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Zeglen v. Northwestern Mutual Life Insurance Co.

United States District Court, M.D. Pennsylvania

August 25, 2014

KURT ZEGLEN, Plaintiff,
v.
NORTHWESTERN MUTUAL LIFE INSURANCE CO., Defendant.

MEMORANDUM OPINION

ROBERT D. MARIANI, District Judge.

I. Introduction

Plaintiff Kurt Zeglen ("Zeglen" or "Plaintiff') filed afour-count Complaint (Doc. 2) against Defendant Northwestern Mutual Life Insurance Company ("Northwestern" or "Defendant"), alleging breach of contract (Count I), "breach of the covenant of utmost fair dealing" (Count II), bad faith pursuant to 42 Pa. C.S.A. § 8371 (Count III), and violation of the Unfair Trade Practices and Consumer Protection Law ("UTPCPL"), 73 Pa. C.S.A. §§ 201-1, et. seq., (Count IV). Presently before the Court is Northwestern's Motion to Dismiss Counts II and IV (Doc. 6). For the reasons that follow, the Court shall grant Northwestern's Motion and dismiss Counts II and IV.

II. Factual Allegations

On October 21, 1988 and September 22, 1998, Northwestern issued Zeglen disability insurance policies. (Compl. at ¶¶ 3, 6). Zeglen, alicensed physician and board certified radiologist, became "disabled under the terms of the policy as he is unable to perform his duties as a radiologist[.]" ( Id. at ¶¶ 20, 24, 50). On March 18, 2012, "Dr. Zeglen made a request for disability benefits asserting he last worked on March 22, 2011." ( Id. at ¶25).

In submitting his request for disability benefits, Dr. Zeglen indicated that there were multiple disabilities' and identified those to include the following: left above knee amputation; limited range of motion and use of left arm; aortic valve replacement, hypertension, cardiac arrhythmia; depression with associated anxiety and panic attacks; short term memory loss; right carpal tunnel syndrome; gastro-esophageal reflex disease; and hiatal hernia.

( Id. ).

On August 28, 2012, Northwestern sent Zeglen a letter approving his claim for the period between February 16, 2012 to May 30, 2012. ( Id. at ¶¶ 31-32). The August 28, 2012 letter indicated that Northwestern's consulting psychiatrist determined Zeglen's condition had improved to the point that his "symptoms were not rising to the level that they would be limiting [him] from work activity." ( Id. at ¶ 33) The letter went on to state that Northwestern would continue to make payments beyond May 30, 2012, subject to "additional information in order to obtain a thorough understanding of Dr. Zeglen's reported symptoms and limitations." ( Id. at ¶ 35).

"Despite having previously advised in its August 28, 2012 letter that it would make disability payments beyond May 30, 2012, " Northwestern subsequently ceased issuing benefits. ( Id. at ¶¶ 34-35). On November 29, 2012, Northwestern sent Zeglen a letter stating, "[I]f Dr. Zeglen is willing to participate in the evaluative medical examinations that we are requesting, we will provide benefits on an accommodation basis until we receive the reports from the examiners, which will allow us to continue our review of his request for disability benefits." ( Id. at ¶ 36). In accordance with the November 29, 2012 letter, Plaintiff underwent examinations scheduled by Defendant. ( Id. at ¶¶ 37, 39). As agreed, Northwestern issued Zeglen payments for "disability benefits from June 30, 2012 and stated[, ] in a letter dated January 9, 2013[, ] that it was willing to make a payment on an accommodation basis while the review continues.'" ( Id. at 1138).

"On March 8, 2013 and April 4, 2013, Defendant acknowledged that it had not yet completed its review." ( Id. at ¶ 41A[1]). "Despite having agreed to make a payment during the review period, Defendant issued no payment to the Plaintiff in March 2013." ( Id. at ¶ 40B). "On March 18, 2013, Defendant sent a letter stating that it was declining the request of the Plaintiff for copies of the reports of Dr. Morgan and/or Dr. Fischbein, " the doctors who examined Zeglen in accordance with November 29, 2012 letter. ( Id. at ¶¶ 37, 39, 41). The letter also stated Defendant would share the reports with Plaintiffs treating physician but only on the condition that his doctor not release the report to Plaintiff without Defendant's authorization. ( Id. at ¶ 42). Northwestern has "continued to refuse to allow the release of the reports of Dr. Morgan and/or Dr. Fischbein[.]" ( Id. at ¶ 45).

On November 3, 2013, Northwestern determined that Dr. Zeglen was not disabled beyond May 30, 2012 and denied Plaintiffs internal appeal of its decision. ( Id. at ¶ 49).

III. Standard of Review

A complaint must be dismissed under Federal Rule of Civil Procedure 12(b)(6), if it does not allege "enough facts to state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 1974, 167 L.Ed.2d 929 (2007). The plaintiff must aver "factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 1949, 173 L.Ed.2d 868 (2009).

"Though a complaint does not need detailed factual allegations, ... a formulaic recitation of the elements of a cause of action will not do.'" DelRio-Mocci v. Connolly Prop. Inc., 672 F.3d 241, 245 (3d Cir. 2012) (citing Twombly, 550 U.S. at 555). In other words, "[f]actual allegations must be enough to raise a right to relief above the speculative level." Covington v. Int'l Ass'n of Approved Basketball Officials, 710 F.3d 114, 118 (3d Cir. 2013) (internal citations and quotation marks omitted). A court "take[s] as true all the factual allegations in the Cornplaint and the reasonable inferences that can be drawn from those facts, but... disregard[s] legal conclusions and threadbare recitals of the elements of a cause of ...


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