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GOOMAR v. CENTENNIAL LIFE INS. CO.

March 8, 1994

MOHINDER S. GOOMAR, Plaintiff,
v.
THE CENTENNIAL LIFE INSURANCE COMPANY; SENTRY LIFE INSURANCE COMPANY, Defendants.



The opinion of the court was delivered by: JOHN S. RHOADES

 This case is before me on both plaintiff's and defendants' cross motions for summary judgment. For the reasons given below, defendants' motion is granted, and plaintiff's motion is denied. *fn1"

 SUMMARY OF DECISION

 The court grants defendants' motion for summary judgment and denies plaintiff's motion for summary judgment. To be eligible for benefits under both the Centennial Life Policy and the Sentry Life Policy, a claimant must: (1) be totally disabled, such that claimant is unable to perform the material and substantial duties of his current occupation; (2) receive the regular care and attendance of a physician; and (3) submit a proof of loss within one year of the loss, unless claimant is mentally incompetent. Plaintiff has failed to satisfy any of these criteria. Accordingly, defendants Centennial Life and Sentry Life are entitled to summary judgment in their favor on all issues raised in plaintiff's Complaint.

 FACTS

 This action involves claims for disability benefits submitted to two separate insurance companies in 1992: Centennial Life Insurance Company and Sentry Life Insurance Company. Plaintiff Mohinder Goomar contends that a psychological disability (visions of astral beings) caused him to sexually molest four female patients during the time period from 1980 to 1984, while he was in private medical practice in Saratoga Springs, New York. The molestations resulted in public hearings before the Regents Review Committee of the State of New York. The Committee revoked Dr. Goomar's license to practice medicine, effective June 1987. Plaintiff has not practiced medicine since that time.

 Plaintiff was covered under the Sentry Policy from September 1, 1974 to September 1, 1988. He was covered under the Centennial Policy from October 1, 1982 to on or about June 7, 1987. In March 1992, plaintiff submitted a claim to both Centennial Life and Sentry Life at the urging of his treating psychiatrist, Dr. David Garmon. Plaintiff alleges that his disability led to the conduct that caused the loss of his medical license.

 Both Centennial Life and Sentry Life, acting independently, investigated plaintiff's claims and denied those claims on the ground that plaintiff had failed to satisfy policy requirements for payment of disability benefits. Specifically, defendants found no evidence showing that plaintiff was totally disabled from performing the material duties of his occupation during the time period that either policy was in force. Additionally, both policies require that the insured be under the care of a physician during the period of total disability. Defendants assert that plaintiff sought no medical attention for the problems he now contends disable him until September 1989--after both policies had terminated.

 Defendants Centennial Life and Sentry Life seek summary judgment in their favor on all issues raised by plaintiff in this lawsuit and request that the entire Complaint be dismissed with prejudice. Alternatively, defendants request that plaintiff's third claim for breach of the implied covenant of good faith and fair dealing and fourth claim for breach of fiduciary duties be dismissed on the ground that defendants' denials of plaintiff's claims were reasonable and these claims must therefore fail as a matter of law. Plaintiff, on the other hand, contends that he is entitled to summary judgment that there is coverage under both disability insurance policies based on the language of the policies.

 DISCUSSION

 A. LEGAL STANDARD FOR SUMMARY JUDGMENT

 Pursuant to Rule 56(c) of the Federal Rules of Civil Procedure, summary judgment shall be granted if "the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." One of the principal purposes of the rule is to dispose of factually unsupported claims or defenses. Celotex Corp. v. Catrett, 477 U.S. 317, 325, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986).

 In considering a motion for summary judgment, the Court must examine all the evidence in the light most favorable to the nonmoving party. United States v. Diebold, Inc., 369 U.S. 654, 655, 8 L. Ed. 2d 176, 82 S. Ct. 993 (1962). A moving party who bears the burden of proof at trial is entitled to summary judgment only when the evidence indicates that no genuine issue of material facts exists. Fed. R. Civ. P. 56(c); Celotex, 477 U.S. at 325. If the moving party does not bear the burden of proof at trial, he may discharge his burden of showing that no genuine issue of material fact remains by demonstrating that "there is an absence of evidence to support the non-moving party's case." Celotex, 477 at 325. The moving party is not required to produce evidence showing the absence of genuine issue of material fact on such issues, nor must the moving party support its motion with evidence negating the non-moving party's claim. Lujan v. National Wildlife Fed'n, 497 U.S. 871, 885, 111 L. Ed. 2d 695, 110 S. Ct. 3177 (1990); United Steelworkers v. Phelps Dodge Corp., 865 F.2d 1539, 1542 (9th Cir.), cert. denied, 493 U.S. 809, 107 L. Ed. 2d 20, 110 S. Ct. 51 (1989). Instead, "the motion may, and should, be granted so long as whatever is before the District Court demonstrates that the standard for the entry of judgment, as set forth in Rule 56(c), is satisfied." Lujan, 497 U.S. at 885 (quoting Celotex, 477 U.S. at 323).

 Once the moving party meets the requirement of Rule 56 by either showing that no genuine issue of material fact remains or that there is an absence of evidence to support the non-moving party's case, the burden shifts to the party resisting the motion, who "must set forth specific facts showing that there is a genuine issue for trial." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256, 91 L. Ed. 2d 202, 106 S. Ct. 2505 (1986). It is not enough for the party opposing a properly supported motion for summary judgment to "rest on mere allegations or denials of his pleadings." Id. Genuine factual issues must exist that "can be resolved only by a finder of fact because they may reasonably be resolved in favor of either party." Id. at 250.

 To make such a showing, the non-moving party must go beyond the pleadings to designate specific facts showing that there is a genuine issue for trial. Celotex, 477 U.S. at 325. Such evidence need not be in a form admissible at trial to avoid summary judgment. Id. The moving party is entitled to judgment as a matter of law if the non-movant fails to make a sufficient showing of an element of its case with respect to which it has the burden of proof. Id.

 B. THE CENTENNIAL POLICY

 The Centennial Life Policy provides coverage to "Eligible Persons." An "Eligible Person" is defined in relevant part as:

 
An active Member of the Holder who is: . . . Under age 60 and actively performing the full-time duties of his profession or occupation.

 (McClelland Declaration, Exhibit A at p.6.) Following the cessation of his medical practice in June 1987, plaintiff was no longer an "Eligible Person" under the Centennial Policy because he was no longer actively performing the full-time duties of his occupation. The issue is then whether plaintiff met the Policy's requirements for disability benefits prior to June 1987.

 The Centennial Policy defines "Total Disability" in relevant part as:

 
Total Disability for Present Occupation shown in the Schedule of Benefits shall mean Sickness or Injury which totally and continuously prevents an Insured who is: . . . A medical, dental or osteopathic practitioner, at least 75% of whose practice has been limited to one recognized specialty area of medicine, dentistry or osteopathy for at least 2 years prior to such disability, from performing the material and substantial duties of that specialized area of practice . . . .

 (McClelland Declaration, Exhibit A at p.8.) The term "Sickness" is defined in pertinent part as:

 
Sickness or disease which causes the Insured to be totally disabled for a period of time. The Sickness must begin while the Insured's coverage is in force.

 (McClelland Declaration, Exhibit A at p.7.) With respect to the criteria for the payment of disability benefits, the Policy provides:

 
We will pay the Monthly Disability Benefit shown in the Schedule of Benefits for Present Occupation or Any Occupation under these conditions:
 
(1) Total Disability exists as defined above; and
 
(2) The Insured receives the Regular Care and Attendance ...

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