X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.

OPINION & ORDER   The issue in this case is whether an orthopedic surgeon was “totally disabled” for purposes of his disability insurance policy. Plaintiff Dr. Richard Sternberg (“Sternberg”) brings breach of contract claims against Defendant The Paul Revere Insurance Company (“Paul Revere”), alleging that he is entitled to disability payments as the result of an injury. Plaintiff filed a motion for summary judgment seeking damages and declaratory relief that it properly denied Plaintiff’s claim for total disability. The Court finds that, for the reasons set forth below, Plaintiff was not “totally disabled” for purposes of the insurance policy, and according, that Plaintiff’s motion for summary judgment is DENIED and Defendant’s motion for summary judgment is GRANTED. BACKGROUND The following factual summary consists of only undisputed material facts (“UMF”), unless otherwise indicated. These facts are, in significant part, copied from the parties’ Rule 56.1 Statements.1 Where the facts are subject to legitimate dispute, they are construed in favor of the non-moving party. Heublein, Inc. v. United States, 996 F.2d 1455, 1461 (2d Cir. 1993). Plaintiff is a physician who purchased three disability insurance policies from Defendant. UMF 1. Policy 0102298485 was issued effective August 18, 1987 (“1987 Policy”), Policy 0102358689 was issued effective January 18, 1989 (“1989 Policy”), and Policy 01025172030 was issued effective September 18, 1991 (“1991 Policy”) (collectively, “Policies”). Id. at 2. The Policies provided benefits for total and residual disability due to sickness or injury. Id. at 3. In relevant part, the Policies included the following definitions: “Your Occupation” means the occupation in which You are regularly engaged at the time You become Disabled.2 “Total Disability” means that because of Injury or Sickness: a. You are unable to perform the important duties of Your Occupation; and b. You are under the regular and personal care of a Physician.3 “Residual Disability” prior to the Commencement Date, means that due to Injury or Sickness: a. (1) You are unable to perform one or more of the important duties of Your Occupation; or (2) You are unable to perform the important duties of Your Occupation for more than 80 percent of the time normally required to perform them; and b. Your loss of Earnings is equal to at least 20 percent of Your Prior Earnings while You are engaged in Your Occupation or another occupation; and c. You are under the regular and personal care of a Physician.4 The Policies also include a Lifetime Total Disability Benefit Rider, under which benefits are paid monthly if: (1) the Total Disability begins before age 65; (2) the Total Disability continues to age 65; and (3) The benefits under the Policy are during the Total Disability. If these three conditions are met, then on the insured 65th birthday (or the date the Total Disability benefits payable under the policy end), Paul Revere pays a monthly amount based on a Policy schedule. The amount in the Policy schedule (plus any Cost of Living increase) is multiplied by a factor that varies based on the age at which the disability commenced.5 Sternberg was an orthopedic surgeon who was employed by Bassett Healthcare in Cooperstown, New York. Id. at 5. His primary responsibilities included working in the hospital owned clinic 5 half days per week, performing open surgical procedures (i.e., those involving an incision), taking call via the emergency room, and inpatient responsibilities with surgical involvement. Id. at 6. Due to a detached retina and the resultant intraocular bleed, and then due to complications from spinal decompression surgery, Sternberg took leave from his employment starting April 6, 2012. Id. at 53. He returned to work on a part-time basis on July 3, 2012 and on a full-time basis on July 16, 2012. Id. at 54. However, when he returned, Sternberg was no longer able to take call in the emergency room or perform open surgical procedures in the operating room. Id. at

 
Reprints & Licensing
Mentioned in a Law.com story?

License our industry-leading legal content to extend your thought leadership and build your brand.

More From ALM

With this subscription you will receive unlimited access to high quality, online, on-demand premium content from well-respected faculty in the legal industry. This is perfect for attorneys licensed in multiple jurisdictions or for attorneys that have fulfilled their CLE requirement but need to access resourceful information for their practice areas.
View Now
Our Team Account subscription service is for legal teams of four or more attorneys. Each attorney is granted unlimited access to high quality, on-demand premium content from well-respected faculty in the legal industry along with administrative access to easily manage CLE for the entire team.
View Now
Gain access to some of the most knowledgeable and experienced attorneys with our 2 bundle options! Our Compliance bundles are curated by CLE Counselors and include current legal topics and challenges within the industry. Our second option allows you to build your bundle and strategically select the content that pertains to your needs. Both options are priced the same.
View Now
September 05, 2024
New York, NY

The New York Law Journal honors attorneys and judges who have made a remarkable difference in the legal profession in New York.


Learn More
April 29, 2024 - May 01, 2024
Aurora, CO

The premier educational and networking event for employee benefits brokers and agents.


Learn More
May 15, 2024
Philadelphia, PA

The Legal Intelligencer honors lawyers leaving a mark on the legal community in Pennsylvania and Delaware.


Learn More

Shipman is seeking an associate to join our Labor & Employment practice in our Hartford, New Haven, or Stamford office. Candidates shou...


Apply Now ›

Evergreen Trading is a media investment firm headquartered in NYC. We help brands achieve their goals by leveraging their unwanted assets to...


Apply Now ›

Duane Morris seeks an associate with 3-4 years of experience to join its Employee Benefits and Executive Compensation Group in its Philadelp...


Apply Now ›
04/15/2024
Connecticut Law Tribune

MELICK & PORTER, LLP PROMOTES CONNECTICUT PARTNERS HOLLY ROGERS, STEVEN BANKS, and ALEXANDER AHRENS


View Announcement ›
04/11/2024
New Jersey Law Journal

Professional Announcement


View Announcement ›
04/08/2024
Daily Report

Daily Report 1/2 Page Professional Announcement 60 Days


View Announcement ›