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Sternberg v. Paul Revere Life Insurance Co.

United States District Court, S.D. New York

January 3, 2020

RICHARD STERNBERG, Plaintiff,
v.
THE PAUL REVERE LIFE INS. CO., Defendants.

          OPINION & ORDER

          ANDREW L. CARTER, JR., UNITED STATES DISTRICT JUDGE

         The issue in this case is whether an orthopedic surgeon was "totally disabled" for purposes of his disability insurance policy. Plaintiff Dr. Richard Sternberg ("Sternberg") brings breach of contract claims against Defendant The Paul Revere Insurance Company ("Paul Revere"), alleging that he is entitled to disability payments as the result of an injury. Plaintiff filed a motion for summary judgment seeking damages and declaratory relief that he was "totally disabled" for purposes of the policy. Defendant filed a motion for summary judgment seeking declaratory relief that it properly denied Plaintiffs claim for total disability. The Court finds that, for the reasons set forth below, Plaintiff was not "totally disabled" for purposes of the insurance policy, and according, that Plaintiff's motion for summary judgment is DENIED and Defendant's motion for summary judgment is GRANTED.

         BACKGROUND

         The following factual summary consists of only undisputed material facts ("UMF"), unless otherwise indicated. These facts are, in significant part, copied from the parties' Rule 56.1 Statements.[1] Where the facts are subject to legitimate dispute, they are construed in favor of the non-moving party. Heublein, Inc. v. United States, 996 F.2d 1455, 1461 (2d Cir. 1993).

         Plaintiff is a physician who purchased three disability insurance policies from Defendant. UMF ¶l. Policy 0102298485 was issued effective August 18, 1987 ("1987 Policy"), Policy 0102358689 was issued effective January 18, 1989 ("1989 Policy"), and Policy 01025172030 was issued effective September 18, 1991 ("1991 Policy") (collectively, "Policies"). Id. at¶2.

         The Policies provided benefits for total and residual disability due to sickness or injury. Id. at ¶3. In relevant part, the Policies included the following definitions:

"Your Occupation" means the occupation in which You are regularly engaged at the time You become Disabled.[2]
"Total Disability" means that because of Injury or Sickness:
a. You are unable to perform the important duties of Your Occupation; and
b. You are under the regular and personal care of a Physician.[3]
"Residual Disability" prior to the Commencement Date, means that due to Injury or Sickness:
a. (1) You are unable to perform one or more of the important duties of Your Occupation; or (2) You are unable to perform the important duties of Your Occupation for more than 80% of the time normally required to perform them; and
b. Your loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your Occupation or another occupation; and
c. You are under the regular and personal care of a Physician.[4]

         The Policies also include a Lifetime Total Disability Benefit Rider, under which benefits are paid monthly if: (1) the Total Disability begins before age 65; (2) the Total Disability continues to age 65; and (3) The benefits under the Policy are during the Total Disability. If these three conditions are met, then on the insured 65th birthday (or the date the Total Disability benefits payable under the policy end), Paul Revere pays a monthly amount based on a Policy schedule. The amount in the ...


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