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Metropolitan Life Insurance Co. v. Ogandzhanova

United States District Court, D. Arizona

May 27, 2014

Metropolitan Life Insurance Company, a New York corporation, Plaintiff/Counter-Defendant,
v.
Inna Ogandzhanova, M.D., Defendant/Counter-Claimant.

ORDER

G. MURRAY SNOW, District Judge.

Pending before the Court are Plaintiff's Motion for Summary Judgment (Doc. 280) and Defendant's Motion for Summary Judgment (Doc. 282). For the following reasons, Plaintiff's Motion is granted in part and denied in part and Defendant's Motion is denied.

BACKGROUND

This case arises from two disability insurance policies (collectively, the "Policies"). Defendant Dr. Inna Ogandzhanova practiced as a radiation oncologist. (Doc. 283 ("DSOF") ¶ 12.) On March 10, 1999, Dr. Ogandzhanova purchased an individual disability insurance policy (the "1999 Policy") from Plaintiff Metropolitan Life Insurance Company ("MetLife"). (Doc. 1 ¶ 7.) The 1999 Policy provides for the payment of a monthly benefit of $9, 500, plus any applicable cost-of-living adjustments, to Dr. Ogandzhanova if and while she is "totally disabled" under the terms of the policy. ( Id. ¶ 8.) The 1999 Policy defines "total disability" as when, "because of injury or sickness, you are not able to perform the material and substantial duties of your regular occupation (your regular occupation is your usual work when total disability starts), even if you are gainfully employed in another occupation." ( Id. ) The 1999 Policy also states that "[y]ou will not be considered to be totally disabled for any time you are not receiving care by a physician which is appropriate for the condition causing the disability." (Doc. 281-2 at 81.)

Dr. Ogandzhanova moved to Arizona around the year 2000 and established Desert Rose Oncology. (DSOF ¶ 13.) In November 2001, her son was diagnosed with leukemia and began lengthy cancer treatment in Phoenix and Tucson. (DSOF ¶ 19-51.) Dr. Ogandzhanova continued to practice medicine during the course of this treatment. (DSOF ¶ 34.) On March 15, 2006, Dr. Ogandzhanova's son died at age seven from complications caused by his cancer. (DSOF ¶ 52.)

On July 28, 2006, Dr. Ogandzhanova purchased a second individual disability insurance policy from MetLife (the "2006 Policy"). (Doc. 1 ¶ 11.) The 2006 Policy provides for the payment of a monthly benefit of $5, 500, plus any applicable cost-of-living adjustments, to Dr. Ogandzhanova if and while she is "totally disabled" under the terms of the policy. ( Id. ¶ 12.) The 2006 Policy defines "totally disabled" or "total disability" as "that due solely to Impairment caused by Injury or Sickness, you are: a. Prevented from performing the material and substantial duties of Your Regular Occupation; and b. Receiving appropriate care from a Physician who is appropriate to treat the condition causing the Impairment." (Doc. 281-2 at 132.)

Dr. Ogandzhanova continued to practice as a radiation oncologist following her son's death. (Doc. 315 ("PCSOF") ¶ 69.) In the fall of 2006, she claims she began to experience symptoms of depression and panic attacks, but continued to practice full-time. (DSOF ¶ 97.) In January 2007, she began to see Dr. Rozansky, a psychiatrist in Los Angeles. (DSOF ¶ 103.) Dr. Ogandzhanova claims that Dr. Rozansky diagnosed her with Post-Traumatic Stress Disorder ("PTSD"), depression, and complicated grief. (DSOF ¶ 116.) Dr. Ogandzhanova continued to work at Desert Rose Oncology until she sold the practice on March 12, 2007. (Doc 281-1 at 173.) Dr. Ogandzhanova asserts that in June 2007, Dr. Rozansky suggested it might better for her mental health if she did not continue practicing radiation oncology (DSOF ¶ 125), but MetLife disputes this claim as unsupported by Dr. Rozansky's treatment records (PCSOF ¶ 125).

In early June 2007, Dr. Ogandzhanova gave notice to MetLife of her intention to file a disability claim. (DSOF ¶ 130.) On or around September 14, 2007, Dr. Ogandzhanova's counsel submitted a formal claim package to MetLife. (DSOF ¶ 150.) In her application, Dr. Ogandzhanova claimed she was disabled from her occupation of radiation oncologist as of March 13, 2007 due to depression, anxiety, and panic attacks. (Doc. 1 ¶ 23.) MetLife requested Dr. Ogandzhanova's medical records and began to evaluate her claim. ( Id ¶ 25.) This investigation included a review of the treatment notes of Dr. Ogandzhanova's medical providers and an independent medical examination ("IME") by neuropsychologist Dr. David Lamb.

In a letter dated April 22, 2008, MetLife accepted Dr. Ogandzhanova's claim without reservation. (Doc. 1 ¶ 29.) Pursuant to the Policies, MetLife continued to evaluate Dr. Ogandhzanova's condition to verify her continuing eligibility for benefits. This included a psychiatric IME by psychiatrist Dr. Joel Parker on September 21, 2010 and a second neuropsychological evaluation by Dr. Lamb, conducted on March 2 and 8, 2011. (Doc. 1. ¶ 35.) On June 2, 2011, Dr. Parker supplemented his earlier report after reviewing additional data, including Dr. Lamb's second IME report and a November 2011 letter from Dr. Rozansky. (Doc. 1 ¶ 37.) On June 8, 2011, Dr. Kaplan reviewed the file and determined that the documentation did not support that Dr. Ogandzhanova was unable to work as a radiation oncologist. (Doc. 1 ¶ 38.) Based on the totality of information, MetLife determined that Dr. Ogandzhanova was no longer disabled under the Policies. (Doc. 281 ("PSOF") ¶ 1.) On June 27, 2011, MetLife advised Dr. Ogandzhanova's counsel by telephone that MetLife had completed its review and found that she had no restrictions or limitations that would prevent her return to practice as a radiation oncologist. (Doc. 1 ¶ 39.) On July 1, 2011, MetLife sent a letter to Dr. Ogandzhanova's counsel, stating that "[r]egarding the current status of the claim, based upon the totality of information reviewed, we do not find that Dr. Ogandzhanova is experiencing any restrictions and limitations as a result of her claimed psychiatric condition, and we firmly believe this finding is supported by the independent and objective testing carried out by Drs. Parker and Lamb, as well as in the opinions offered by our consulting psychiatrist and neuropsychologist." (Doc. 281-2 at 74.) The letter went on to state that MetLife had provided copies of Dr. Parker's and Dr. Lamb's reports to Dr. Rozansky and invited feedback on those reports. ( Id. ) MetLife explained that while it found that Dr. Ogandzhanova had no current restrictions "we want to afford Dr. Ogandzhanova the opportunity to provide us with any additional information to consider in our review" including "details of any other treatment she is receiving or doctor that she is seeing." ( Id. )

On February 22, 2012, MetLife filed the present action seeking a declaratory judgment that, as of July 1, 2011, Dr. Ogandzhanova was not disabled as defined by the Policies and thus that MetLife is entitled to recover all benefits paid since that date. (Doc. 1.) MetLife has continued to pay Dr. Ogandzhanova the full amount of benefits owed under the Policies during the course of this action. (PSOF ¶ 3; Doc. 313 ("DCSOF") ¶¶ 2, 3.) In her Answer to the Complaint, Dr. Ogandzhanova asserted a counterclaim alleging that MetLife has breached the implied duty of good faith and fair dealing by deciding that she is no longer entitled to benefits, by filing the instant declaratory judgment action, and by seeking repayment of benefits since July 2011. (Doc. 8.) MetLife now moves for summary judgment both on its declaratory judgment claim and on Dr. Ogandzhanova's counterclaim. (Doc. 280.) Dr. Ogandzhanova now moves for summary judgment on MetLife's declaratory judgment claim. (Doc. 282.)

DISCUSSION

I. Legal Standard

Summary judgment is appropriate if the evidence, viewed in the light most favorable to the nonmoving party, demonstrates "that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). "[A] party seeking summary judgment always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986).

Substantive law determines which facts are material and "[o]nly disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). "A fact issue is genuine if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.'" Villiarimo v. Aloha Island Air, Inc., 281 F.3d 1054, 1061 (9th Cir. 2002) (quoting Anderson, 477 U.S. at 248). Thus, the nonmoving party must show that the genuine factual issues "can be resolved only by a finder of fact because they may reasonably be resolved in favor of either party.'" Cal. Architectural Bldg. Prods., Inc. v. Franciscan Ceramics, Inc., 818 F.2d 1466, 1468 (9th Cir. 1987) (quoting Anderson, 477 U.S. at 250). Because "[c]redibility determinations, the weighing of the evidence, and the drawing of legitimate inferences from the facts are jury functions, not those of a judge, ... [t]he evidence of the nonmovant is to be believed, and all justifiable inferences are to be drawn in his favor" at the summary judgment stage. Anderson, 477 U.S. at 255 (citing Adickes v. S.H. Kress & Co., 398 U.S. 144, 158-59 (1970)). Furthermore, the party opposing summary judgment "may not rest upon ...


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