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HSK v. Unumprovident Corporation

United States District Court, Fourth Circuit

September 19, 2013

HSK
v.
UNUMPROVIDENT CORPORATION, ET AL.

MEMORANDUM

CATHERINE C. BLAKE UNITED STATES DISTRICT JUDGE

Now pending before the court is a motion for partial summary judgment on contract interpretation, filed by plaintiff HSK against defendants Unum Group (f/k/a UnumProvident Corporation) and Provident Life and Accident Insurance Company (collectively, “defendants”). This motion arises out of a dispute over whether the terms of HSK’s disability insurance policy require him to submit to a mental, psychiatric, or psychological examination as a condition of receiving disability benefits. The issues in this case have been fully briefed, and no hearing is necessary. See Local R. 105.6 (D. Md. 2011). For the reasons stated below, HSK’s motion for partial summary judgment will be granted, and, to the extent the defendants’ opposition is intended to include a renewed motion to compel mental examination (ECF No. 41 at 17), it will be denied.

BACKGROUND

On February 1, 1995, Provident Life and Accident Insurance Company (“Provident”) issued a disability insurance policy (no. 06-338-6114643) to HSK. On June 6, 2011, HSK made a claim for benefits on his policy. (ECF 41-2, Ex. B at 5.) He claimed that, beginning March 10, 2011, he became disabled due to “major depression, [obsessive-compulsive disorder], panic disorder, [attention deficit hyperactivity disorder], phobias, generalized anxiety disorder [and] opioid dependence.” (ECF No. 41-1, Ex. A at 2; ECF No. 41-2, Ex. B at 2.) As a result, HSK maintained that he was unable to continue his job as a mortgage business executive. (ECF No. 41-2, Ex. B at 4; ECF No. 2 at 3.)

Provident initially paid monthly benefits to HSK, yet stated that it paid these benefits under a “Reservation of Rights” while the investigation of HSK’s claim was pending.[1] (ECF No. 41, Ex. C at 3; ECF No. 9 ¶ 12.) As part of its investigation, Provident requested complete copies of HSK’s medical and psychiatric records, documents and employment contracts, and income tax returns. (ECF No. 41 at 2.) After reviewing the submitted documents, on August 10, 2011, Provident requested that HSK undergo a psychiatric independent medical examination (“IME”). (ECF No. 41, Ex. C.) HSK declined the IME, claiming the language of his policy did not provide for such an examination. (ECF No. 41-4, Ex. D at 2.) The policy language at issue was:

PHYSICAL EXAMINATIONS

We, at our expense, have the right to have you examined as often as is reasonable while a claim is pending.

(ECF No. 40-5, Ex. 3 at 26.)

HSK and Provident could not agree on whether his policy provided for a psychiatric IME, and on November 8, 2011, Provident terminated the insurance benefits. (ECF No. 40-9, Ex. 7 at 3.) Provident asserted that HSK had not provided sufficient information to support to his claim.[2] (Id.) HSK then brought a breach of contract action against the defendants in the Circuit Court of Maryland for Baltimore City. The defendants removed the action to this court on the grounds of diversity of citizenship.

STANDARD

Federal Rule of Civil Procedure 56(a) provides that summary judgment should be granted “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a) (emphasis added). Whether a fact is material depends upon the substantive law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247–48 (1986). Accordingly, “the mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment.” Id. “A party opposing a properly supported motion for summary judgment ‘may not rest upon the mere allegations or denials of [his] pleadings, ’ but rather must ‘set forth specific facts showing that there is a genuine issue for trial.’” Bouchat v. Baltimore Ravens Football Club, Inc., 346 F.3d 514, 522 (4th Cir. 2003) (alteration in original) (quoting Fed.R.Civ.P. 56(e)). The court must view the evidence in the light most favorable to the nonmovant and draw all justifiable inferences in his favor. Scott v. Harris, 550 U.S. 372, 378 (2007) (citation omitted); see also Greater Baltimore Ctr. for Pregnancy Concerns, Inc. v. Mayor and City Council of Baltimore, 721 F.3d 264, 283 (4th Cir. 2013) (citation omitted). At the same time, the court must not yield its obligation “to prevent factually unsupported claims and defenses from proceeding to trial.” Bouchat, 346 F.3d at 526 (citation and internal quotation marks omitted).

ANALYSIS

In Maryland, an insurance contract is construed as any other contract. Nat’l Union Fire Ins. Co. of Pittsburgh, Pa. v. David A. Bramble, Inc., 388 Md. 195, 208, 879 A.2d 101, 109 (2005); see also Dutta v. State Farm Ins. Co., 363 Md. 540, 556, 769 A.2d 948, 957 (2001) (“Maryland does not follow the rule that insurance policies should, as a matter of course, be construed against the insurer.”) (citations omitted). The court “begins [its analysis] with the language employed by the parties.” MAMSI Life & Health Ins. Co. v. Callaway, 375 Md. 261, 279, 825 A.2d 995, 1005 (2003). The language is given its “customary, ordinary, and accepted meaning[].” Walk v. Hartford Cas. Ins. Co., 382 Md. 1, 14–15, 852 A.2d 98, 106 (2004); see also Kendall v. Nationwide Ins. Co., 348 Md. 157, 166, 702 A.2d 767, 771 (1997) (stating that the court “analyze[s] the plain language of the [insurance] contract according words and phrases their ordinary and accepted meanings as defined by what a reasonably prudent lay person would understand them to mean”). This means the clear language of the contract is controlling, and not “what the parties thought the agreement meant or was intended to mean.” Wells v. Chevy Chase Bank, F.S.B., 363 Md. 232, 251, 768 A.2d 620, 630 (2001) (citations and internal quotation marks omitted). Accordingly, the initial question is whether the plain language of HSK’s disability insurance policy provides for only physical examinations, and not mental examinations.

Here, the plain language of the policy issued to HSK provides for only physical examinations of the insured. The caption indicates, in bold and capital lettering, that the insured may be required to submit to “PHYSICAL EXAMINATIONS.” (ECF No. 40-5, Ex. 3 at 26.) Nowhere in the caption or the below text does the policy specify that the insured may be forced to undergo a mental examination. Moreover, although the caption is followed by more general language that the insurer has “the right to have [the insured] examined as often as is reasonable while a claim is pending, ” this language is limited by the caption. To interpret the contract otherwise would be to “disregard[] a meaningful part of the language of the writing, ” a result abhorred by the Court of Appeals of Maryland. See Tomran, Inc. v. Passano, 391 Md. 1, 14, 891 A.2d 336, 344 (2006) (citation and internal quotation marks omitted); David A. Bramble, 388 Md. at 209, 879 A.2d at 109 (citation and internal quotation marks omitted). Accordingly, the defendants’ attempt to have the court overlook the “physical examinations” caption does not comport with the repeated instruction of the Court of Appeals of Maryland to consider a contract in its entirety so that effect is given to each clause. See, e.g., David A. ...


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