• Insured’s Refusal to Participate in IME, When Required by Contract, Negates Insurer’s Obligation to Provide Benefits
  • July 25, 2013
  • Law Firm: Semmes Bowen Semmes A Professional Corporation - Baltimore Office
  • Curry v. Trustmark Ins. Co., No.: 11-cv-2069-JKB (Maryland District Court, July 15, 2013)

    On July 15, 2013, Judge Bredar granted this motion for summary judgment, dismissing the Plaintiff’s claims for breach of contract. Clarifying the nature of contractual obligations to provide disability insurance, the court found that many of Plaintiff’s claims were time barred by the statute of limitations, with the remaining claims barred by the Plaintiff’s refusal to attend an Independent Medical Evaluation, as requested by Trustmark Insurance Co. (‘Trustmark’), and required under the policy.

    This suit arose from a dispute between an insured, Curry, and Trustmark regarding disability benefits. Curry, a chiropractor, purchased the insurance policy in 1989. Thereafter he was injured while performing chiropractic services on November 25, 2003. Curry required surgery as a result of this injury and was unable to work afterwards. Under the policy, Curry was required to provide continuing proof of his disability and to submit to a reasonable number of independent medical evaluations (‘IME’) as requested by the insurer. The insurer, in turn, was required to provide monthly benefit payments to the insured while he remained disabled.

    From 2004 until July 2007, Trustmark paid disability benefits to Curry, who provided certain information concerning his physical condition and loss of income. After July however, Trustmark ceased making these monthly payments, and the parties continued to exchange correspondence. On January 9, 2008, Curry wrote a letter to Trustmark complaining that they had failed to provide monthly payments to him as required under the policy, and again on April 17, 2008, Curry reiterated this complaint in another letter. In response, on April 22, 2008, Trustmark informed Curry that they would pay his benefits under the policy through September 25, 2007, and requested he undergo an IME. Because Trustmark was already months overdue in payments to Curry, he refused to attend this exam. On July 31, 2008, Trustmark informed Curry that his claim was not closed, but they could not accept continuing liability, and then on September 29, 2008, Trustmark informed Curry his claim was closed.

    Curry filed his complaint, alleging breach of contract by Trustmark through these actions, on July 27, 2011. The statute of limitations for contract claims is three (3) years, so all claims that accrued before July 27, 2008 were barred by the statute of limitations. The Court considered each monthly payment that was due and unpaid a separate breach of contract action, each of which accrued on the day it was due to the insured. Thus, the claims for payments due after July 27, 2008 were timely.

    Under the contract, the Plaintiff was required to provide continuing proof of his disability and undergo IMEs, “as often as reasonably necessary.” Id. at 2. The insurer requested the Plaintiff undergo an IME on April 22, 2008, and again on June 5. Plaintiff chose not to attend these exams because the insurer was delinquent in payment of benefits owed; however, since each monthly payment that was due and not paid constituted a separate breach of action, Curry’s act of refusing to comply with his obligations under the policy negated Trustmark’s continuing obligations as well. The Court concluded that Trustmark acted within their contractual rights when they denied benefits after Curry failed to attend the IME. Furthermore, no reasonable jury could conclude that the insurer’s request for an IME, the first such request, which was made after they paid benefits for nearly three (3) years, was an unreasonable demand. Under these circumstances, Curry failed to raise a genuine dispute of material fact, and the trial court properly granted Trustmark’s Motion for Summary Judgment, according to the appellate court.