policy, meant he could not prevail against MetLife and consequently, could not demonstrate he suffered damages proximately caused by any alleged malpractice when that MetLife suit was dismissed. Defendants contend, however, the motion judge erred in interpreting the terms of the policy and in concluding Dr. Maffei did not present proof he was totally disabled and entitled to recover against MetLife. Defendants argue the term "main duties" used within the total disability definition is open to interpretation. Therefore, under a broad interpretation of the policy, he qualified for benefits. To support this position, defendants cite a myriad of case authority from widespread jurisdictions suggesting total disability does not mean a party is unable to work. We find this contention unfounded as the argument ignores the fundamental principles guiding our review of an insurance contract.
The interpretation and construction of a contract are matters of law subject to plenary review on appeal.
When interpreting a contract, "we first examine the plain language of the [contract] and, if the terms are clear, they `are to be given their plain, ordinary meaning.'"
We find no ambiguity in the policy's provision specifying a determination of total disability required an applicant to show he or she "cannot do the main duties of [his or her] Occupation[.]" Giving these words their plain meaning,
In this matter, benefits were denied because Dr. Maffei's injury did not prevent him from working as a chiropractor. As the motion judge properly noted, the main duty of a chiropractor is to adjust patients. From 1998 through 2004, Dr. Maffei continued to schedule and treat patients and did not abandon his implementation of AKT, although, at times, he modified the procedure using his elbow instead of his fingers. His appointment book recorded patient appointments. Further, in his March 17, 2009 deposition, Dr. Maffei provided the following testimony:
Although Dr. Maffei's work hours and the number of patients treated may have decreased, he continued to perform the main duties of his chiropractic occupation.
We also must view the total disability provision in the context of related policy provisions.
Once Dr. Maffei could not demonstrate he qualified for total disability benefits under the policy, he was unable to demonstrate a nexus between Mercadien and Druker's failure to timely prepare tax returns and the dismissal of the disability litigation. This lack of connection is fatal to presentation of a professional negligence claim against Mercadien and Druker. Accordingly, the motion judge properly awarded third-party defendants' request for summary judgment on this issue.
Defendants also argue the disability litigation complaint averred Dr. Maffei was totally disabled and not working from January 2002 through August 2002. He suggests this shows he was totally disabled at that time,
Any additional arguments advanced by defendants have been found to be without sufficient merit to warrant consideration in our opinion.
Affirmed.