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Pogue v. Northwestern Mutual Life Insurance Co.

United States District Court, W.D. Kentucky

March 7, 2018



          Charles R. Simpson III, Senior Judge United States District Court

         I. Introduction

         This 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.

         II. Factual Background

         This 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.

         On 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.

         On 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.[1] ECF No. 1. The case was subsequently removed to this court. Id.

         NWML 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.

         III. Legal Standard

         The 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).

         In 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).

         IV. Discussion

         A. Rule 56(d) Objections

         As an 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.

         i. Need For ...

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