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Simmons v. The Paul Revere Life Insurance Co.

United States District Court, W.D. Washington, Seattle

January 25, 2018

WILLIAM SIMMONS, DDS, Plaintiff
v.
THE PAUL REVERE LIFE INSURANCE COMPANY, et al. Defendants.

          ORDER ON CROSS MOTIONS FOR SUMMARY JUDGMENT

          BARBARA JACOBS ROTHSTEIN U.S. DISTRICT COURT JUDGE

         I. INTRODUCTION

         Plaintiff William Simmons, DDS instituted this lawsuit against Defendants The Paul Revere Life Insurance Company (“Paul Revere”) and Unum Life Insurance Company of America (“Unum Life”) (collectively, “Defendants”), alleging that they wrongfully denied him benefits under a disability insurance policy Simmons purchased from Defendants. Simmons brings three claims: (1) breach of contract, (2) breach of the covenant of good faith and fair dealing, and (3) violation of the Washington Insurance Fair Conduct Act. See Dkt. No. 17. Currently before the Court is Simmons' motion for partial summary judgment and Defendants' cross motion for summary judgment. Dkt. Nos. 39 and 42. Having reviewed the motions, the oppositions and replies thereto, the record of the case, and the relevant legal authorities, the Court will deny Simmons' motion and grant Defendants' cross motion. The reasoning for the Court's decision follows.[1]

         II. BACKGROUND

         The following material facts are undisputed unless otherwise noted:

         A. Simmons' Dental Practice

         Dr. Simmons, who is currently 67 years old, has a dental practice in the Seattle area. The practice consists of two offices, one in Seattle and one in Bellevue. Dkt. No. 40, Ex. C at 8:12-20; Dkt. No. 43, Ex. D 6:14-25, Ex. C at 8:17-19. Simmons works four days a week from 8:00 a.m. to 5:00 p.m. Dkt. No. 40, Ex. C at 18:11-28. He typically works three days in the Seattle clinic and one day in the Bellevue clinic. Dkt. No. 42, Ex. D 8:22-9:3. His wife, Anna Simmons, manages the dental practice. Dkt. No. 43, Ex C at 7:2-6.

         Simmons' practice is a “general dentistry practice, ” meaning that he performs “typical dental procedures [including] crown, bridge, cleanings, hygiene, operative dentistry, surgery [and orthodontics].” Dkt. No. 43, Ex. D 8:1-17. He also treats patients with craniofacial and temporomandibular (“TMD”) pain disorders and sleep apnea. Dkt. No. 40, Ex. C at 8:12-20, Dkt. No. 43, Ex. C at 10:10-24, Ex. D at 7:24-26:11; Ex. E at 139:18-140:14. In November 2008, [2] at least a quarter of Simmons' dental practice was devoted to treating craniofacial pain and he was trying to “grow that component of [his] practice.” Dkt. No. 43, Ex. D 11:13-19, 12:3-16; Dkt. No. 52, Dkt. No. 52, Ex. I at 49:5-9.

         B. The Disability Insurance Policy

         Simmons obtained a disability insurance policy (the “Policy”) from Paul Revere in 1984. Dkt. No. 43, Ex. A. The Policy provides both total disability and residual disability benefits and defines them as follows:

         1.10 “Total Disability” means that because of Injury or Sickness:

a. You are unable to perform the important duties of Your regular occupation; and
b. You are not engaged in any other gainful occupation; and
c. You are under the regular and personal care of a Physician.

         1.11 “Residual Disability” means that because of Injury or Sickness:

a. (1) You are unable to perform one or more of the important duties of Your regular occupation; or
(2) You are unable to perform the important duties of Your regular occupation for more than 80% of the time normally required to perform them; and
b. You are engaged in Your regular occupation or another occupation and Your Monthly Earnings are reduced to 80% or less of Your Prior Earnings; and
c. You are under the regular and personal care of a Physician.

Dkt. No. 40, Ex. A ¶¶ 1.10 and 1.11.

         Simmons paid extra for a provision entitled “Total Disability in Your Occupation Benefit Rider” (the “Rider”). Id. at 25. The Rider deleted the foregoing definition of total disability and replaced it with the following:

         “Total Disability” means that because of Injury or Sickness:

a. You are unable to perform the important duties of Your regular occupation; and
b. You are under the regular and personal care of a Physician.

Id. In other words, the Rider eliminates the “You are not engaged in any other gainful occupation” language from the definition of “Total Disability.” The Rider further states that “[a]ll definitions in Your Policy apply to this rider. All provisions of Your Policy ...


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