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Hunter v. Massachusetts Mutual Life Insurance Co.

United States District Court, District of Columbia

July 20, 2014

JOHN S. HUNTER, Plaintiff,
v.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, Defendant.

MEMORANDUM OPINION

Emmet G. Sullivan United States District Judge

John Hunter brings this lawsuit alleging that Massachusetts Mutual Life Insurance Company (“MassMutual”) breached an insurance contract by failing to pay him the correct amount of monthly disability benefits and commencing payment on the wrong date. Pending before the Court is defendant’s motion for summary judgment. Upon consideration of the motion, the responses and replies thereto, the applicable law, the oral argument, and the entire record, the Court GRANTS defendant’s motion.

I. BACKGROUND

A. The Disability-Insurance Policy

Dr. Hunter, a dentist, has practiced in Washington, D.C. since 1985. Def.’s Statement of Material Facts (“Def.’s SMF”), ECF No. 22-1 ¶¶ 1–2. On October 5, 1992, he obtained a disability-insurance policy (“the Policy”) from MassMutual. Id. ¶ 3. The Policy provides a maximum monthly benefit of $3, 000 and an additional $1, 000 monthly maximum if Dr. Hunter does not receive other disability benefits. See Ex. 1 to Def.’s Mot. for Summ. J. (“Mot.”), ECF No. 24 at 3, 23.[1] The amount of benefits to be paid each month is tied to Dr. Hunter’s “loss of earned income, ” which is the difference between his average monthly income during the twelve months preceding the onset of his disability and his income during the current month. See Id . at 7-8.

Benefits may be paid only after a waiting period, which lasts for sixty days after the onset of the disability. Id. at 3-4, 9. Benefits are then available “subject to certain notice and proof of disability requirements.” Id. at 13. The insured must provide “notice” by indicating in writing that he “is disabled and that a claim may be made, ” and must do so “before the end of 20 days after the Waiting Period, or as soon afterwards as it is reasonably possible to do so.” Id. He must also submit “proof of claim . . . before the end of 90 days after the end of each monthly period” for which he claims benefits. Id. “[I]f it is not reasonably possible to give . . . proof within this time limit, then proof may be given as soon thereafter as it is reasonably possible to do so.” Id. This extension is limited to one year, “[u]nless the delay is due to legal incapacity.” Id.

B. Dr. Hunter’s Injury and Insurance Claim

On July 17, 2004, Dr. Hunter was involved in a motorcycle accident. See Pl.’s Opp. to Mot. for Summ. J. (“Opp.”), ECF No. 27 at 2. He did not contact MassMutual about the accident until March 4, 2011, when he provided notice of a claim. See Ex. 2 to Mot., ECF No. 22-5 at 1–2. That day, MassMutual sent him a claim package and asked him to complete certain forms. Ex. 3 to Mot., ECF No. 22-6 at 1. On April 12, 2011, Dr. Hunter submitted his forms and listed various medical conditions as resulting from the accident. See Ex. 4 to Mot., ECF No. 24-1 at 5.

MassMutual wrote Dr. Hunter on April 21, 2011 to request that he “explain, in detail, why he filed a claim more than 6 years after the date on which he is claiming Partial Disability.” Ex. 5 to Mot., ECF No. 22-8 at 2. Dr. Hunter replied on June 3, 2011, and attached a letter from a doctor stating that the conditions resulting from the accident “caused [Dr. Hunter] to not pursue or understand the option of pursuing disability coverage since 2004.” Ex. 2 to Opp., ECF No. 28-1 at 3.

On October 20, 2011, MassMutual approved Dr. Hunter’s claim for disability benefits and assigned him a “temporary disability date of January 3, 2011.” Ex. 6 to Mot., ECF No. 22-9 at 1. On February 14, 2012, MassMutual wrote to Dr. Hunter to inform him of its conclusion that his “permanent date of disability” for the purpose of calculating his entitlement to benefits would be January 3, 2011. See Ex. 7 to Mot., ECF No. 22-10. Among other reasons for this decision, MassMutual stated:

[W]e did not receive notice of claim from Dr. Hunter until March 4, 2011 and we did not receive the initial Proof of Loss until April 6, 2011. It is important to note that this is more than 6 ½ years after Dr. Hunter’s reported date of disability. As a result of the late notice of claim and proof of loss submission, MassMutual’s rights have been severely prejudiced . . . . As such, we are unable to make an accurate assessment of any benefits to which Dr. Hunter may be eligible for prior to January 3, 2011.

Id. at 3 (emphasis added).

C. Procedural History

Dr. Hunter filed this lawsuit on July 9, 2012, alleging that MassMutual breached the insurance contract by failing to pay disability benefits to cover the period from July 17, 2004 to January 2, 2011, and by calculating his prospective benefits based on his average monthly income from the twelve months preceding January 3, 2011, rather than July 17, 2004. See Compl., ECF No. 3 ΒΆΒΆ ...


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