Anderson v. National Union Fire Insurance Company of Pittsburgh, PA

Filing 35

RULING granting 27 Motion for Partial Summary Judgment. Signed by Chief Judge Brian A. Jackson on 7/11/12. (DCB)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA
KATHLEEN ANDERSON
CIVIL ACTION
VERSUS
NO. 09-616-BAJ-DLD
NATIONAL UNION FIRE INSURANCE
COMPANY OF PITTSBURGH, PA
RULING ON MOTION FOR PARTIAL SUMMARY JUDGMENT
I.

BACKGROUND
This matter is before the Court on a “Motion for Summary Judgment, or in the

Alternative, Motion in Limine” (doc. 27) by the defendant, National Union Fire
Insurance Company of Pittsburgh, PA (“National Union”). The plaintiff, Kathleen
Anderson, has submitted a memorandum in opposition to the defendant’s motion for
partial summary judgment (doc. 29) and the National Union has filed a reply brief in
support of its motion (doc. 33). This Court has jurisdiction over the matter pursuant
to 28 U.S.C. § 1332, diversity of citizenship.
II.

FACTS
Kathleen Anderson (“Anderson”) was injured in an accident during August

2006, while working as an independent courier for Velocity Express. National Union
issued an occupational accident insurance policy (policy no. OCC9106648) covering
certain independent contractors of the company, including Anderson.1 Following the

1

National Union Fire Ins. Co. Policy (“Policy”), p. 10 (doc. 1-2).
1

accident, National Union began to provide disability benefits to Anderson pursuant
to the policy. On January 21, 2009, National Union sent written notice to Anderson’s
attorney, indicating that the plaintiff did not qualify for the Continuous Total Disability
benefit under the policy and that National Union would not provide any additional
disability benefit payments to her.2 The policy provides, in pertinent part:
Continuous Care means at least quarterly monitoring
and/or evaluation of the disabling condition by a Physician.
The Company must receive proof of continuing
Continuous Total Disability on a quarterly basis.
Continuous Total Disability, Continuously Totally
Disabled means disability that: (1) prevents an insured
from performing the duties of any occupation for which he
or she is qualified by means of education, training or
experience; and (2) requires that, and results in, the
Insured receiving Continuous Care.

Following National Union’s discontinuation of disability benefits payments to
Anderson, the plaintiff filed the present law suit, alleging bad faith breach of the
insurance contract by the insurer.3

2

Letter from Ilda Miranda, Claims Adjuster for National Union, to Attorney
Robert Campbell, Williamson & Fontenot, LLC. (Jan. 21, 2009) (doc. 12-11)
3

Plaintiff’s Petition for Damages, p. 2 , ¶ 9. (doc. 1-1)
2

III.

SUMMARY JUDGMENT
The purpose of summary judgment is to pierce pleadings and to assess proof

in order to determine whether there is a genuine need for trial. R.J. Reynolds
Tobacco Co. v. Hudson, 314 F.2d 776, 788 (5th Cir. 1963). In considering a motion
for summary judgment, the court must construe all pleadings liberally in favor of the
party against whom the motion is made, and the motion should be granted only
where the moving party is entitled to judgment as a matter of law and the record
clearly shows that no genuine issue of material fact exists. Dassinger v. South
Central Bell Tel. Co., 505 F.2d 672, 674 (5th Cir. 1974). The party seeking summary
judgment bears the burden of showing that there is no material fact in dispute, and
every reasonable inference arising from the record must be resolved in favor of the
party opposing the motion. Hodges v. Exxon Corp., 727 F.2d 450, 452 (5th Cir.
1984). A fact is material if it might affect the outcome of the suit under the governing
law. Harken Exploration Co. v. Sphere Drake Ins. PLC, 261 F.3d 466, 471 (5th Cir.
2001). There is a genuine issue as to a material fact if the evidence is such that a
reasonable jury could return a verdict for the non-movant. Id.

IV.

LAW AND ANALYSIS
National Union seeks dismissal of the plaintiff’s claim for “full and permanent”

reinstatement of disability benefits. National Union submits that, pursuant to the
terms of the policy, the insured is subject to an ongoing obligation to submit proof
of her disability to the insurer on a quarterly basis. Accordingly, National Union
3

argues that any judgment purporting to award to the plaintiff a “permanent”
reinstatement of benefits, unqualified by the requirement of a quarterly evaluation,
would circumvent and violate the terms of this policy. In opposition, the plaintiff
submits that the Court has the discretion to order the payment of future disability
benefits to the plaintiff.
Both parties submit as supporting evidence excerpts of the deposition
testimony of the plaintiff’s treating physicians. While the physicians’ statements may
be relevant to the ultimate issue to be determined at trial – whether the plaintiff is
disabled and therefore entitled to recover disability benefits under the policy – the
question presented by National Union’s motion does not depend on the doctors’
deposition testimony, but rather is a legal issue of the interpretation of the insurance
contract. “When a contract can be construed from the four corners of the instrument
without looking to extrinsic evidence, the question of contractual interpretation is
answered as a matter of law and summary judgment is appropriate.” Sims v.
Mulhearn Funeral Home, Inc., 2007-0054 (La. 5/22/07), 956 So.2d 583, 590. “When
the words of an insurance contract are clear and explicit and lead to no absurd
consequences, courts must enforce the contract as written and may make no further
interpretation in search of the parties’ intent.” Peterson v. Schimek, 98-1712 (La.
3/2/99), 729 So.2d 1024, 1028.
The plaintiff argues that it is possible for the finder of fact to conclude at trial
that she has suffered an injury related to a workplace accident, that she was and is
4

unable to return to her occupation as a truck driver, that her medical restrictions are
permanent, that her medical restrictions prevent her from returning to work in jobs
for which she is qualified, and that she is not a candidate for vocational retraining.
Based upon these findings of fact, the plaintiff submits that this Court would have
the authority to reinstate her benefits and to award the payment of future benefits.
The plaintiff does not address, however, how these potential findings of fact would
eliminate the policy’s requirement that the plaintiff submit quarterly proof of her
disability. The plain language of the policy does not provide for a final or permanent
determination of disability, but instead requires that a “Continuous Total Disability”
be proven on a quarterly basis by medical evidence from a treating physician. As
there is no contention by the plaintiff that this provision of the policy is unlawful or
against public policy, there is no basis for the Court to rule that the plaintiff is exempt
from it.
IV.

ORDER
Accordingly, for the reasons stated herein, the Motion for Partial Summary

Judgment (doc. 27) by the defendant, National Union Fire Insurance Company is
GRANTED.
Baton Rouge, Louisiana, July 11, 2012.

______________________________
BRIAN A. JACKSON, CHIEF JUDGE
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA