United States District Court, E.D. Louisiana
EDGARDO J. SUSSMANN
AMERITAS LIFE INSURANCE CORP., UNION CENTRAL LIFE INSURANCE COMPANY, XYZ INSURANCE COMPANY
ORDER AND REASONS
S. VANCE UNITED STATES DISTRICT JUDGE
the Court is defendant Ameritas Life Insurance Corp.'s
motion for partial summary judgment. For the following reasons,
the Court grants the motion.
case arises out of a dispute over disability insurance
coverage.Plaintiff Edgardo Sussman alleges that he
is owed benefits under multiple disability insurance policies
issued by defendant. Plaintiff asserts that he has been totally
disabled and unable to perform his occupation since 2013
because of chronic back pain. According to plaintiff, he began
to suffer back pain from stenosis of the lumbar spine in
2011, was declared totally disabled in 2013, underwent lumbar
surgery in 2014, and continues to suffer from the same
pain. He was later diagnosed with stenosis of
the cervical spine.Plaintiff further declares that, on
December 18, 2015, he fell down a flight of steps and
suffered injuries to his back that aggravated his lumbar
condition.On December 23, 2015, plaintiff was
involved in an automobile accident that allegedly caused
further injuries to his spine. Plaintiff was diagnosed with
nerve compression in July 2016, underwent lumbar laminectomy
surgery in September 2016, and has allegedly not recovered
from this condition.Finally, plaintiff attests that a
psychiatrist has declared him totally disabled because of
mental and nervous issues since January 2013.
filed a petition for damages in state court in March
2017.According to the petition, defendant
failed to pay plaintiff all the benefits to which he is
entitled for several time periods between 2013 and
2016. On April 6, 2017, defendant removed the
matter to this Court on the basis of diversity of
citizenship. Defendant now moves for partial summary
judgment with respect to two disability overhead expense
policies issued to plaintiff.
judgment is warranted when “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); see also Celotex Corp. v.
Catrett, 477 U.S. 317, 322-23 (1986); Little v.
Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir. 1994).
When assessing whether a dispute as to any material fact
exists, the Court considers “all of the evidence in the
record but refrain[s] from making credibility determinations
or weighing the evidence.” Delta & Pine Land
Co. v. Nationwide Agribusiness Ins. Co., 530 F.3d 395,
398-99 (5th Cir. 2008). All reasonable inferences are drawn
in favor of the nonmoving party, but “unsupported
allegations or affidavits setting forth ‘ultimate or
conclusory facts and conclusions of law' are insufficient
to either support or defeat a motion for summary
judgment.” Galindo v. Precision Am. Corp., 754
F.2d 1212, 1216 (5th Cir. 1985); see also Little, 37
F.3d at 1075. “No genuine dispute of fact exists if the
record taken as a whole could not lead a rational trier of
fact to find for the non-moving party.” EEOC v.
Simbaki, Ltd., 767 F.3d 475, 481 (5th Cir. 2014).
dispositive issue is one on which the moving party will bear
the burden of proof at trial, the moving party “must
come forward with evidence which would entitle it to a
directed verdict if the evidence went uncontroverted at
trial.” Int'l Shortstop, Inc. v. Rally's,
Inc., 939 F.2d 1257, 1264-65 (5th Cir. 1991) (internal
citation omitted). The nonmoving party can then defeat the
motion by either countering with evidence sufficient to
demonstrate the existence of a genuine dispute of material
fact, or “showing that the moving party's evidence
is so sheer that it may not persuade the reasonable
fact-finder to return a verdict in favor of the moving
party.” Id. at 1265.
dispositive issue is one on which the nonmoving party will
bear the burden of proof at trial, the moving party may
satisfy its burden by pointing out that the evidence in the
record is insufficient with respect to an essential element
of the nonmoving party's claim. See Celotex, 477
U.S. at 325. The burden then shifts to the nonmoving party,
who must, by submitting or referring to evidence, set out
specific facts showing that a genuine issue exists. See
Id. at 324. The nonmovant may not rest upon the
pleadings, but must identify specific facts that establish a
genuine issue for trial. See, e.g., id.;
Little, 37 F.3d at 1075 (“Rule 56
mandates the entry of summary judgment, after
adequate time for discovery and upon motion, against a party
who fails to make a showing sufficient to establish the
existence of an element essential to that party's case,
and on which that party will bear the burden of proof at
trial.” (quoting Celotex, 477 U.S. at 322)).
requests partial summary judgment dismissing plaintiff's
claims under disability overhead expense policies nos.
E00002895D and E00001058D. Both policies provide
reimbursement to the insured for business overhead expenses
incurred during periods of partial or total
disability. These two policies contain identical
provisions, with the exception of the premiums and benefits
listed in the respective Schedule of Benefits and Premium
Summary. Each policy has a maximum monthly
benefit and a maximum overhead expense benefit.
maximum overhead expense benefit for a disability starting
before age 65 is $126, 000 under policy no. E00002895D and
$132, 000 under policy no. E00001058D. Plaintiff is
not yet 65 years old. Defendant presents two affidavits
from its employee, Lori Compton, who served as the claims
handler for plaintiff's claims. Compton attests that
defendant has paid out the maximum benefit amounts of $126,
000 on policy no. E00002895D and $132, 000 on policy no.
E00001058D. Plaintiff does not contest that he
received these payments, but contends that he suffers from
multiple separate disabilities, and is entitled to a full set
of benefits for each disability.
Louisiana law, insurance policies are subject to the same
interpretative rules as other contracts. See Arceneaux v.
Amstar Corp., 200 So.3d 277, 286 (La. 2016). In
construing an insurance contract, the Court must
“determine the parties' common intent” with
reference to the text of the contract. Sims v. Mulhearn
Funeral Home, Inc., 956 So.2d 583, 589 (La. 2007).
“An insurance contract is to be construed as a whole
and each provision in the contract must be interpreted in
light of the other provisions.” Id.; see
also La. Civ. Code art. 2050. If a policy provision is
ambiguous and is subject to two or more reasonable
interpretations, it is generally construed against the
insurer. Sims, 956 So.2d at 589-90.
the relevant provisions of the overhead expense policies read
Definition of Total Disability: We will
consider you totally disabled if a sickness or injury, in and
of itself, prevents you from performing the material and
substantial duties of your occupation.
Successive Periods of Disability: Successive
periods of disability will be considered as one period if:
(1) they are caused by the same or related conditions; and
(2) they are separated by less than six months; and (3) the
successive periods each begin while this policy is in force.