Thursday, September 28, 2017

No. 236: Country Life Suffers a Court Defeat Over a Disability Insurance Claim

On September 8, 2017, a jury in Arizona awarded $6.5 million to the plaintiff in a lawsuit against Country Life Insurance Company (Bloomington, IL). The case involved a disability insurance claim.

Benjamin McClure, an Arizona resident, purchased a disability insurance policy from Country Life in November 1995. The policy provided disability benefits of $1,500 per month after a 90-day elimination period, and a waiver-of-premium benefit.

In November 2012 McClure suffered a severe head injury. Since then he has suffered, among other problems, memory loss, seizures, headaches, vertigo, confusion, fatigue, and difficulty focusing. He has been hospitalized periodically, cannot drive, and requires assistance with activities of daily living. He cannot engage in his regular occupation or any other occupation for which he is trained, educated, or experienced.

In January 2013 McClure filed a claim for disability benefits. After the elimination period, Country Life began paying the $1,500 monthly benefit. In December 2013 the company notified McClure that its review of the medical correspondence from his attending physicians did not support disability from a physical standpoint. The company requested additional medical information, including a neuropsychological evaluation. In February 2014 McClure underwent the evaluation.

In April 2014 the company informed McClure it was ending his benefits because the medical information did not show physical or cognitive impairments that would prevent him from performing the duties of his regular occupation. Months later, after McClure notified the company that he had been hospitalized and undergone further medical treatment, the company again refused to pay benefits without requesting further medical reports and without a follow-up investigation.

The Lawsuit
In December 2015 McClure filed a lawsuit against Country Life. The two claims for relief were for breach of contract and for insurance bad faith (breach of the covenants of good faith and fair dealing). He sought, among other things, compensatory damages, punitive damages, pre- and post-judgment interest, attorney fees, and costs. The company filed a perfunctory answer to the complaint. (See McClure v. Country Life, U.S. District Court, District of Arizona, Case No. 2:15-cv-2597.)

The case was assigned to U.S. District Judge Douglas L. Rayes. President Obama nominated him in September 2013, and the Senate confirmed him in May 2014.

In July 2016 McClure filed a first amended complaint that included a second defendant: CC Services, Inc. (CCS), a Country Life affiliate that administers Country Life's claims. The defendants filed perfunctory answers to the first amended complaint.

The complaints do not include a copy of the policy. According to the complaints, "disability" is defined as a:
[c]ontinuous inability to perform substantially all important duties of your regular occupation because of your injury or sickness. After benefits have been paid for two years, it means continuous inability to engage in any occupation because of your injury or sickness.
The policy defines "regular occupation" as "your occupation at the time disability begins." The policy defines "any occupation" as "any occupation in which you could be expected to engage," and "[c]onsideration is given to your education and training or experience."

In March 2017, after discovery, the parties filed motions for partial summary judgment. Judge Rayes denied the motions in early August. In his denial of the defendants' motion for partial summary judgment, the judge referred to McClure's expert witness, Mary Fuller. Here are a few of the judge's comments:
Fuller explains that Country Life neglected to obtain records related to McClure's inpatient hospitalization for depression and suicidal thoughts, questioned the reasonableness of the findings of medical providers and examiners without a reasoned basis, and denied McClure's claim based on an [independent medical examination] without first having those results reviewed by an appropriately credentialed medical source or obtaining input from McClure's treatment providers on those findings. Fuller also discusses financial incentives that could have motivated Country Life to deny McClure's claim when it did.
Judge Rayes also commented on Country Life's arguments about why Fuller's opinions should not be allowed. He said: "Whether Fuller's opinion should be credited, however, is a quintessential jury question."

The Trial
On August 24, 2017, the trial began. On September 8, 2017, after ten days of trial, the jury found in favor of McClure. On September 15, Judge Rayes filed a judgment that describes the jury's findings. In terms of dollar amounts, the three most significant findings were:
  • $1,290,000 against Country Life and CCS for emotional distress, humiliation, inconvenience, and anxiety.
  • $2,500,000 against Country Life for punitive damages.
  • $2,500,000 against CCS for punitive damages.
Interest will accrue at the legal rate of 1.23 percent per annum from the date of the judgment until it is paid. I do not know when the judgment will be paid or whether the defendants will appeal.

General Observations
As mentioned, the defendants' answers to the complaints were perfunctory, but they gave their views in their motion for partial summary judgment. Almost four years elapsed between the termination of monthly benefits and the jury's findings, and at this moment it is not known when McClure will receive what the jury awarded. It is unfortunate that it is taking so long for him to obtain redress.

Available Material
I am offering a 40-page complimentary PDF containing the first amended complaint (14 pages), the defendants' motion for partial summary judgment (19 pages), the judge's order denying the motion (5 pages), and the judgment (2 pages). Email and ask for the September 2017 package about the case of McClure v. Country Life.