Recently, in the case of Steven J. Kravitz v Provident Life & Accident Insurance Company (Provident Life), an action alleging breach of a disability insurance contract and promissory estoppel was filed at the District Court of the Southern district of Florida by a disability attorney. This lawsuit deals with the issue of whether a disability was caused by an accident or sickness. In this case if the claimant can prove that his disability was caused by an accident, then he will be entitled to lifetime disability benefits.
Background of the Case
The plaintiff Steven J. Kravitz was a former leading real estate attorney who purchased a disability income insurance policy from Provident Life which had became effective on July 1st 1980. Under the terms of the policy, total disabilitycan result from an accident or sickness. The terms of the policy also indicated that if an insured was to suffer from a Sickness Total Disability prior to age 50, or an Accident Total Disability, the maximum period for which the disability benefits will be paid out will be the insured’s lifetime. For a Sickness Total Disability that occurred after age 50, the maximum period for the disability benefits to be payable will be until the insured’s 65th birthday. It was also stated that not less than 24 months of benefits will be paid out to the insured in the case of the second scenario.
In December 1996, the plaintiff received a flu vaccination which caused him to be totally disabled from his occupation due to chronic inflammatory demyelinating polyneuropathy (CIDP), a variant of Guillain-Barre syndrome (GBS). At the time when the plaintiff was diagnosed with CIDP, he was unaware that the flu vaccination was a rare cause of GBS. In 1998, due to further deterioration of his physical condition, the plaintiff was unable to work and submitted to Provident Life a claim for long term disability benefits. Provident Life determined that the plaintiff was totally disabled under the terms of the policy as of April 1st 1998 and approved the plaintiff’s claim for disability benefits. Since then, the plaintiff has remained totally disabled as defined under the terms of the policy.
Offer to buyout insurance policy by Provident Life
On April 1st 2005, Provident Life while in the administration of the plaintiff’s disability claim offered to buyout the plaintiff’s policy bundled with the plaintiff’s two other disability polices administered by Provident Life parent company, UNUM. In the letter dated April 1st 2005 informing the plaintiff of the offer, Provident Life also indicated that the plaintiff was entitled to receive lifetime benefits under the policy. Prior to this letter, Provident Life had never informed the plaintiff whether it was administrating the plaintiff’s disability claim under a sickness disability or an accident disability.
Because Provident Life had indicated that the plaintiff was entitled to a lifetime of benefits, he rejected the buyout offer made by Provident Life. Provident Life then informed the plaintiff on July 9th 2010 that his benefits under the policy would terminate on April 1st 2011 (at age 65 instead of lifetime benefits).
The plaintiff subsequently reminded Provident Life of its prior representation that the plaintiff was entitled to lifetime benefits. In addition, the plaintiff provided medical statements from his physicians that his disability was accidental due to the flu vaccination he received in December 1986. On October 14th 2010, the plaintiff filed a Civil Remedy Notice to the Florida Department of Financial Services about Provident Life’s refusal to pay lifetime benefits to the plaintiff under the policy.
Provident Life in response to the Civil Remedy Notice argued that its prior representation of lifetime benefits to the plaintiff was a “mistake” as a result of an “administrative error”. Although Provident Life’s internal medical review had also indicated that the plaintiff’s disability could had been caused by the flu vaccination, Provident Life still maintained that the plaintiff was disabled due to sickness and as such limited the payment of disability benefits to the insured until the insured’s 65th birthday. Subsequently Provident Life terminated the plaintiff’s benefits on April 1st 2011.
Judgment sought under the Lawsuit
In the action filed against Provident Life in the District Court, the plaintiff alleged that he had suffered damages due to the conduct by Provident Life. As such, the plaintiff is demanding from Provident Life:
- Payment of unpaid benefits
- Prejudgment interest
- Attorney fees and costs
- Other relief deemed proper by the court
- That Provident Life be prevented from asserting that the plaintiff’s disability is a result of sickness for which disability benefits are payable until the insured had reached the age of 65 as this would represent an injustice upon the plaintiff as he had relied upon Provident Life’s representation of lifetime disability benefits.