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Argotte v. Northwestern Mut. Life Ins.

United States District Court, W.D. Kentucky, Paducah Division

March 26, 2015

ALEX ARGOTTE, Plaintiff
v.
NORTHWESTERN MUTUAL LIFE INSURANCE, Defendant

Page 727

For Alex Argotte, Plaintiff: Bartley K. Hagerman, M. Austin Mehr, Philip G. Fairbanks, LEAD ATTORNEYS, Mehr Fairbanks Trial Lawyers, PLLC, Lexington, KY.

For Northwestern Mutual Life Insurance Co., doing business as Northwestern Mutual, Defendant: Allison L. Brown, Cornelius E. Coryell, II, LEAD ATTORNEYS, Wyatt, Tarrant & Combs, LLP - Louisville, Louisville, KY.

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MEMORANDUM OPINION AND ORDER

Thomas B. Russell, Senior United States District Judge.

This matter is before the Court on competing motions for summary judgment. Defendant Northwestern Mutual Life Insurance (" Northwestern Mutual" ) has moved for summary judgment on all claims (Docket #39), Plaintiff Alex Argotte has responded (Docket #45), and Northwestern Mutual has replied and supplemented that reply. (Docket #52, 60). Argotte has moved for partial summary judgment (Docket #43), Northwestern Mutual has responded (Docket #49), and Argotte has replied (Docket #55). Northwestern Mutual's motion (Docket #39) will be GRANTED in part and DENIED in part. Argotte's motion (Docket #43) will be DENIED.

BACKGROUND

This case arises out of six disability policies that Dr. Alex Argotte purchased from Northwestern Mutual. Argotte is a surgeon. He has suffered two maladies -- carpal tunnel syndrome and central serous retinopathy -- which he claims qualify him for disability benefits. (Docket #43).

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The parties strongly disagree on how to interpret several medical examinations of Argotte.

In 1994, Argotte purchased his first " own occupation" disability insurance policy from Northwestern Mutual. (Docket #43). Argotte added coverage, ultimately purchasing six disability policies. The policies define " total disability" as: " Until the end of the Initial Period,[1] the Insured is totally disabled when he is unable to perform the principal duties of his regular[2] occupation. After the Initial Period, the Insured is totally disabled when he is unable to perform the principal duties of his regular occupation and is not gainfully employed in any occupation." (Docket #1-1).

Argotte's first disability claim stemmed from the pain and limited range of motion he was experiencing in his right hand. In June, 2009, Argotte underwent surgery to remove a carpal boss in the joint of his right wrist. The surgery was performed by Dr. Charles Goldfarb. Argotte also received treatment from Dr. Shiraz Patel and underwent physical therapy at Restoration Physical Therapy. (Docket #43). Argotte filed a disability claim for this ailment in November, 2009. (Docket #43). In May, 2011, Northwestern Mutual had Argotte submit to an independent medical evaluation performed by Dr. Martin. (Docket #43-17). In August, 2011, Northwestern Mutual denied Argotte's claim.

Argotte's second disability claim stemmed from central serous retinopathy in his right eye. Central serous retinopathy is a condition in which fluid accumulates under the retina causing distorted vision. Argotte was diagnosed with central serous retinopathy in February, 2010. (Docket #39). Argotte received treatment from Dr. Carl Baker and Dr. Steven Charles. (Docket #43). Argotte filed a claim for this condition with Northwestern Mutual. Northwestern Mutual had Dr. Marilyn Kay perform a " paper review" of Argotte's medical records. (Docket #43). Northwestern Mutual determined Argotte became partially disabled in February, 2010 and that his disability resolved in September, 2010. (Docket #49). Argotte was paid disability benefits for this period. Argotte argues both that his condition is chronic and therefore unresolved and that Northwestern Mutual's calculation of benefits was incorrect. (Docket #45).

In addition to these disputes, Northwestern Mutual argues " Argotte's surgical career was derailed, not by any physical condition, but by a grievance that was filed against him with the Kentucky Board of Medical Licensure involving allegations of drug use, domestic violence, and questionable medical practices." (Docket #49). Argotte was suspended from Lourdes Hospital in Paducah, Kentucky, and subsequently resigned his position. (Docket #39-4). Argotte accepted a position with Southern Illinois Medical Services (" SIMS" ) in Herrin, Illinois. However, several months later SIMS learned of grievance against Argotte and terminated him. (Docket #49-10).

Finally, Northwestern Mutual argues Argotte has repeatedly represented that he is physically able to perform surgery by seeking reinstatement at Lourdes Hospital, by applying for positions at other hospitals, and by applying for malpractice insurance. (Docket #49).

Each party argues the record supports summary judgment in their favor. A review

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of the extensive evidence submitted by each party shows there are factual issues in dispute on most claims which render ...


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