Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

PROUSI v. UNUM LIFE INS. CO. OF AMERICA

December 21, 1999

ANDREW S. PROUSI, PLAINTIFF,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, DEFENDANT.



The opinion of the court was delivered by: Lowell A. Reed, Jr., Senior District Judge.

MEMORANDUM

Plaintiff Andrew S. Prousi ("Prousi") has brought this action for breach of contract seeking to recover for the refusal of defendant UNUM Life Insurance Company of America ("UNUM") to approve an application by Prousi to purchase an additional disability income policy under a "Future Insurance Option Rider" ("FIOR"). Presently before the Court are cross motions for summary judgment (Document Nos. 12 & 13). The parties agree that there are no issues of fact and that the resolution of this case turns on questions of law now before the Court. Jurisdiction is proper pursuant to 28 U.S.C. § 1332 as the parties are diverse and the amount in controversy exceeds $75,000.00, exclusive interest and costs. It is undisputed that Pennsylvania law applies. For the reasons stated below, summary judgement will be granted in favor of UNUM and against Prousi.

I. BACKGROUND

Prior to the summer of 1992, Prousi was self-employed as a dentist in Montgomery County, Pennsylvania. On May 8, 1992, Prousi fell from a ladder and injured his spine. In July, 1992, Prousi became unable to practice dentistry due to his spinal injuries.

At the time of the accident, Prousi had a disability insurance policy with UNUM which provided that if Prousi, due to sickness or injury, became unable to perform the material and substantial duties of his regular occupation, that he would be entitled to receive a regular disability benefit. UNUM does not contest that Prousi has been continuously disabled since July 1992. Upon Prousi's claim for disability benefits, UNUM paid Prousi all monthly disability benefits in the base amount of $4,500.00, plus additional benefits in the amount of $392.85, for a current monthly disability benefit from UNUM in the amount of $4,892.85.

The policy also contains a FIOR rider, for which Prousi paid a separate, additional premium and which provides, inter alia:

Standard Purchase Option

  During each Standard Option Period, you may apply for
  an additional disability income insurance policy. We
  will issue the new policy on a Standard Option Date
  subject to the following terms:
    (6) We will not issue an amount which, with all
    policies in force, would exceed our disability
    income limits for new applicants on the effective
    date of this rider or on the Option Date, whichever
    is higher. The limits are set by our normal
    underwriting procedures and apply to your average
    earned income. . . .
    (11) We will not issue a policy while the insured
    is disabled except as provided in the section
    entitled Option During Disability.
  Option During Disability
  While you are disabled, you may apply for one
  additional policy during which the first Standard
  Option Period. The new policy will be subject to the
  same terms as a Standard Purchase Option except:
    (1) the amount of the new policy may not exceed the
    Option Amount. . . .

(Defendant UNUM Life Insurance Company of America's Memorandum of Law In Support of Its Motion for Summary Judgment ("Def.Exh."), Exh. D). The Option Amount is defined by reference to the benefit amount specified in the policy, i.e., five hundred dollars. (Exhibits to Plaintiff's Motion for Summary Judgment ("Plt.Exh."), Exh. D). At the time Prousi became disabled he was 42 years old. ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.