The opinion of the court was delivered by: Robert L. Carter, District Judge.
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
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
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
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
. . . 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.
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
suffering from. Dr. Halperin also indicated on the ...