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UNITED STATES DISTRICT COURT DISTRICT OF MARYLAND
Chambers of BENSON EVERETT LEGG United States District Judge 101 West Lombard Street Baltimore, Maryland 21201 410-962-0723

January 24, 2011
TO COUNSEL OF RECORD RE: Antonio Medina v. Provident Life and Accident Insurance Company Civil Action No. L-10-3146

Dear Counsel: This case arises out of a decision by Defendant, Provident Life and Accident Insurance Co. ("Provident"), to award Plaintiff, Dr. Antonio Medina, only "residual disability" benefits, rather than the total disability benefits to which he believes he is entitled under a policy he purchased in 1989. Dr. Medina requests a declaratory judgment stating that he is eligible for total disability benefits, subject to the continuing eligibility requirements of the policy. Dr. Medina originally filed this action in the Circuit Court for Baltimore County, and on November 5, 2010 Provident removed the action to this Court. On November 23, 2010, Dr. Medina filed the Motion to Remand now before the Court. Docket No. 16. The Court has carefully reviewed the papers and has determined that supplemental briefing is necessary.

I.

BACKGROUND Dr. Medina is an orthopedic surgeon. Since 1989, he has held a disability income policy

written by Provident, designated policy # 46-00198476, pursuant to which he paid additional annual premiums for "pure definition" disability coverage, as opposed to the more standard "basic definition" coverage.1 According to the terms of the policy, one is totally disabled under
1

The instant suit apparently does not implicate a related Overhead Expense Disability Policy, also written by Provident, designated policy # 00198475.

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either definition when, because of injury or sickness, one cannot perform the substantial and material duties of one's "regular" occupation. The difference between the two is that under "basic definition" coverage, the insured may not be engaged in any other occupation, in addition to his or her "regular" occupation. "Pure definition" coverage does not contain this restriction. The Complaint alleges that, beginning in 2000, Dr. Medina suffered occasional but recurrent attacks of vertigo and dizziness. The attacks grew increasingly severe, causing Dr. Medina to cease emergency room work in 2004 and to discontinue performing surgery altogether in 2007. Dr. Medina continued, however, in his practice of performing file reviews for the Social Security Administration. He maintains that, prior to closing his medical practice, this work constituted a minority of both his professional time and professional income. In June of 2007, Dr. Medina applied for total disability benefits under the terms of the policy purchased from Provident. Provident initially classified Dr. Medina as "residually disabled," a condition which entitles the policyholder only to a percentage of total disability benefits, calculated based on the policyholder's income. According to Dr. Medina, these payments continued through August of 2010 while Provident continued to evaluate his claim. By a letter dated August 31, 2010, Provident informed Dr. Medina that it had completed a third appeal review of his claim for total disability benefits and decided to deny total disability. According to Provident, in prior years Dr. Medina's income from Social Security work was actually greater than his income from his orthopedic surgery practice. It accordingly defined his "regular" occupation as both orthopedic surgeon and consultant, and determined that he was still able to perform a portion of his material and substantial duties, namely the Social Security case reviews.

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Dr. Medina contends that this decision deprives him of the additional premiums he paid for "pure definition" disability coverage. He presumably reasons that Provident's decision to treat the Social Security work as part of his "regular" occupation puts him in the same position he would be in had he purchased only "basic definition" coverage, under which any additional occupation, regular or not, would foreclose the award of total disability benefits. Dr. Medina therefore seeks a declaration that he is totally disabled under the terms of the policy. Following the filing of Dr. Medina's Complaint, Provident removed the action from the Circuit Court for Baltimore County to this Court. Dr. Medina then filed the instant Motion to Remand, arguing that Provident has failed to satisfy its burden of showing that the amount in controversy exceeds the statutory jurisdictional amount.

II.

LEGAL STANDARD Provident's removal is governed by 28 U.S.C.

Download Antonio Medina v. Provident Life and Accident Insurance Company.pdf

Maryland Law