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STEINBERG v. PAUL REVERE LIFE INS. CO.

August 3, 1999

NANCY ALLEN STEINBERG, M.D., PLAINTIFF,
v.
THE PAUL REVERE LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Robert L. Carter, District Judge.

OPINION

Plaintiff Nancy Allen Steinberg, M.D., ("Steinberg") initiated this action to recover disability benefits under an insurance policy that she holds with defendant The Paul Revere Insurance Company ("Paul Revere"). Now before the court is defendant's motion for summary judgment, and plaintiff's cross-motion for summary judgment.

BACKGROUND

On November 10, 1987, Paul Revere issued to Steinberg, a resident of New York, a disability income policy that provided for the payment of monthly benefits in the event of a total disability arising from injury or illness. In 1991, Steinberg, a board-certified radiologist at the time, underwent a routine eye examination for glaucoma. During the examination, the ophthalmologist did not find glaucoma, but did find abnormalities in both of plaintiff's eyes. A subsequent Magnetic Resonance Imaging ("MRI") performed in January, 1991, indicated multiple, abnormal lesions in her brain. Because Steinberg had lived in Connecticut prior to the MRI, her physician surmised that she had contracted Lyme disease and set a course of treatment for that disease.

In addition to the abnormalities in her eyes, plaintiff began to experience an increasing degree of fatigue and weakness that she believed to be symptomatic of Lyme disease. In 1994, Dr. Eileen Draga ("Dr.Draga"), an ophthalmologist, detected a loss of vision in Steinberg's right eye. Dr. Draga determined that due to a hole on the macula of the eye, Steinberg effectively had no vision in the core of her right eye. Aware of Steinberg's condition and the nature of her work, Dr. Draga opined that plaintiff was disabled from performing radiology. However, despite her vision impairments, deteriorating physical condition and Dr. Draga's determination that she was disabled, plaintiff continued to work full-time as a radiologist.

In 1995, Steinberg was named as a co-defendant in three medical malpractice lawsuits. At that time, Steinberg decided that she could no longer perform radiology. In May, 1995, plaintiff advised her employees that she could no longer work. On July 8, 1996, Steinberg submitted a Claimant's Statement For Disability Benefits and Attending Physician's Statement ("July 8 Physician's Statement"), seeking benefits from May 13, 1995, her last day of employment. (Defendant's Ex. 8). On the July 8 Physician's Statement, Dr. Draga diagnosed Steinberg as having a macular hole in her right eye, causing visual impairment. Neither Steinberg nor Dr. Draga reported her fatigue symptoms, however.

In a letter to Steinberg dated July 17, 1996, Paul Revere wrote, in pertinent part, "We would like to remind you that your policy requires notification of a claim within 30 days from the beginning of your disability. Since we were not notified within this time period, we are in the process of forwarding your file to our Field Claim Representative. . . . Although we are not certain of the exact schedule, our representative will be contacting you in the near future." (Defendant's Ex. 9). In response, Steinberg stated in a letter dated August 8, 1996, that she did not file her claim within 30 days because she was unaware of the time limitations in the insurance policy. (Defendant's Ex. 10). Plaintiff also noted that she was attempting to improve her vision through visual training and that she had tried to work as long as possible before filing a claim.

In a letter dated August 30, 1996, Paul Revere stated in relevant part:

  Please be advised that Section 9.2 of your contract
  entitled `Written Notice of Claim' outlines that
  written notice of claim must be given to us within 30
  days after a covered loss starts or as soon as
  reasonably possible. Should you wish to submit a
  claim for benefits under the provisions of your
  contract, we ask that you do so within 30 days after
  a covered loss starts so we may be of the best
  possible service to you.
  We have gathered additional medical information
  regarding your condition from which you are claiming
  disability benefits for. It appears that your
  condition has not changed significantly from 1994 and
  was not preventing you from working until May 1995.
  Furthermore, it appears that your reasons for leaving
  your current position are not for health reasons
  according to the information received from your
  employer. Also, it appears that your condition has
  not warranted any regular treatment since you stopped
  working in May 1995.
  In light of the above, we regret that we are unable
  to be of service to you for consideration of
  disability benefits as it appears that you do not fit
  the definition of total disability as outlined in
  your policy.
  . . . Should you have any additional medical
  information which we are not aware of, kindly submit
  this information to us as soon as possible so we may
  take further action on your claim.

(Defendant's Ex. 11).

On November 18, 1996, Steinberg submitted another Claimant's Statement For Disability Benefits and Attending Physician's Statement ("November 18 Physician's Statement"). (Defendant's Ex. 13). On the November 18 Physician's Statement, Dr. John Halperin ("Dr.Halperin") set forth a primary diagnosis of demylinating disease and a secondary diagnosis of Lyme disease. With regard to the demylinating disease diagnosis, Dr. Halperin was apparently referring to Multiple Sclerosis, the disease from which Steinberg is currently suffering from. Dr. Halperin also indicated on the ...


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