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Allen M. Entin v. the Superior Court of Los Angeles County

August 20, 2012

ALLEN M. ENTIN, PETITIONER,
v.
THE SUPERIOR COURT OF LOS ANGELES COUNTY, RESPONDENT; PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY, REAL PARTY IN INTEREST.



ORIGINAL PROCEEDING; petition for writ of mandate from an order of the Superior Court of Los Angeles County. Michael B. Harwin, Judge. (Super. Ct. No. LC030998)

The opinion of the court was delivered by: Zelon, J.

CERTIFIED FOR PUBLICATION

Petition granted.

INTRODUCTION

Petitioner Allen Entin owned two disability income insurance policies. In 2009, Entin filed a claim asserting that migraine headaches had rendered him totally disabled. Entin's insurer, respondent Provident Life and Accident Insurance Company, agreed to pay Entin benefits while investigating his claim. At the conclusion of its investigation, Provident filed a declaratory relief action seeking a determination that Entin was not totally disabled within the meaning of his policies. The complaint clarified that Provident would continue to pay Entin benefits during the pendency of the action and would not seek reimbursement of those payments. Entin requested a jury trial. The trial court denied the request, concluding that Provident's claim was equitable in nature because Provident was continuing to pay Entin disability benefits during the pendency of the action.

Entin filed a petition for writ of mandate seeking an order directing the superior court to grant his request for a jury trial. We issued an order to show cause and now conclude that the trial court erred in denying Entin a jury trial. In the context of declaratory relief actions, the right to a jury trial depends on whether the issues raised in the complaint are legal or equitable in nature. Provident's declaratory relief claim raises factual questions pertaining to contractual rights, which are legal in nature. Although Provident has elected to pay Entin benefits while pursuing the action, that does not transform the nature of the dispute into one arising in equity. Entin is therefore entitled to a jury trial.

FACTUAL AND PROCEDURAL BACKGROUND*fn1 [1]

In 1991, petitioner Allen Entin purchased a disability income insurance policy that provided benefits of $20,000 per month in the event that he became totally disabled. Entin also purchased an "overhead expense disability policy" that provided benefits up to $360,000 in the event that he became totally disabled. Both polices defined the term "totally disabled" to mean: "(1) [the insured is] not able to perform the substantial and material duties of [his] occupation; and [¶] (2) [the insured is] receiving care by a [p]hysician which is appropriate for the condition causing the disability."

On September 3, 2009, Entin filed a claim alleging that migraine headaches had rendered him incapable of performing the substantial and material duties of his occupation as an obstetrician and gynecologist. Entin's insurer, Provident Life and Accident Insurance Company, reviewed the claim and began paying Entin disability benefits under a reservation of rights.

On August 31, 2010, Provident filed a declaratory relief action seeking a determination that Entin was not entitled to disability benefits. The complaint did not raise any issue regarding the construction of the insurance policies. Instead, it asserted that the parties disputed whether the evidence showed Entin was "totally . . . disabled within the meaning of [those] [p]olicies." According to the allegations in the complaint, Entin informed Provident that the "doctors whom he ha[d] consulted" believed he was "no longer capable of performing his occupation as an obstetrician and gynecologist because of . . . migraine headaches of totally disabling proportions" After receiving this information, Provident conducted a medical examination of Entin, reviewed his medical records and interviewed his "[medical care] treaters." Provident's investigation allegedly revealed "Entin [wa]s not totally . . . disabled within the meaning of the Policies" and raised "substantial question[s]" as to whether he was "receiving appropriate care for his claimed medical condition as contractually required."

The complaint clarified that although Provident did not believe Entin was totally disabled, it would "continue[] to pay [his] disability claim . . . until [the] Court issue[d] its determination of the rights and responsibilities of the parties . . . ." The complaint also stated that Provident "[would] not attempt[] to recoup any sums" paid prior to the entry of judgment.

Entin filed a cross-complaint for breach of the implied covenant of good faith and fair dealing alleging that Provident's declaratory relief action was part of a "scheme" to "forc[e] its insureds . . . to settle otherwise legitimate claims for less than the value of the claim."*fn2 The cross-complaint further alleged that Provident filed its action knowing that Entin was entitled to benefits and would be forced to "incur attorneys fees defending the charges brought against him."

Provident demurred to the cross-complaint, arguing that Entin could not pursue a "claim for bad faith . . . in the absence of a breach of the underlying insurance contract[s]." Provident contended that the allegations in the cross-complaint admitted Entin was still receiving disability benefits, thereby demonstrating that no breach had occurred. In his opposition, Entin asserted that regardless of whether he was still receiving benefits, he had properly stated a claim for breach of the implied covenant by alleging that Provident filed a "a sham Complaint for Declaratory Relief" that "placed a cloud on [his] disability benefits causing [him] to incur litigation expenses and emotional distress." The trial court sustained Provident's demurrer "without leave to amend."*fn3

In February of 2012, the parties submitted opposing briefs addressing the issue of Entin's right to a jury on Provident's declaratory relief claim. Entin argued that he had a right to a jury because the case raised factual issues concerning his entitlement to contractual insurance benefits. Provident, however, argued that there was no right to a jury because "the underlying claim and relief sought - identification of prospective right under the insurance policies - is [sic] purely equitable in nature." On February 22, 2012, the trial court ordered that Entin did not have a right to a jury "in light of the fact that payments [under the policies] are ongoing."

Entin filed a petition for writ of mandate seeking an order from this court directing the superior court "to vacate its order . . . granting . . . a court trial" and "to enter a new and different order . . . granting [Entin's] motion for a jury trial." We issued an order to show cause on April 10, 2012.

DISCUSSION

A. Standard of Review

The issue of whether Entin is "constitutionally entitled to a jury trial . . . is a pure question of law that we review de novo." (Caira v. Offner (2005) 126 Cal.App.4th 12, 23 (Caira); see also Jogani v. Superior Court (2008) 165 Cal.App.4th 901, 904 ["[w]hether [plaintiff] is entitled to a jury trial is an issue of law that we review de novo"].)

B. Summary of Relevant Case Law

1. The right to a jury trial in declaratory ...


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