MATTHEW W. BRANN, District Judge.
Defendants Unum Group and Provident Life and Accident Insurance Company (collectively, "Defendants") moved for partial summary judgment on Plaintiff Dr. Robert Brugler's five-count complaint. For the reasons that follow, Defendants' motion will be granted.
Dr. Brugler, a dentist, purchased from Defendants a long term disability policy that provided him with monthly benefits if he were to become disabled and unable to practice his profession. After being diagnosed with a retinal detachment in his right eye, Dr. Brugler filed a claim for disability benefits under his policy. Defendants paid Dr. Brugler benefits for a number of months and then sought to determine whether his vision had improved. Defendants conferred with Dr. Brugler's treating physician, and Dr. Brugler was ultimately referred to another physician to conduct an independent medical examination.
The independent medical examination concluded that Dr. Brugler's claim for disability was not medically supported. As a result, Defendants stopped paying Dr. Brugler disability benefits. Sometime later, Dr. Brugler began receiving care from a new physician. Defendants requested copies of Dr. Brugler's new medical records for further review. Defendants forwarded those records to the physician who had conducted the initial independent medical examination, who again concluded that Dr. Brugler continued to lack an indemnifiable disability.
Dr. Brugler alleges he is entitled to disability benefits under the policy and filed a five-count complaint against Defendants. Count I alleges a breach of contract claim and seeks various monetary damages. Count II is a declaratory judgment claim seeking to order Defendants to pay Dr. Brugler payments withheld under the policy and requiring the Defendants to continue to make such payments until Dr. Brugler's treating physicians or other qualified specialists determine he is not entitled to them. Count III alleges an unfair trade practices claim under Pennsylvania's Unfair Trade Practices and Consumer Protection Law, 73 P.S. § 201-203 et seq. Count IV alleges a statutory bad faith claim under 42 Pa.C.S.A. § 8371. Count V alleges a common law bad faith claim.
Currently pending before the Court is Defendants' motion for partial summary judgment on Dr. Brugler's declaratory judgment claim, unfair trade practices claim, and statutory bad faith claim.
Summary judgment is granted when "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."
While Dr. Brugler's papers
The essence of Dr. Brugler's declaratory judgment action is whether Defendants must provide him with benefits so long as his physician continues to certify that he is disabled as defined by the policy.
When interpreting an insurance policy, a court must "ascertain the parties' intentions as manifested by the policy's terms."
The policy states in pertinent part:
Dr. Brugler hones in on this language—"[t]o be considered totally disabled, you must be receiving care by a Physician which is appropriate for the condition causing the disability"—and argues that he is entitled to disability benefits as long as his treating physician concludes that he is disabled.
Dr. Brugler's argument fails because the plain language of that statement contravenes his construction. First, the language of the policy is clear and we give effect to its plain meaning: to receive benefits under the policy an insured must have a (1) a qualifying disability, (2) be receiving care for that disability by a physician, and (3) must file a monthly claim proving the disability. Specifically, "[t]o be considered totally disabled, you must be receiving care by a Physician which is appropriate for the condition causing the disability" means that for an insured to be considered totally disabled, a physician must be providing treatment to the insured for the injury giving rise to the disability. The reasonable interpretation of this language is that an insured must be receiving care by a physician as a condition precedent to coverage.
Second, the fact that the policy confers upon the insurer a right to independently investigate the insured's claim at the insurer's expense further undermines Dr. Brugler's proffered interpretation. The policy states that Defendants have the right to have Dr. Brugler examined "as often as reasonable." This clause comports with well-settled principles of insurance law permitting insurers to rely on independent medical evaluations when investigating claims.
Third, while Dr. Brugler's papers are unclear as to whether he argues the term "Physician" is either ambiguous or means that only his treating physician can certify a disability, such an argument does not support his proffered interpretation. The term "physician," though broad, is not ambiguous. Physician is defined as "any person other than you who is licensed by law, and is acting within the scope of the license, to treat Injuries or Sickness which results in covered loss." This means that a physician with authority to act under the policy could be treating Dr. Brugler, or be employed by the insurance company. This language may be broad; but its breadth does not generate ambiguity.
Accordingly, because Dr. Brugler's interpretation as to who may certify his disability is incorrect and there are no genuine issues of material fact precluding us from making this termination as a matter of law, this Court grants summary judgment in favor of Defendants on Dr. Brugler's declaratory judgment claim.
As the parties proceed in this litigation, the Court reiterates that it is using its discretionary declaratory judgment authority to resolve in Defendants' favor only the narrow issue brought to bear at summary judgment. Granting summary judgment on Dr. Brugler's declaratory judgment claim does not prevent Dr. Brugler from recovering damages he otherwise may be entitled to under his breach of contract claim.
Defendants also contend that Dr. Brugler's unfair trade practices claim is not actionable under Pennsylvania's Unfair Trade Practices and Consumer Protection Law (UTPCPL), 73 P.S. § 201-203, et seq, because it alleges nonfeasance rather than malfeasance.
The purpose of the UTPCPL is "to protect the public from fraud and deceptive business practices" and provides relief for malfeasance, not nonfeasance.
Here, the essence of Dr. Brugler's complaint is that Defendants failed to pay him the disability benefits he believes he should receive under the policy.
Defendants additionally argue they did not act in bad faith because they had a reasonable basis to deny Dr. Brugler disability benefits under the policy.
To prevail on a claim for statutory bad faith under 42 Pa.C.S.A. § 8371, a plaintiff must "present clear and convincing evidence (1) that the insurer did not have a reasonable basis for denying benefits under the policy and (2) that the insurer knew of or recklessly disregarded its lack of a reasonable basis."
Here, Dr. Brugler cannot meet this burden because Defendants had a reasonable basis to deny his claim.
Second, this record does not yield an inference that Defendants acted frivolously or with an "unfounded refusal" to pay.
Third, an insurer has a right to evaluate legitimate coverage issues
Because no reasonable jury could find in Dr. Brugler's favor, Defendants' motion for summary judgement is granted on Dr. Brugler's bad faith claim.
For the reasons discussed above, Defendants' partial motion for summary judgment will be granted. An appropriate Order follows.
Additionally, pursuant to this discretionary declaratory judgment authority, courts have, at the motion to dismiss stage, dismissed declaratory judgment claims when they duplicate breach of contract claims within the same action. See, e.g., Morris v. American Nat. Ins. Corp., 4:13-CV-2236, 2015 WL 4092393, *8 n.7 (M.D.Pa. July 7, 2015) (describing declaratory judgment as "redundant in light of the breach of contract claim"); accord; Smithkline Beecham Corp. v. Continental Ins. Co., No. Civ.A. 04-2252, 2004 WL 1773713, at *2 (E.D.Pa. Aug. 4, 2004) ("Hence, because [Defendant's] breach of contract claims require resolution of the same issues raised in [Defendant's] declaratory judgment claims and because [Defendant] can be afforded full relief on its breach of contract claims, and will, therefore, suffer no prejudice from the dismissal of its declaratory judgment claims, the Court will decline to entertain [Defendant's] claims for declaratory judgment."). Cf. Landau v. Viridian Energy PA LLC, 223 F.Supp.3d 401, 421022 (E.D.Pa. 2016) (refusing to dismiss duplicative declaratory judgment claim when it served as potential basis for class certification under Federal Rule of Civil Procedure 23(b)(2) and dismissal would prejudice plaintiff). In those cases, courts are concerned by redundant litigation when plaintiffs' declaratory judgment claims raise the same issues and seek the same relief as in their breach of contract claims. As Defendants suggest, concerns of duplicative litigation are present here. On the one hand, in his breach of contract claim Dr. Brugler seeks monetary damages and "such other relief as the Court deems just and proper." See Complaint (ECF No. 1) at 11. On the other hand, in his declaratory judgment claim Dr. Brugler seeks monetary damages and an order that "permanently requir[es] the Defendants to continue to make such payments until Plaintiff's treating physicians or other qualified specialists who regularly and routinely treat the Plaintiff conclude that he is not entitled thereto." Id. at 13. Determining what relief Dr. Brugler may be entitled to under either claim requires resolution of the same issue—interpreting the insurance policy. While this Court is mindful of Defendants' concerns that elements of Dr. Brugler's breach of contract and declaratory judgment claims may overlap, I will not avoid the declaratory judgment claim now simply by labeling it "duplicative." Providing parties with an intellectual ruling at this stage of the litigation may clarify the legal relationships at issue and eliminate some lurking uncertainty.
