Sternberg v. The Paul Revere Life Insurance Company, No. 1:2017cv08523 - Document 64 (S.D.N.Y. 2020)
Court Description: OPINION & ORDER re: 57 MOTION for Summary Judgment . filed by Richard Sternberg, 45 MOTION for Summary Judgment . filed by The Paul Revere Life Insurance Company. For the reasons set forth above, Plaintiff's motion for summary judgment is DENIED and Defendant's motion for summary is GRANTED. (Signed by Judge Andrew L. Carter, Jr on 1/3/2020) (rj) Transmission to Orders and Judgments Clerk for processing.
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Sternberg v. The Paul Revere Life Insurance Company Doc. 64 Dockets.Justia.com judgment." Int'! Multfoods Corp. v. Commercial Union Ins. Co., 309 F.3d 76, 83 (2d Cir. 2002) (citations and quotation marks omitted). Under New York law,"a claimant is 'totally disabled' when he or she is no longer able to perorm the 'material' and 'substantial' responsibilities of his or her job." Shapiro v. Bershire Lfe Ins. Co., 212 F.3d 121,124 (2d Cir. 2000); see also Hershman v. Unumprovident Corp., 660 F. Supp. 2d 527, 531 (S.D.N.Y. 2009) ("The policy deines 'total disability' as the inability 'to perorm the important duties of [the insured's] Occupation.' Courts applying New York law on summary judgment have construed substantially similar language to mean that an insured is totally disabled if 'he or she is no longer able to perorm the material and substantial responsibilities of his or her job."') ( citation and quotation marks omitted). The insured bears the burden of proving that he or she is totally disabled within the meaning of the insurance policies. Shapiro, 212 F.3d at 124. The inquiry into whether a claimant is totally disabled entails "a act-oriented, unctional approach that look[s] to the proessional activities in which the insured was regularly engaged at the time of the onset of the insured's disability." I. (citations and quotation marks omitted). Thus, the operative question is whether the insured's work is of the "same general character" as prior to his disability, or whether he is perorming "undamentally diferent job duties ater the onset of the disability." London v. Bershire Life Ins. Co., 71 F. App'x 881,884 (2d Cir. 2003). DISCUSSION This case presents a single issue: whether Plaintif's disability renders him "totally disabled" or the Interim Periods,when he was still able to perorm some of the important duties of his occupation but was unable to perorm open surgery or take call in the emergency room. Under the Policies,total disability includes two components. First,the insured must be "unable to 8 and ater the onset of the disability.7 Moreover, since the Court holds that Stenberg was not totally disabled even under this less strict construction of total disability, he would certainly not be totally disabled under the more stringent deinition ofered by Defendants. In Hershman, an invasive cardiologist brought a claim against Paul Revere under a nearly identical policy, also alleging that he qualified or "total disability." Hershman, 660 F. Supp. 2d 527,528 (S.D.N.Y. 2009). Because of his disability, Dr. Hershman was unable to perform invasive cardiac procedures, but continued to practice as a "consultative" cardiologist. Beore his disability, Hershman spent approximately half of his time on consultations and the other half perorming invasive procedures in the hospital and on call. I. at 530. The court held that Hershman was not totally disabled. As the court noted, there was "ar too much continuity between his work beore and ater the onset of his back condition" because he "works or the same ofice, sees many of the same patients, supervises the same multi-million dollar laboratory business, and eans roughly the same income." I. at 532. Similarly, in London v. Bershire Lfe Ins. Co., the Second Circuit held that a cardiologist who could no longer perorm bypass surgery and who alleged that he had become a mere "consultant" was not totally disabled, because "it is uncontested that he continued to see and treat his own patients in his capacity as a cardiologist, using 'similar skills and training' 7 Deendants argue that this approach renders the "residually disabled " coverage superfluous.See, e.g., Simon v. Unum Grp., No 7-CV-11426, 2009 L 857635 at *5 (S.D.N.Y.Mar.30, 2009) ("If the residual disability provision is to be given meaning, an insured can only be 'totally disabled' ifhe can no longer perorm any ofthe 'substantial and material duties' of his occupation.An inability to perorm one or more of those duties would only render an insured residually disabled."); Parker v. Paul Revere Lfe Ins. Co., No. 97-CV-4339, at *3 (E.D.N.Y. Dec. 20, 2000) ("The policy provides clearly and unambiguously, however, that an insured who is unable to perorm some of the important duties of his occupation is residually disabled ....Thus, total disability can only mean the inability to perorm all of the important duties ofone's occupation.").This Court disagrees.Instead, it adopts the reasoning ofthe court in Hershman: "Both contract terms retain meaning under the established test: an insured is 'totally disabled' only where incompetent to perorm work of the 'same general character,' and is 'residually disabled' by an inability to perorm a particular duty or duties that does not carry this consequence." 660 F. Supp. 2d at 532. This interpretation provides meaning to both types of disability insurance while also hewing to the well-established test in New York or total disability. IO
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