United States District Court, W.D. Kentucky
JAMES H. POGUE PLAINTIFF
NORTHWESTERN MUTUAL LIFE INSURANCE COMPANY DEFENDANT NO. 3
Charles R. Simpson III, Senior Judge United States District
case is before the court on defendant Northwestern Mutual
Life Insurance Company's (hereinafter “NWML”)
motion for summary judgment. ECF No. 133. Plaintiff James H.
Pogue (hereinafter “Pogue”) responded, submitting
two Rule 56(d) objections and opposing the motion for summary
judgment. ECF No. 144. NWML subsequently replied. ECF No.
157. For the reasons set forth below, Pogue's Rule 56(d)
objections will be overruled and NWML's motion for
summary judgment will be granted.
case arises from NWML's denial of Pogue's claim for
benefits under his three long-term disability insurance
policies. Pogue is a physician who previously practiced
medicine in Nashville, Tennessee. ECF No. 133-3, p. 5. On
April 28, 2013, Pogue submitted a request for disability
benefits to NWML, stating that he suffered from a
“severe anxiety disorder” and that “on Nov.
9, 2012 [he] had a total nervous breakdown and could no
longer think clearly enough to practice medicine.”
Id. at 3. Pogue's request also stated that he
“chose to surrender [his medical] license due to a
feeling of personal incompetence to handle work
stresses.” Id. at 7.
January 9, 2014, NWML issued a letter denying Pogue's
request for total disability benefits. ECF No. 117-3. The
letter stated that NWML did “not find proof of
disability” and believed that Pogue “made
intentional, and even fraudulent, misrepresentations
throughout [his] claim in order to deceive [NWML] into
providing benefits. . .” Id. at 8. The
insurance company pointed to several discrepancies in the
information Pogue provided. Of particular significance was an
order issued by the Tennessee Board of Medical Examiners
dated November 28, 2012- less than three weeks after
Pogue's alleged nervous breakdown-suspending Pogue's
medical license due to his improper prescribing of controlled
substances to patients and family members. Id. at 6;
ECF No. 124-3. NWML referred to Pogue's insurance
contract, which states that “there will be no benefits
for a disability or loss that results from or is caused by or
contributed to by the suspension, revocation, or surrender of
a professional or occupational license or certificate.”
ECF No. 117-3, p. 8. NWML concluded that “although
[Pogue] may [have had] a nervous breakdown on November 9,
2012 . . . [it] was unable to establish proof that, apart
from [his] licensing issues, [he had] been unable to perform
the duties of [his] occupation because of a disabling
psychiatric illness.” Id. Pogue appealed this
denial twice, and in both instances NWML upheld the claim
denial. ECF No. 117-4; ECF No. 117-5.
August 6, 2014, Pogue filed suit against NWML in Jefferson
Circuit Court, alleging breach of contract, common law bad
faith, violation of the Kentucky Unfair Claims Settlement
Practices Act, and violation of the Kentucky Consumer
Protection Act. ECF No. 1. The case was subsequently
removed to this court. Id.
now moves for summary judgment, asserting that Pogue's
claim of disability is expressly excluded under the terms of
his three insurance policies. ECF No. 133-1.
trial court shall grant summary judgment in a case “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). The party moving
for summary judgment bears the initial burden of
“demonstrating that [there is] no genuine issue of
material fact.” Celotex Corp. v. Catrett, 477
U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). If the
moving party satisfies this burden, the burden then shifts to
the nonmoving party to “point to evidence demonstrating
that there is a genuine issue of material fact for
trial.” Id. at 323 (emphasis added).
considering a motion for summary judgment, the court must
consider the facts in the light most favorable to the
nonmoving party. Scott v. Harris, 550 U.S. 372, 378,
127 S.Ct. 1769, 167 L.Ed.2d 686 (2007). However, the
nonmoving party “must do more than simply show that
there is some metaphysical doubt as to the material
facts.” Matsushita Elec. Indus. Co. v. Zenith Radio
Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538
(1986). There must actually be “evidence on which the
jury could reasonably find for the [nonmoving] party.”
Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252,
106 S.Ct. 2505, 91 L.Ed.2d 202 (1986).
Rule 56(d) Objections
initial matter, Pogue sets forth two Rule 56(d) objections
claiming that (i) he has not been permitted to seek necessary
discovery from NWML specific to his breach of contract
claims, and (ii) NWML relies on documents in its motion that
are not properly before the court. Pogue requests that the
court deny NWML's motion for summary judgment, or
alternatively, defer the motion to allow him a reasonable
opportunity to obtain discovery.
Need For ...