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Madden v. National Life Insurance Co.

United States District Court, M.D. Florida, Fort Myers Division

August 30, 2019


          OPINION AND ORDER [1]


         This matter comes before the Court on Defendant's Motion to Dismiss Amended Complaint (Doc. 19) filed on July 15, 2019. Plaintiff filed a Response in Opposition (Doc. 27) on August 12, 2019. For the reasons set forth below, the Motion is denied.


         This case involves a single claim for breach of contract in which Plaintiff Christine P. Madden[2], a retired chiropractor, alleges that her disability insurance company, National Life Insurance Company (National Life), improperly denied her total disability benefits due under a disability insurance policy. The Court recounts the factual background as pled in Plaintiff's Amended Complaint, which it must take as true to decide whether the Amended Complaint states a plausible claim. See Chandler v. Sec'y Fla. Dep't of Transp., 695 F.3d 1194, 1198-99 (11th Cir. 2012).

         Madden, while living in Georgia, purchased an individual disability income insurance policy from National Life, Policy No. D2163414, effective January 14, 1991 (the Policy). (Doc. 8 at ¶ 8; Doc. 8-1). The Policy provides a monthly benefit if Madden becomes totally disabled from her occupation. (Doc. 8 at ¶ 9).

         Prior to her disability, Madden was a dermatologist operating her practice near Atlanta, Georgia. (Doc. 8 at ¶ 13). She suffers from cervical disc disease and torticollis, which causes her head to tilt and turn to the left, as well as muscle spasms and pain in her neck. (Doc. 8 at ¶ 14). Madden had surgery for her condition in 2013 and as of March 19, 2013, she was unable to return to her dermatology practice. (Doc. 8 at ¶ 17). It is on this date that Plaintiff alleges she became totally disabled under the terms of the Policy.

         Madden reported her disability to National Life on April 15, 2013, when she spoke to a National Life representative. As a result of that conversation, Madden understood that she would not be eligible for benefits under the Policy. (Doc. 8 at ¶ 19). That same day, National Life sent Plaintiff a letter enclosing forms to be completed for her disability claim. (Doc. 8 at ¶ 20). Madden did not receive the claim forms, nor would she have completed them, since she had been advised by National Life that her claim would not be viable. (Doc. 8 at ¶ 21).

         On or about June 26, 2013, Madden wrote to National Life requesting cancellation of the Policy, as she did not want to continue paying premiums for ineffective coverage. The Policy states that the termination became effective on July 14, 2013. (Doc. 8-1). Madden had no reason to abandon her claim at that time if she believed it was viable, since she was still disabled and expected that her condition was permanent. (Doc. 8 at ¶ 22).

         In early 2015, Madden contacted National Life to request a copy of her Policy so she could determine whether to renew her disability claim, but National Life did not provide it. (Doc. 8 at ¶ 23). In November 2015, after several exchanges, National Life agreed to reopen Madden's claim but still failed to produce a copy of the Policy. (Doc. 8 at ¶ 24). On or about February 29, 2016, National Life produced a copy of the Policy to Madden's counsel. (Doc. 8 at ¶ 25).

         Madden resubmitted her claim to National Union on or about February 7, 2017 which National Union denied on or about July 24, 2017. (Doc. 8 at ¶¶ 26-27). Madden submitted an appeal to National Life on October 30, 2018 after gathering and preparing information to respond to the concerns raised in National Life's denial letter. (Doc. 8 at ¶ 28). National Life has upheld its decision. (Doc. 8 at ¶¶ 29-31).

         National Life moves to dismiss for failure to state a claim, arguing that because Plaintiff breached the contract herself, she cannot recover, and that Plaintiff's claims are implausible.


         When considering a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), the court must accept all factual allegations as true and view them in a light most favorable to the plaintiff. See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). This consideration is limited “to the pleadings and exhibits attached thereto[.]” Grossman v. Nationsbank, N.A., 225 F.3d 1228, 1231 (11th Cir. 2000). However, a complaint listing mere “labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Bell Atl. Corp. v. Twombly, 550 U.S. 554, 555 (2008). Likewise, “[f]actual allegations that are merely consistent with a defendant's liability” are insufficient. Chaparro v. Carnival Corp, 693 F.3d 1333, 1337 (11th Cir. 2012) (internal citations omitted). And the allegations must not force the court to speculate or operate on mere suspicion. Twombly, 550 U.S. at 555. In contrast, the Court will not dismiss a complaint where the Plaintiff pleads facts that make the claim facially plausible. SeeTwombly, 550 U.S. at 570. A claim is facially plausible when the court can draw a reasonable inference, based on the facts pleaded, that the opposing party is liable for the alleged misconduct. See Iqbal, 556 U.S. at 678. This plausibility standard ...

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