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Sigal v. General American Life Insurance Co.

United States District Court, W.D. Pennsylvania

October 6, 2014

MICHAEL B. SIGAL, Plaintiff,
v.
THE GENERAL AMERICAN LIFE INSURANCE COMPANY, THE PAUL REVERE LIFE INSURANCE COMPANY, and UNUM GROUP, Defendants.

MEMORANDUM OPINION

CYNTHIA REED EDDY, Magistrate Judge. [1]

I. Introduction

On January 2, 2013, Plaintiff, Michael B. Sigal filed the instant action in the Court of Common Pleas of Allegheny County, Pennsylvania. On February 1, 2013, this case was removed on diversity grounds. See Compl. [ECF No. 1]. Plaintiff filed an Amended Complaint on February 28, 2013 alleging wrongful denial of claims made under disability insurance policies issued by Paul Revere Insurance Company ("Paul Revere"), Paul Revere's wholly owned subsidiary, Unum Group ("Unum"), and General American Life Insurance Company ("General American") (collectively "Defendants" or "the insurers") and set forth various claims against Defendants including breach of contract, breach of the duty of good faith and fair dealing, breach of third-party beneficiary contract, violation of the Pennsylvania Unfair Trade Practices and Consumer Protection Act ("UTPCPL"), 73 P.S. § 201, et seq., bad faith denial of insurance claims under 42 Pa.C.S.A. § 8371, and civil conspiracy to violate the UTPCPL originating from insurance policies issued to Plaintiff by Defendants. Am. Compl. [ECF No. 10]. The only claims remaining in this case are the breach of contract claims for the Defendants denial of benefits in 2010. See Memo. Order [ECF No. 22] at 21-22 ("[T]hree causes of action survive Defendants' Motion. These are the breach of contract claims against Paul Revere and General American, respectively, based on the 2010 denial of benefits allegedly due under relevant disability insurance policies. Also remaining is Sigal's claim that he is entitled to damages as a third party beneficiary under RSAs breached by U[num] and Paul Revere.").

Following a period of time for the parties to conduct discovery, Defendants collectively filed the present Motion for Partial Summary Judgment. Defs.' Mot. for Partial Summ. J. [ECF No. 44]. The matter has been fully briefed and is ripe for disposition. See Defs.' Br. in Supp. of Mot. for Partial Summ. J. [ECF No. 45]; Pl.'s Resp. to Defs.' Mot. for Partial Summ. J. [ECF No. 48]; Defs.' Reply Br. [ECF No. 50]. For the following reasons, Defendants' Motion for Partial Summary Judgment is granted.

II. Statement of the Facts[2]

A. The Insurance Policies

Plaintiff, a medical ophthalmologist purchased two disability insurance policies from Paul Revere in 1989. In 1990, Plaintiff secured a third policy from General American. At the time he purchased the policies, Plaintiff practiced as a "surgical" ophthalmologist. Compl. [ECF No. 10] at ¶ 14-17. Each policy contained the following pertinent language as set forth below.

1. The Paul Revere Policies

The Paul Revere Policies include a "Total Disability in Your Occupation Benefit Rider" which defines "Total Disability" as follows:

"Total Disability" means that because of Injury or Sickness:

1. You are unable to perform the important duties of Your regular occupation; and

2. You are under the regular and personal care of a Physician.

App. [ECF No. 46] at 2, 34, 60. The "Total Disability in Your Occupation Benefit Rider" also provides that: "All definitions in Your Policy apply to this rider. All provisions of Your Policy remain the same except where We change them by this rider." Id. at 2, 34, 30. The policy further defines "Your Occupation" as follows:

"Your Occupation" means the occupation in which You are regularly engaged at the time You become Disabled.

Id. at 3, 22, 48. The policy further defines "Disabled" as follows:

"Disability" or "Disabled" refers to a continuing period of Total and/or Residual Disability. Successive periods will be deemed to be continuing if:
a. Due to the same or related causes; and
b. Separated by no more than 6 months;
Otherwise such periods will be deemed to be new and separate Disabilities.

Id. at 3, 23, 49. The Paul Revere policy also included benefits for Residual Disability which is defined as follows:

"Residual Disability", prior to the Commencement Date, means that due to Injury or Sickness:
a. (1) You are unable to perform one or more of the Important duties of Your Occupation; or
(2) You are unable to perform the important duties of Your Occupation for more than 80% of the time normally required to perform them; and
b. Your Loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your Occupation or another occupation; and
c. You are under the regular and personal care of a Physician.
As of the Commencement Date, Residual Disability means that due to the continuation of that Injury or Sickness:
a. Your Loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your ...

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