Martin v. Berkshire Life Insurance Company of America
- Jesse Furman
- 1:20-cv-10428
- U.S. District Court · Southern District of New York
- 5
In Martin v. Berkshire, Judge Furman granted summary judgment on OED-policy claims but denied it on Martin’s other disability-insurance claims.
Denny Martin’s claims under the three Overhead Expense Disability policies were resolved against him on summary judgment; his other disability-insurance claims were not resolved by this order and remained subject to further proceedings.
What happened
In Martin v. Berkshire Life Insurance Company of America, Denny Martin sought benefits under eight disability-insurance policies after claiming that neurological disorders prevented him from working. Berkshire argued that his inability to work resulted instead from an arrest and release order that barred him from submitting Medicare and Medicaid claims.
The court found factual disputes about Martin’s occupation, whether the release order prevented him from performing his job duties, and whether his medical disability began before that order. But it ruled that the three Overhead Expense Disability policies did not cover expenses incurred after Martin’s medical practices stopped operating.
Judge Jesse M. Furman granted Berkshire’s summary-judgment motion on the Overhead Expense Disability claims and otherwise denied the motion. The remaining claims were set to proceed toward pretrial proceedings.
The detailed version
- Martin v. Berkshire Life Insurance Company of America · No. 1:20-cv-10428
- Jesse Furman
- Jan. 31, 2023
Background
Denny Martin, a licensed neurosurgeon and owner of several medical practices in New York, held eight disability-insurance policies issued by Berkshire Life Insurance Company of America: five Individual Disability policies and three Overhead Expense Disability policies. In October 2019, Martin submitted a claim asserting that trigeminal neuralgia and cervical myelopathy prevented him from working. Berkshire denied the claims.
Berkshire moved for summary judgment under Federal Rule of Civil Procedure 56. Summary judgment is appropriate when the evidence shows that there is no genuine dispute about an important fact and the moving party is entitled to judgment as a matter of law. Berkshire argued that Martin’s inability to work resulted from a “legal disability”—his September 2019 arrest and a release order barring him from submitting claims to Medicaid and Medicare—rather than from his neurological conditions. Berkshire also argued that the Overhead Expense Disability claims failed because Martin did not incur covered expenses while continuing to operate his businesses.
Court’s Analysis
The court denied summary judgment on Berkshire’s broader argument concerning Martin’s inability to work. The court identified factual disputes about Martin’s occupation under the policies, including whether it was being a doctor or a medical director; whether the release order prevented him from performing the material and substantial duties of that occupation; and whether any factual disability began before the release order. The court stated that these disputes could not be resolved on summary judgment, which is not a stage at which the court weighs evidence or resolves factual disagreements.
The court reached a different conclusion regarding the Overhead Expense Disability policies. Those policies covered normal, necessary, and customary expenses incurred and paid in the continued operation of Martin’s business. The court concluded that no reasonable jury could find that Martin’s businesses continued operating in October 2019, when he submitted his claims. Martin had stated in affidavits that he was compelled to close his medical practice, said that he had no income, described the practice as “phasing out,” and conceded that his entities had stopped providing medical care to patients.
The court held that the businesses’ continued legal existence and expenses such as rent or loan interest did not change the result. Because the businesses were no longer in continued operation when the expenses were incurred, the expenses were not reimbursable under the Overhead Expense Disability policies.
Disposition
Judge Jesse M. Furman granted Berkshire’s motion for summary judgment with respect to Martin’s claims under the Overhead Expense Disability policies, but otherwise denied the motion. The parties were directed to submit a proposed joint pretrial order and related materials within 45 days, unless the court ordered otherwise. The court also directed the parties to confer about settlement.
Read the full 5-page opinion on CourtListener, the free public archive maintained by the Free Law Project.