No bad faith in disability insurer's claims investigation

A federal judge has rejected a dentist’s lawsuit against his disability insurer over its refusal to cover him for an eye injury, finding that the insurer did not act in bad faith in its claims investigation, which allegedly included procuring his golf scores in an attempt to discredit his claim.

U.S. District Judge Matthew Brann of the Middle District of Pennsylvania granted defendants Unum Group and Provident Life and Accident Insurance Co.’s motion for partial summary judgment.

Brann’s ruling eliminates plaintiff Dr. Robert Brugler’s claim seeking a declaratory judgment, as well as claims under the Pennsylvania Unfair Trade Practices and Consumer Protection Law, and bad-faith claims from the litigation.

Brugler filed a claim for disability benefits after being diagnosed with a retinal detachment in his right eye. According to Brann’s opinion, the defendants paid Brugler disability benefits for several months before asking him to be re-examined by an independent physician. The independent examination resulted in a recommendation that disability be discontinued because Brugler lacked an indemnifiable disability.

Related: Beware of bad-faith liability

Disputing Independent examination

Brugler filed a five-count complaint disputing that determination. The defendants asked Brann to dismiss three.

The first, Brugler’s request for declaratory judgment that he is entitled to insurance benefits so long as his physician certifies that he’s disabled, failed to persuade the judge, who said the language of the policy clearly applied only to qualifying disabilities as determined by the insurer.

“The fact that the policy confers upon the insurer a right to independently investigate the insured’s claim at the insurer’s expense further undermines Dr. Brugler’s proffered interpretation. The policy states that defendants have the right to have Dr. Brugler examined ‘as often as reasonable.’ This clause comports with well-settled principles of insurance law permitting insurers to rely on independent medical evaluations when investigating claims,” which could lead to the termination of benefits, Brann said.

Brugler’s unfair trade practices claim also fell flat because it did not allege malfeasance.

“It appears that Dr. Brugler’s papers attempt to argue malfeasance by suggesting that the physicians employed by defendants used unreliable methods to deny Dr. Brugler disability benefits. But Dr. Brugler fails to identify any legal authority suggesting such behavior equals malfeasance as opposed to nonfeasance,” Brann said. “Even if Dr. Brugler’s papers characterize defendants’ claims handling process as reckless, that characterization does not morph nonfeasance into malfeasance.”

No bad faith?

The defendants also argued that they did not act in bad faith because they had a good reason to deny Brugler further benefits.

Brann agreed, noting that an insurer is not required to give more credence to a claimant’s physician than one of its own.

“There is ample, undisputed record evidence showing that defendants, after conducting a thorough investigation of Dr. Brugler’s claim, had a reasonable basis to deny his disability claim,” Brann said.

Further, Brann said, an insurer “does not act in bad faith by aggressively protecting its interests.”

“While Dr. Brugler objects that defendants procured his golf scores and conducted searches about his business to see if they could somehow discredit his claim, he points to no authority setting forth that defendants’ claims handling procedures were improper, or that their methods otherwise went beyond mere negligence and constituted conduct amounting to bad faith,” Brann said.

Louis C. Schmitt Jr. of McIntyre, Hartye, Schmitt & Sosnowski represents Brugler and Luke A. Repici of White and Williams represents the defendants. Neither responded to requests for comment.

Related: Minimizing the unpredictability of claims litigation

P.J. D’Annunzio is a reporter at the Legal Intelligencer covering public corruption, federal courts, and breaking news.