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Bowerman v. National Life Insurance Co.

United States District Court, E.D. Pennsylvania

December 16, 2014

DANIEL S. BOWERMAN, D.C., Plaintiff,
v.
NATIONAL LIFE INSURANCE COMPANY, Defendant.

MEMORANDUM

RONALD L. BUCKWALTER, District Judge.

Currently pending before the Court is Defendant National Life Insurance Company ("Defendant")'s Motion for Summary Judgment as to all claims asserted by Plaintiff Daniel S. Bowerman, D.C. ("Plaintiff"), as well as Plaintiff's Motion for Summary Judgment as to all claims asserted. For the following reasons, Defendant's Motion for Summary Judgment is granted and Plaintiff's Motion for Summary Judgment is denied.

I. FACTUAL HISTORY[1]

Plaintiff, as the owner of Daniel S. Bowerman, D.C., established and maintained for himself and at least one other common law employee Disability Income Policies issued by Defendant, including the Disability Income Policy numbered D1889083 issued to Plaintiff on March 22, 1984. (Def.'s Statement of Facts 4, Ex. 3, Disability Income Policy No. D1889083, with Riders ("the Policy").) The Policy provides coverage for Total Disability and also contains a Rider for Residual Disability Income Benefit (the "Rider"). (Id.) The Policy is non-cancellable and guaranteed continuable, and Defendant itself is not permitted to "change any of its terms" because "[a]ny change may be made only by one of our authorized officers or registrars" and "[t]he change must be written and attached to the policy." (Id.)

The Policy defines Total Disability as follows:

Total Disability. The Insured shall be deemed totally disabled only if the Insured:
1. is unable to perform the material and substantial duties of an occupation due to:
a. accidental injury; or
b. sickness; or
2. has sustained the complete and irrevocable loss of:
a. sight; or
b. hearing; or
c. speech; or
d. use of both hands, or use of both feet, or use of one hand and one foot.
Until an income benefit, for any period of continuous disability, has been paid to the Insured's 55th birthday, or for 120 months, whichever is longer, occupation means the occupation of the Insured at the time such disability begins. Thereafter it means any occupation for which the Insured is or becomes reasonably fitted by education, training or experience.[2] Due regard shall be given to vocation and earnings at the time such disability began. To be deemed totally disabled, the Insured must be under the prudent care of a licensed physician. The physician must be someone other than the Insured. The Insured need not be under such care if disabled under item 2 above.

(Id. at 4-5, Ex. 3 (emphasis added).)

The Rider, which is attached to and made part of the Policy, provides that:

We, National Life Insurance Company, will pay the benefits set forth below while this rider is in force, subject to the terms of this rider.
...
This rider, while in force, and the policy shall be treated as one instrument. The terms of the policy shall apply to this rider unless the rider states otherwise....
DEFINITIONS
Partial Disability. The Insured shall be deemed partially disabled only if, due to accidental injury or due to sickness, the Insured is not able:
1. to perform one or more of the important daily duties of the Insured's occupation as defined in this policy; or
2. to engage in the Insured's occupation as defined in this policy for as much time as was usual prior to the start of disability.
For the Insured to be deemed partially disabled:
1. such disability must result in a Loss of Earnings per Month of at least 20% of the Adjusted Prior Average Earnings per Month; and
2. the Insured must be under the prudent care of a licensed physician. The physician must be ...

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