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Tsiampalis v. Monarch Life Insurance Co.

January 23, 2007

CHRISTOS TSIAMPALIS, PLAINTIFF,
v.
MONARCH LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: John Gleeson, United States District Judge

MEMORANDUM AND ORDER

Christos Tsiampalis brought this action in New York State Supreme Court, Queens County seeking (1) a declaration that a provision in his disability insurance policy ("the Policy") issued by Monarch Life Insurance Company ("Monarch") is "impossible to perform" and "against public policy and void," and injunctive relief reinstating the Policy; (2) a declaration that Monarch's termination of its waiver of Tsiampalis's premium payments, pursuant to a provision of the Policy, was "inconsistent with the terms and conditions" of the Policy,*fn1 and injunctive relief reinstating the waiver; and (3) an award of fees and costs. Compl. at 8-9. Monarch moved to dismiss the complaint in state court. Subsequently, it removed the case to this Court and asked that I decide that motion to dismiss.*fn2 For the reasons discussed below, I grant the motion.*fn3

BACKGROUND

Monarch issued the Policy to Tsiampalis on January 7, 1987. Compl. at 1-2; Vandever Aff. Ex. B. at 3 (Policy at 1)*fn4 . The Policy provides benefits to an insured who is "totally disabled." Vandever Aff. Ex. B.at 5 (Policy at 3). According to the terms of the contract, You [i.e., the policyholder] will be considered totally disabled if all these conditions are met:

* You are unable to do the substantial and material duties of your regular occupation. Your regular occupation is your usual work when total disability starts. If you are retired and not working when total disability starts, your regular occupation will be the normal activities of a retired person of like age and sex.

* Your total disability starts while this policy is in force.

* Your total disability results from sickness or injury.

* You are under a doctor's care. Doctor means a licensed physician other than yourself.

Id.;Compl. at 2. An additional condition of "total disability" must be satisfied "after 60 months of continuous disability":

* You are unable to do the substantial and material duties of each and every reasonable occupation. A reasonable occupation is any gainful work you can do based on your education, training or experience, and with due regard to your earnings before total disability starts.

Vandever Aff. Ex. B.at 5 (Policy at 3); Compl. at 2-3. This general disability provision is the first provision at issue.

The parties to the Policy exchange insurance coverage for premium payments. Pursuant to a "Waiver of Premiums" provision, however, If you [i.e., the policyholder] are totally disabled for a continuous period of at least 90 days:

* we [i.e., Monarch] will waive premiums coming due during the disability; and

* we will refund any payments made for premiums due during the disability. We will continue to waive premiums until you are no longer totally disabled. But no premium due on or after ...


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