Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_03-cv-00068/USCOURTS-caed-2_03-cv-00068-13/pdf.json

Parties Involved:
Massachusetts Mutual Life Insurance Company
Defendant
Marcia Starr-Gordon
Plaintiff

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UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

MARCIA STARR-GORDON,

NO. CIV. S-03-68 LKK/GGH

Plaintiff,

v.

MASSACHUSETTS MUTUAL LIFE O R D E R

INSURANCE COMPANY, a

Massachusetts corporation,

Defendant.

 /

Plaintiff Marcia Starr-Gordon alleges that she suffered an

injury to her right shoulder and lower back that forced her to

stop working as a dental hygienist. Defendant Massachusetts

Mutual Life Insurance Company (“MassMutual”) terminated her

claim for disability benefits. In response, plaintiff brought a

claim alleging eight causes of action: (1) violation of the

California Unfair Competition law, (2) breach of contract, (3)

breach of the implied covenant of good faith and fair dealing

(bad faith), (4) intentional misrepresentation, (5) negligent

misrepresentation, (6) intentional infliction of emotional

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distress, (7) negligent infliction of emotional distress and (8)

declaratory relief. MassMutual now moves for summary judgment

with respect to counts one through seven of plaintiff’s

complaint. The court resolves the matter based on the parties’

papers and after oral argument.

I. Facts1

Defendant issued a disability insurance policy to plaintiff

in 1991. The policy provided plaintiff with monthly income and

waiver of premium benefits if plaintiff became disabled. A

“disability” was defined in the policy as:

an incapacity of the insured which 1) is due to injury

or sickness; and 2) begins while this Policy is in

force, and 3) requires care by or at the discretion of

a legally qualified physician, unless we are furnished

with proof, satisfactory to us, that future care would

be of no use; and 4) reduces the insured’s ability to

work and 5) causes loss of earned income.

Decl. of Robert Pohls (“Pohls Decl.”) ¶ 2, Ex. 2.

A. Plaintiff’s Alleged Disability

In early December of 2000, plaintiff notified defendant of

her disability claim. She claimed that, due to the repetitive

nature of her job, she had injured her right shoulder and lower

back. At the time, plaintiff was working part-time as a dental

hygienist in her husband’s dental office. Defendant then sent

plaintiff the necessary forms required for processing her claim,

including an Occupational Description, a Disability Income

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Claimant’s Statement (the “Statement”), and an Attending

Physician Statement (“APS”), which was to be completed by her

doctors.

In January of 2001, plaintiff submitted the completed

Statement and the Occupational Description. She claimed that

she was partially disabled beginning on January 7, 2000, when

she reduced her work schedule from three to two days a week, and

that she became totally disabled on December 28, 2000, when she

stopped working altogether. In her income statement, plaintiff

complained that she was unable to lift her right arm for “any

length of time.” Pohls Decl. ¶ 5, Ex. 4.

In the above-referenced documents, plaintiff specified that

her duties at work included: cleaning teeth, scaling, probing,

polishing, x-rays, and root planing. She indicated that her

duties also required standing, reaching, walking, pushing,

balancing, sitting, bending, and lifting ten pounds or less. 

She described her daily activities since the alleged disability

as “[h]ousehold chores not involving right arm and back.” Id.

According to the APS submitted by plaintiff’s chiropractor,

Dr. Patterson, plaintiff suffered from “thoracic subluxation and

degenerative shoulder disease.” Pohls Decl. ¶ 6, Ex. 5. Dr.

Patterson reported that plaintiff’s symptoms first appeared on

January 22, 1999. He indicated that plaintiff was unable to

work from January 7, 2001, and that she had “difficulty lifting

her right arm with pain, especially after repetitive motions

that preclude[d] right upper extremity movement.” Id. 

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Moreover, he determined that the condition was likely to be

permanent. Id. In a letter dated March 14, 2001, Dr.

Patterson’s office sent defendant a letter indicating that there

was a typographical error in his original APS and that

plaintiff’s disability began in January 2000, rather than

January 2001, as previously indicated.

Dr. Hughes, plaintiff’s treating orthopedist, also

submitted an APS to defendant on January 5, 2001. He concluded

that plaintiff was able to work with limitations, but was

permanently disabled as a dental hygienist. Id. Subsequently,

treatment notes received from Dr. Hughes showed that on January

24, 2001, plaintiff “had what appears to be an optimistic result

from the steroid injection on her right shoulder.” Pohls Decl.

¶ 10, Ex. 9. These notes stated that “[t]he pain in

[plaintiff’s] shoulder is basically minimal particularly after

the steroid injection . . . Back pain is minimal. She stopped

taking Celebrex and will be taking Advil.” Id.

B. Defendant’s Investigation

1. Pre-Termination Activities

On January 30, 2001, defendant wrote plaintiff informing

her of the need for additional information since plaintiff

sought coverage for partial disability dating back one year

prior to the date she submitted her claim. On March 8, 2001,

defendant informed plaintiff that, although Dr. Patterson

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At this time, Dr. Patterson’s office had not yet sent 2

defendant the letter correcting the start date of plaintiff’s

partial disability from January 2001 to January 2000. This letter

was sent March 14, 2001, six days later.

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certified plaintiff’s disability as of January 2001, additional 2

information was necessary to substantiate her claim for partial

disability beginning in January 2000.

In March 2001, Dr. Hacker, a chiropractor and member of

MassMutual’s medical and vocational department, reviewed

plaintiff’s claim file and concluded that although “Ms. Starr

may have incurred some restrictions and limitations on her right

shoulder/lower back activity beginning about December 18, 2000,”

he needed additional information from plaintiff’s doctors to

better assess plaintiff’s injuries. Pohls Decl. ¶ 12, Ex. 11. 

Dr. Hacker’s assessment pointed out that Dr. Patterson had seen

plaintiff 55 times between 1999 and 2001, but that none of Dr.

Patterson’s treatment notes were included in the materials Dr.

Hacker had for review.

Defendant subsequently requested treatment notes from Dr.

Patterson relating to the period that plaintiff claimed partial

disability. Defendant was told that Dr. Patterson did not have

treatment notes but that he would provide a narrative, which

defendant requested. Dr. Patterson then sent defendant a onepage medical narrative, which plaintiff concedes did not provide

specific information regarding his treatment during plaintiff’s

period of partial disability.

Shortly thereafter, Darci Stevens, defendant’s disability

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claims representative, authorized surveillance of plaintiff to

determine the extent of her injuries. However, by letter dated

July 10, 2001, defendant accepted plaintiff’s disability claim

under a reservation of rights, retroactive to December 18, 2000.

The letter stated, “you are claiming total disability but it

appears as though you may have some capacity to work. . . . [W]e

are continuing to investigate your claim.” Pohls Decl. ¶ 16,

Ex. 15. With regard to plaintiff’s alleged partial disability,

defendant stated that it was denying the claim because it was

unable to verify the condition. Id.

Plaintiff’s file was then transferred to Paul Montanari for

active claim management. Montanari requested that plaintiff

submit to a functional capacity evaluation (“FCE”), which would

measure plaintiff’s physical capacity in light of her claimed

restrictions and limitations. Defendant scheduled an FCE for

plaintiff, which was to take place in September 2001. However,

plaintiff indicated that she would not submit to an examination

unless it was performed by a medical doctor, rather than a

physical therapist.

Meanwhile, the surveillance commissioned by defendant

captured plaintiff engaging in the following activities:

• sweeping her driveway while using her right arm to

sweep and her left arm to hold a dustbin

• jogging up her sidewalk after emptying a dustbin in

the lot next door

• reaching above her head with her right hand to lift an

ice chest off the top of a refrigerator and bending to

place it on the floor

• lifting an ice chest to carry it across her garage

• jumping over her garage door sensor

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• running down her driveway

• carrying groceries with both arms, picking them up out

of her shopping cart and loading them in and out of

her car

• holding a wireless phone between her head and neck,

while using both arms to unload groceries from her car

• installing a car seat in her car, bending over to pick

up a child, and lifting the child into her car

• strapping the child into a car seat using both arms,

while twisting and bending as necessary to talk to a

nearby neighbor, and

• carrying the child on her left hip 

Montanari Dep., Pohls Decl. ¶ 17, Ex. 16.

On October 8, 2001, Montanari submitted the surveillance

reports to Dr. Feingold, a physiatrist hired by defendant as an

outside expert consultant. Based on these reports, Dr. Feingold

concluded, “The surveillance reviewed fails to document any of

the impairments that the insured is reported to have. Overall

the visual impression of the patient is of a healthy and

physically active woman with no particular limitations in the

upper extremity abilities.” Pohls Decl. ¶ 20, Ex. 19. 

Plaintiff argues that the report is misleading, in that it

assumes facts not in evidence, and that it “speaks for itself,”

but offers no further explanation. Pl.’s Response to Def.’s SUF

¶ 38.

2. Post-Termination Activities

On December 14, 2001, defendant sent a letter notifying

plaintiff that she would no longer be receiving disability

benefits. The letter stated that her policy was being placed

back on premium paying status, because defendants’ review of

plaintiff’s activities and her medical records did not support

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the claimed restrictions and limitations. Plaintiff’s counsel

notified defendant that plaintiff wished to appeal defendant’s

decision.

In a letter dated December 28, 2001, defendant communicated

to plaintiff’s counsel that it would “look forward to receiving

any information you may submit that will help us better

understand her claimed limitations and restrictions.” Pohls

Decl. ¶ 27, Ex. 26. Defendant did not receive additional

records from plaintiff until October 11, 2002. Upon receipt of

additional documents, defendant asked Dr. Feingold to review

plaintiff’s updated claim file. Dr. Feingold concluded that:

The medical records to date do not show any change in

the patient’s medical condition. . . . The types of

activities that were described as causing her

difficulty at work are similar in part to activities

she was seen doing in day-to-day activities of daily

living, based on her surveillance. It is not clear

whether she does or does not have pain in her right

shoulder, but it does appear she is not obtaining

active medical care for this, nor is she particularly

restricted in the daily activities, as documented on

her surveillance.

Pohls Decl. ¶ 23, Ex. 22. Plaintiff, however, notes that these

additional documents did not include the 2002 medical records

from Dr. Hughes and Dr. Patterson. Feingold Tr. at 155:4-12,

Aff. of Dean Burnick (“Burnick Aff.”) ¶ 7, Ex. 7.

In December 2001, plaintiff claimed that she once again

began to experience intense feelings of anxiety, panic, anger,

mood swings, helplessness, and depression. Her symptoms

increased steadily over time until she found it necessary, in

March 2002, to return to her treating psychiatrist. Since that

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time, plaintiff claims that she has been taking daily dosages of

Celexa, an antidepressant. Despite being on notice about

plaintiff’s psychological condition, Montanari testified that he

did not consider the impact that surveillance actions might have

on plaintiff. Montanari Tr. at 302:10-303:9, Burnick Aff. ¶ 3,

Ex. B. 

Finally, on December 12, 2002, plaintiff filed her

complaint, giving rise to the present action. Since that time,

defendant has obtained an independent medical examination

(“IME”) of plaintiff. In April 2006, Dr. Schiff conducted a

physical examination, which revealed that “there are subjective

complaints without objective foundation” with regard to her neck

and shoulder, and that her back pain would not prevent her from

performing non-heavy labor. Schiff Rep., Pohls Decl. 34, Ex.

33. In May 2006, Dr. O’Brien, a psychiatrist, also examined

plaintiff and reported that individuals with plaintiff’s profile

pattern have an interest in portraying themselves as physically

disabled.

II. STANDARDS

 

Summary adjudication, or partial summary judgment “upon all

or any part of a claim,” is appropriate where there is no

genuine issue of material fact as to that portion of the claim. 

Lies v. Farrell Lines, Inc., 641 F.2d 765, 769 (9th Cir. 1981)

(“Rule 56 authorizes a summary adjudication that will often fall

short of a final determination, even of a single claim”)

(citations omitted); Playboy Enters., Inc. v. Welles, Inc., 78

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F. Supp. 2d 1066, 1073 (S.D. Cal. 1999), aff’d in part, rev’d in

part, on other grounds, 279 F.3d 796 (9th Cir. 2002); E.D. Local

Rule 56-260(f). Under summary judgment practice, the moving

party

always bears the initial responsibility of informing

the district court of the basis for its motion, and

identifying those portions of ‘the pleadings,

depositions, answers to interrogatories, and

admissions on file, together with the affidavits, if

any,’ which it believes demonstrate the absence of a

genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). “[W]here

the nonmoving party will bear the burden of proof at trial on a

dispositive issue, a summary judgment motion may properly be

made in reliance solely on the 'pleadings, depositions, answers

to interrogatories, and admissions on file.” Id. Indeed,

summary judgment should be entered, after adequate time for

discovery and upon motion, against a party who fails to make a

showing sufficient to establish the existence of an element

essential to that party’s case, and on which that party will

bear the burden of proof at trial. See id. at 322. “[A]

complete failure of proof concerning an essential element of the

nonmoving party's case necessarily renders all other facts

immaterial.” Id. In such a circumstance, summary judgment

should be granted, “so long as whatever is before the district

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court demonstrates that the standard for entry of summary

judgment, as set forth in Rule 56(c), is satisfied.” Id. at

323.

If the moving party meets its initial responsibility, the

burden then shifts to the opposing party to establish that a

genuine issue as to any material fact actually does exist. 

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574,

586 (1986); See also First Nat'l Bank of Ariz. v. Cities Serv.

Co., 391 U.S. 253, 288-89 (1968); Secor Limited, 51 F.3d at 853. 

In attempting to establish the existence of this factual

dispute, the opposing party may not rely upon the denials of its

pleadings, but is required to tender evidence of specific facts

in the form of affidavits, and/or admissible discovery material,

in support of its contention that the dispute exists. See Fed.

R. Civ. P. 56(e); Matsushita, 475 U.S. at 586 n.11; See also

First Nat'l Bank, 391 U.S. at 289; Rand v. Rowland, 154 F.3d

952, 954 (9th Cir. 1998). The opposing party must demonstrate

that the fact in contention is material, i.e., a fact that might

affect the outcome of the suit under the governing law, Anderson

v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986); Owens v. Local

No. 169, Assoc. of Western Pulp and Paper Workers, 971 F.2d 347,

355 (9th Cir. 1992) (quoting T.W. Elec. Serv., Inc. v. Pacific

Elec. Contractors Ass'n, 809 F.2d 626, 630 (9th Cir. 1987), and

that the dispute is genuine, i.e., the evidence is such that a

reasonable jury could return a verdict for the nonmoving party,

Anderson, 477 U.S. 248-49; see also Cline v. Industrial

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Maintenance Engineering & Contracting Co., 200 F.3d 1223, 1228

(9th Cir. 1999).

In the endeavor to establish the existence of a factual

dispute, the opposing party need not establish a material issue

of fact conclusively in its favor. It is sufficient that “the

claimed factual dispute be shown to require a jury or judge to

resolve the parties' differing versions of the truth at trial.” 

First Nat'l Bank, 391 U.S. at 290; See also T.W. Elec. Serv.,

809 F.2d at 631. Thus, the “purpose of summary judgment is to

‘pierce the pleadings and to assess the proof in order to see

whether there is a genuine need for trial.’” Matsushita, 475

U.S. at 587 (quoting Fed. R. Civ. P. 56(e) advisory committee's

note on 1963 amendments); see also International Union of

Bricklayers & Allied Craftsman Local Union No. 20 v. Martin

Jaska, Inc., 752 F.2d 1401, 1405 (9th Cir. 1985).

In resolving the summary judgment motion, the court

examines the pleadings, depositions, answers to interrogatories,

and admissions on file, together with the affidavits, if any. 

Rule 56(c); See also In re Citric Acid Litigation, 191 F.3d

1090, 1093 (9th Cir. 1999). The evidence of the opposing party

is to be believed, see Anderson, 477 U.S. at 255, and all

reasonable inferences that may be drawn from the facts placed

before the court must be drawn in favor of the opposing party,

see Matsushita, 475 U.S. at 587 (citing United States v.

Diebold, Inc., 369 U.S. 654, 655 (1962)(per curiam)); See also

Headwaters Forest Defense v. County of Humboldt, 211 F.3d 1121,

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1132 (9th Cir. 2000). Nevertheless, inferences are not drawn

out of the air, and it is the opposing party's obligation to

produce a factual predicate from which the inference may be

drawn. See Richards v. Nielsen Freight Lines, 602 F. Supp.

1224, 1244-45 (E.D. Cal. 1985), aff'd, 810 F.2d 898, 902 (9th

Cir. 1987).

Finally, to demonstrate a genuine issue, the opposing party

“must do more than simply show that there is some metaphysical

doubt as to the material facts. . . . Where the record taken as

a whole could not lead a rational trier of fact to find for the

nonmoving party, there is no ‘genuine issue for trial.’” 

Matsushita, 475 U.S. at 587 (citation omitted).

III. ANALYSIS

 Defendant has moved for summary judgment with respect to

the following claims: (1) violation of the California Unfair

Competition Law, (2) breach of contract, (3) breach of the

implied covenant of good faith and fair dealing (bad faith), (4)

intentional misrepresentation, (5) negligent misrepresentation,

(6) intentional infliction of emotional distress, (7) negligent

infliction of emotional distress, and (8) punitive damages. 

A. California Unfair Competition Law

. MassMutual first moves for summary judgment with respect to

 plaintiff’s representative claims under the California Unfair

Competition Law (“UCL”). Cal. Bus. and Profs. Code § 17200 et

seq. Originally, the UCL permitted plaintiffs to bring causes

of action on behalf of the general public without first seeking

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 The court continued MassMutual’s initial motion for summary 3

judgment, as this case was pending at the time of Proposition 64's

passage, and the California Supreme Court had yet to rule on cases

addressing the applicability of Proposition 64 to cases pending

during its passage. Since then, the California Supreme Court has

decided that Proposition 64 indeed applies to cases pending at the

time of its passage. See California for Disability Rights v.

Mervyn’s LLC, 39 Cal. 4th 223 (2006); Branick v. Downey, Savings

and Loan Ass’n, 39 Cal. 4th 235 (2006).

 Pursuant to Federal Rule of Evidence 201, and in response 4

to plaintiff’s request, the court takes judicial notice of all

papers on file in this case.

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class certification. In November 2004, however, California

voters passed Proposition 64, which requires private parties to

obtain class certification prior to bringing a representative

action. See Cal. Bus. & Prof. Code § 17203; see also Cal. Code 3

Civ. P. § 382 (setting forth the requirements for class action

certification).

In plaintiff’s opposition papers, plaintiff has stated her 4

intent to abandon any representative claims under the UCL, and

there is no dispute that plaintiff has not complied with class

certification requirements. Nonetheless, as she correctly

notes, she is still entitled to pursue her individual action

under the UCL. See Cal. Bus. & Prof. Code § 17204 (“Actions for

relief pursuant to this chapter shall be prosecuted . . . by any

person who has suffered injury in fact and has lost money or

property as a result of such unfair competition.”). Defendant’s

attempt in its reply brief to address whether MassMutual has

engaged in unfair business practices with regard to plaintiff’s

individual action comes too late.

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MassMutual also contends that disgorgement of profits,

which plaintiff seeks in her complaint, is not an available

remedy under the UCL. Compl. ¶ 95 (“Mass Mutual is liable to

provide restitution to the Plaintiff/insured and is required

under law to effect a disgorgement of all profits made from its

illicit business practices . . .”). Although the UCL affords a

broad range of remedies, non-restitutionary disgorgement of

profits is not among them. See Korea Supply Co. v. Lockheed

Martin Corp., 29 Cal. 4th 1134 (2003). Typically, when a

defendant is ordered to disgorge profits, it must surrender all

money obtained through the illegal business practice, including

money not obtained from plaintiffs. The UCL does not permit

this. Rather, disgorgement is permissible “only to the extent

that it constitutes restitution.” Id. at 1145. Tellingly,

plaintiff does not respond to MassMutual’s on this point. 

Because plaintiff has abandoned her representative UCL

claim, and there is no genuine dispute that non-restitutionary

disgorgement is not an available remedy under the UCL, summary

judgment is proper as to the claim for disgorgement. 

Nonetheless, of course, plaintiff may pursue her individual

action to the extent she seeks disgorgement of money defendant

improperly obtained from her.

B. Breach of Contract

Defendant next argues that plaintiff’s claim for breach of

contract should fail as a matter of law because she has failed

to demonstrate coverage for her claim. The issue of coverage is

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There is some dispute as to whether plaintiff changed her 5

position on this issue during the course of litigation. Defendant

argues that plaintiff initially took the position that California

law supplied the definition of disability in her responses to

interrogatories. Pl.’s Supp. Responses to Def.’s Second Set of

Interrogatories at 11. However, plaintiff’s present position — and

the one the court addresses — is that the court should examine the

plain language of the contract. 

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a question of law that the court may adjudicate on summary

judgment. Waller v. Truck Ins. Exchange Co., 11 Cal. 4th 1, 18

(1995). For the reasons set forth below, the court denies

defendant’s motion on this claim.

As noted earlier, the policy defines disability as “an

incapacity of the insured which “(1) is due to injury or

sickness; and (2) begins while this policy is in force; and (3)

requires care by or at the direction of a legally qualified

physician . . . and (4) reduces the insured’s ability to work;

and (5) causes a loss of earned income.” Pohls Decl. ¶ 2, Ex.

2. For purposes here, the issue in dispute is the fourth

criterion — that is, whether plaintiff’s injury reduces her

ability to work.

Defendant maintains that California law provides the

controlling definition of disability, whereas plaintiff

maintains that, based on the plain language of the policy,

plaintiff’s injury has reduced her ability to work. Defendant 5

places heavy reliance on Erreca v. Western States Life Ins.

Co., 19 Cal. 2d 388 (1942). However, contrary to defendant’s

assertion, the definition of disability in Erreca does not

supplant every definition of disability in all insurance

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 Erreca merely stands for the proposition that California 6

courts should interpret the meaning of total/general disability in

a practical rather than literal fashion. Prior to Erreca, some

courts had held that under “general disability” policies, an

insured could only obtain benefits upon proof that the insured was

unable to perform the work of any occupation. Id. at 394. This

was in contrast to “occupational disability” policies, which

provided benefits so long as the insured was unable to perform the

work that was engaged in at the time the policy was written. Id.

at 393. Erreca tempered the harshness of “general disability”

policies by holding that, where an insured is prevented from

pursuing other employment in light of his capabilities and station

in life (e.g., level of education). Benefits may be obtained even

though other employment is theoretically possible.

Where Erreca applies, the plaintiff is required to prove that

these other employment options are effectively foreclosed, which

Starr-Gordon has not done here. Erreca does not, however, insert

this definition of “total disability” into every policy, as

defendant maintains. Tellingly, Erreca’s recitation of the

language typically employed in a general disability clause does not

resemble that found in plaintiff’s policy. Id. at 393 (“[A]

general disability clause defines total disability to mean

‘whenever the insured is wholly incapacitated from performing any

work whatsoever for remuneration or profit.’”). 

There is no reason why every insurance policy must fit into

the categories of either general disability or occupational

disability, and defendant has not cited any authority to the

contrary. For example, there are also “disability income” policies

that focus on whether an injury that reduces an insured’s ability

to work also causes a loss of earned income. These policies do not

generally identify any specific occupation. Aff. of Mary Fuller,

¶¶ 1-5, 7, Ex. A.

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policies. Accordingly, the court finds that Erreca 6

inapplicable to the facts of the present case.

“The rules governing policy interpretation require us to

look first to the language of the contract in order to ascertain

its plain meaning or the meaning a layperson would ordinarily

attach to it.” Waller, 11 Cal. 4th at 18; see also Cal. Civ.

Code § 1638 (plain meaning controls where language is

unambiguous and does not lead to an absurd result). The policy

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 The court notes that even if there was an ambiguity in the 7

policy, plaintiff would be entitled to coverage so long she could

demonstrate that her interpretation of the policy was objectively

reasonable. Bank of the West v. Superior Court of Contra Costa

County, 2 Cal. 4th 1254, 1264-65 (1992). 

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here is unambiguous, and, as MassMutual points out, any policy

accepted and approved by the California Insurance Commissioner

is conclusively presumed to be unambiguous. Cal. Ins. Code §

10291.5. Accordingly, the plain meaning of the policy

determines whether plaintiff is covered.

Plaintiff has tendered sufficient evidence to prove that,

at a minimum, there is a genuine dispute that she experienced a

reduced ability to work as a dental hygienist. On this basis

alone, defendant’s motion for summary judgment with respect to

the breach of contract issue must be denied. Under the plain

meaning of the policy, if plaintiff has a reduced ability to

perform the job that she was engaged in at the time of her

injury, she has satisfied the policy requirement of a reduced

“ability to work.” The court need not go further than this in

order to resolve the present dispute.7

Defendant’s contention that only the purchase of a “Regular

Occupation Rider” would have provided plaintiff with coverage

for occupational disability is unavailing. Its existence does

not alter the plain meaning of the policy, and the intentions of

contracting parties will generally be discerned from only the

written provisions of the contract itself. Waller, 11 Cal. 4th

at 19. Moreover, the rider appears to provide the insured with

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 Plaintiff asks that the court sua sponte enter judgment in 8

her favor on the breach of contract claim. While the court has the

ability to do so even when there is no cross-motion for summary

judgment, Gospel Missions of America v. City of Los Angeles, 328

F.3d 548, 553 (9th Cir. 2003), it is inappropriate here. The

definition of disability in the policy includes five elements, only

one of which defendant has fully briefed in its papers.

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a more generous calculation of benefits; it does not suggest

that policies without the rider deny coverage altogether when

the insured is only disabled from performing one particular job.

As there is a genuine dispute as to whether plaintiff is

disabled within the meaning of the policy, defendant’s motion

for summary judgment as to the breach of contract claim is

denied.8

C. Breach of the Implied Covenant of Good Faith and Fair

Dealing

Defendant maintains that plaintiff’s bad faith claim fails

because she has not demonstrated that she is entitled to

benefits under the policy and that there is a genuine dispute as

to coverage. For the reasons set forth below, summary judgment

should be granted with respect to plaintiff’s bad faith claim. 

There is an implied covenant of good faith and fair dealing

in every insurance contract. White v. Western Title Ins. Co.,

40 Cal. 3d 870, 885 (1985). In order to establish bad faith, or

breach of the implied covenant of good faith and fair dealing, a

plaintiff must show that benefits due under the policy were

withheld, and that the reason for withholding benefits was

unreasonable or without proper cause. Love v. Fire Ins.

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Exchange, 221 Cal. App. 3d 1136, 1151 (4th Dist. 1990); Guebara

v. Allstate Ins. Co., 237 F.3d 987, 992 (9th Cir. 2002)

(applying California law). “The key to a bad faith claim is

whether denial of a claim was unreasonable.” Id. Even though

bad faith is typically a question of fact for the jury, if a

defendant’s conduct is objectively reasonable, then its

subjective intent is irrelevant. Morris v. Paul Revere Life

Ins. Co., 109 Cal. App. 4th 966, 973 (4th Dist. 2003) (“[I]f the

conduct of [the insurer] in defending this case was objectively

reasonable, its subjective intent is irrelevant.”).

A court may dismiss a bad faith claim on summary judgment

if the defendant can demonstrate that there was a genuine

dispute as to coverage. Guebara, 237 F.3d at 992 (describing

the “genuine dispute doctrine”); Amadeo v. Principal Mut. Life

Ins. Co., 290 F.3d 1152, 1162 (holding that summary judgment is

proper where it is indisputable that the basis for an insurer’s

denial of benefits was reasonable). It is not unreasonable for

an insurer to resolve good faith doubts, whether factual or

legal, against the insured. Blake v. Aetna Life Ins. Co., 99

Cal. App. 3d 901, 924 (4th Dist. 1979). Therefore, in the

present posture, the court may grant the defendant summary

judgment if no reasonable jury could disagree that there is a

genuine dispute that plaintiff was entitled to benefits. 

Even if defendant was ultimately wrong to terminate

benefits -- which is the issue in the breach of contract claim -

- that is a distinct issue from whether defendant acted in bad

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faith. Chateau Chamberay Homeowners Ass’n v. Associated Intern.

Ins. Co., 90 Cal. App. 4th 335, 347 (2d Dist. 2001) (noting that

liability for breach of contract and bad faith are not

coterminous). To illustrate the difference in standards, if the

court finds that there is a reasonable and genuine dispute as to

whether plaintiff was disabled within the meaning of the policy,

it must grant summary judgment as to the bad faith claims, and

deny summary judgment as to the breach of contract claim.

Broadly, defendant’s alleged bad faith acts can be divided

into two categories: bad faith related to the termination of

benefits and bad faith related to the investigation process of

plaintiff’s claim. The court addresses each in turn.

1. Termination of Benefits

Defendant cites to multiple reasons for why its decision to

terminate plaintiff’s benefits were reasonable under the

circumstances. First, plaintiff waited for over a year to make

her claim. Second, the evidence ultimately produced to document

plaintiff’s claim (e.g., Dr. Patterson’s narrative report) was

equivocal and suggested that plaintiff’s symptoms might improve. 

Third, video surveillance, and the reports of medical

consultants reviewing that footage, reveal that plaintiff’s

claims of injury were false or exaggerated.

Plaintiff responds in two ways. First, she notes that the

reasonableness of an insurer’s decisions and actions must be

evaluated based on the information that it had at the time the

decisions were made -- not based on information acquired

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If the court were to permit defendant to rely on information 9

acquired after it decided to terminate benefits, it is highly

likely that defendant’s decision would be deemed reasonable,

particularly in light of the reports from Dr. Schiff and Dr.

O’Brien.

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afterwards. See Chateau Chamberay, 90 Cal. App. 4th at 347; 9

see also Filippo Industries, Inc. v. Sun Ins. Co. of New York,

74 Cal. App. 4th 1429, 1441 (2d Dist. 1999). For example, if an

insurer unreasonably denied benefits in the first instance, it

could not shield itself from liability by merely conducting

medical examinations at some future date when the insured’s

health condition had improved. 

Defendant responds that it should not be limited to

information in existence at the time plaintiff’s benefits were

terminated because she has a continuing claim of disability

(i.e., if her disability disappears at any time, so too do her

benefits). Furthermore, at least some of the subsequently

acquired information consisted of evaluations of medical records

already in existence at the time benefits were terminated,

rather than ones reflecting plaintiff’s condition at a future

date. However, the court need not rule on defendant’s

continuing disability argument because, as described below, it

finds that defendant had a reasonable basis for terminating

benefits based on information available as of the date of

termination.

Second, plaintiff disputes the substance of defendant’s

reasons for termination. As defendant points out, however, the

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very existence of a reasonable dispute precludes a finding of

bad faith. For example, Dr. Hughes’ treatment notes indicated

that plaintiff was responding well to a steroid injection and

that her back might improve with rest. Moreover, the

surveillance footage corroborates this, as plaintiff was seen

using her right hand and leaning over without any apparent

difficulty. In addition, defendant had both Dr. Hughes’ APS and

the surveillance results at the time it terminated benefits. 

To be sure, not all of the activities caught on the

surveillance footage would necessarily indicate an ability to

perform the fine motor skills required of a dental hygienist,

which is the critical issue given the court’s construction of

the policy. However, plaintiff’s apparent ability to engage in

gross motor movements contradict her previous statements,

calling into doubt the veracity of her claims as a general

matter. This doubt remains even if the movements were not

analogous to those required of a dental hygienist. 

Furthermore, plaintiff stated that the use of her right arm

would allow her to return to work. The surveillance video can

reasonably be read to show her using her arm. Burnick Aff., Ex.

B at 404:16-19. Of course, plaintiff is not a medical

professional, and she might have incorrectly assessed her own

condition. Nevertheless, plaintiff was also intimately familiar

with her job functions and the movements that caused her

discomfort; accordingly, her statement is entitled to some

weight.

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At oral argument, plaintiff’s counsel argued that the

genuine dispute doctrine is limited to situations where there

are serious evidentiary disputes, as when parties offer the

conflicting reports of doctors. Certainly, the doctrine has

been applied in such circumstances. See, e.g., Allstate Ins.

Co. v. Madan, 889 F. Supp. 374, 380 (C.D. Cal. 1995) (finding

that dispute between experts as to cause and origin of a fire

established genuine dispute and therefore precluded bad faith). 

However, there is no case law indicating that only conflicting

expert reports may give rise to a reasonable factual dispute. 

Moreover, Dr. Feingold provided defendant with his expert

report, which stated that “[t]he surveillance reviewed fails to

document any of the impairments that the insured is reported to

have.” Pohls Decl. ¶ 20, Ex. 19. Although Dr. Feingold did not

personally examine plaintiff, his report took as an assumption

that the diagnoses of plaintiff’s doctors were accurate.

In light of the foregoing reasons, the court cannot find

that the defendant acted unreasonably. Mr. Montari summarized

the evidence relied upon to terminate plaintiff’s benefits:

So all of that together, the occupational

description, the inconsistencies in the

surveillance tape, the medical reviews, the medical

records showing improvement from the injection, no

treatment for six months, gaps in treatments from

both Dr. Patterson and Dr. Hughes, Dr. Patterson’s

statement that there are no current limitations and

restrictions that rise to a disabling level, Dr.

Feingold’s, Dr. Hacker’s, and Dr. Gordon’s reviews

all raising question to the extent of disability.

Me combining all of that with the specifics of this

case came to the conclusion that she was no longer

eligible for benefits.

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Burnick Aff. Ex. B at 412:24-413:11. Viewed collectively, the

evidence establishes sufficient justification for defendant’s

termination of benefits such that it cannot be held liable for

bad faith.

2. Investigation

Additionally, an insurer breaches the implied covenant of

good faith and fair dealing by failing to investigate thoroughly

its insured’s claim. Egan v. Mutual of Omaha Ins. Co., 24 Cal.

3d 809 (1979); Guebara, 237 F.3d at 996. An insurer may also be

liable for failing to investigate a claim in an unbiased manner.

See Hangarter v. Provident Life and Acc. Ins. Co., 373 F.3d 998,

1010 (9th Cir. 2004). This is significant because if the

“genuine dispute” discussed above is, for example, based upon

expert opinions that were the fruit of a biased investigation,

the insurer may still be liable for bad faith. Here, plaintiff

argues that defendant’s investigation of her total disability,

partial disability, and psychological disability were all

deficient in some respect.

a. Total Disability

First, plaintiff alleges that defendant failed to

investigate her total disability claim in a thorough and

unbiased manner. Specifically, plaintiff argues that defendant

ignored her back condition as a basis for disability, that

defendant failed to conduct a timely IME, and that defendant

failed to conduct a formal job analysis. I cannot agree.

First, defendant took into consideration plaintiff’s back

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condition. Dr. Feingold’s review discussed plaintiff’s back and

found that the “cervical and lumbar spine diagnoses, if active,

could cause decrease in use of upper extremities,” which “was

not evident from the surveillance.” Pohls Decl., ¶ 20, Ex. 19.

Moreover, Mr. Montanari testified that in reviewing plaintiff’s

claim, he took into account the records of Dr. Hacker, a

chiropractor, as well as Dr. Hughes’ opinions regarding

plaintiff’s back pain. 

Plaintiff’s argument with regard to the IME is also

unavailing. While it is true that defendant did not schedule an

IME of plaintiff until 2006, it is also true that defendant

attempted to schedule an FCE as early as 2001. Defendant

scheduled the exam, but plaintiff expressed that she would only

consent to an examination conducted by a physician rather than

a physical therapist. This distinction, while significant, is

not sufficient to establish that defendant abnegated its duty to

investigate plaintiff’s claim. 

Plaintiff also argues that defendant’s failure to

commission a formal analysis of plaintiff’s job duties was an

act of bad faith. However, plaintiff overlooks the fact that

she filled out a detailed form describing her job functions for

defendant. Pohls Decl., Ex. 4. This form stated that her

duties and activities included teeth cleaning, scaling, root

planing, and taking x-rays, and that the maximum weight she was

required to lift was ten pounds. The form also contained a

fairly comprehensive checklist of physical movements required by

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a job and corresponding boxes for the frequency of those

movements. Plaintiff argues that the form represented her lay

opinion on her job duties, but tellingly, does not dispute the

accuracy of the tasks listed. In light of this information, it

would not be bad faith for defendant to refrain from conducting

a formal job analysis.

In general, plaintiff focuses on the investigatory

activities that defendant allegedly failed to conduct, but it

ignores the activities that defendant in fact ordered. For

example, defendant obtained medical reviews from Dr. Feingold

and Dr. Hacker, commissioned video surveillance of plaintiff,

and reviewed the claim forms submitted by plaintiff as well as

what medical records it received from plaintiff’s treating

doctors. While defendant might have done more to substantiate

its ultimate decision, the court cannot find that defendant

breached its duty to investigate based on the aforementioned

conduct.

b. Partial Disability

Plaintiff further contends that defendant also failed to

adequately investigate her claim for partial disability, in

which she reduced her work week from three days per week to two

days in January 2000. Although, as described above, the duty to

investigate typically exists independent of whether there is a

reasonable dispute over plaintiff’s entitlement to benefits,

when the dispute is clearly genuine and non-pretextual, the duty

to investigate is correspondingly lower. See Brinderson-Newberg

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Joint Venture v. Pacific Erectors, Inc., 971 F.2d 272, 283 (9th

Cir. 1992) (finding that “an insurer [need] not conduct a more

thorough investigation [when] the insurer already has good

reason to dispute liability”).

Here, defendant’s investigation was reasonable in light of

plaintiff’s one-year delay in submitting the claim, the sporadic

treatment that plaintiff sought for her condition during that

one year period, and the fact that plaintiff’s work duties

remained unchanged, even though her hours were reduced. Indeed,

even though defendant requested them, Dr. Patterson was unable

to provide treatment notes regarding plaintiff’s period of

partial disability. His narrative report was similarly silent

as to the specific dates of plaintiff’s treatment. Even viewing

the evidence in the light most favorable to the plaintiff, it

cannot be said that defendant’s investigation of the partial

disability claim was unreasonable.

c. Psychological Disability

Plaintiff alleges that defendant failed to investigate her

psychological disability. She argues that defendant was on

notice of this possibility, as the medical records from Dr.

Patterson indicated that she was emotionally fragile, suffered

from panic attacks and anxiety, and was taking medication to

manage her symptoms. Defendant has stated that its policy is to

investigate all possible concurrent causes of disability.

Plaintiff’s argument is unavailing. First, there is no

explanation as to how plaintiff’s psychological condition might

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have caused the physical disability, and plaintiff does not

allege that the psychological condition itself constitutes a

disability within the meaning of the policy. Plaintiff stated

that she stopped working in 2000 because of her physical

condition, not her psychological condition. Second, in response

to the question, “Do you have any other health problems that may

be contributing to your difficulties or aggravating your

condition?”, plaintiff responded “No.” Pohls Supp. Decl., Ex.

41. Third, the initial claims examiner on plaintiff’s file

testified that “I didn’t see anything significant that would

indicate to me there was a possible disability.” Pohls. Supp.

Decl., Ex. 44 at 369:5-10 (referring to plaintiff’s

psychological condition). Accordingly, there is no genuine

dispute as to the adequacy of defendant’s investigation into

plaintiff’s psychological disability.

d. Other Alleged Acts of Bad Faith

Plaintiff submits that defendant engaged in a litany of bad

faith acts, which she recites over the course of twenty-two

pages in its fifty-six page brief. The court has addressed

plaintiff’s more serious arguments and finds that the remainder

are without merit.

For example, plaintiff maintains that defendant has failed

to “give at least as much consideration” to the interests of its

insured as to its own interests. As evidence, she points to

defendant’s institutional practices of communicating the

company’s financial plan and performance targets to examiners.

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 First, plaintiff argues that defendant acted in bad faith 10

by failing to reference Erreca in its policy, but, as noted above,

that case has no bearing on how to interpret the policy. Second,

plaintiff notes that the termination letter failed to identify in

detail each activity observed during surveillance and how each

observed activity was inconsistent with plaintiff’s alleged

injuries. However, the insurance code merely requires insurers to

provide a reasonable explanation of the basis for termination “in

relation to the facts,” which the court finds that defendant did

here. Cal. Ins. Code § 790.03(h)(13). Third, plaintiff maintains

that defendant only gave plaintiff a small window of time after the

termination letter was sent in order to prevent the lapse of her

policy. However, plaintiff ultimately paid her premium on time,

and defendant’s conduct is not of the magnitude that typically

characterizes bad faith actions.

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The inference is that examiners are pressured to deny claims in

order to meet these performance targets. However, by her own

admission, plaintiff concedes that it is not improper for an

insurance company to maintain and communicate claims handling

statistics. Without a more specific nexus to the facts of the

present case, this generic information about defendant’s

“corporate culture and environment,” Pl.’s Opp’n to Def.’s Mot.

for Summ. J. at 21, cannot support a claim of bad faith. The

remainder of plaintiff’s arguments are similarly without merit.10

To summarize, defendant’s motion for summary judgment as to

bad faith should be granted because its decision to terminate

plaintiff’s benefits was based on at least reasonable disputes

regarding plaintiff’s medical condition and whether the

condition reduced plaintiff’s ability to work as defined in the

policy. Furthermore, its investigation of plaintiff’s claims

(psychological, total, and partial) was reasonable under the

circumstances. 

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D. Intentional and Negligent Misrepresentation

Defendant also moves for summary judgment on plaintiff’s

intentional and negligent misrepresentation claims. Plaintiff’s

primary claim is that defendant promised coverage without the

intent to provide such coverage, or without a reasonable basis

for believing it would provide such coverage. For the reasons

set forth below, summary judgment with respect to these claims

should be denied.

In California, a cause of action for intentional

misrepresentation or fraud requires that the plaintiff to prove

the existence of the following: (1) misrepresentation (false

representation, concealment, or nondisclosure), (2) knowledge of

falsity, (3) intent to deceive or induce reliance, (4)

justifiable reliance, and (5) resulting damage. Lazar v.

Superior Court, 12 Cal. 4th 631, 638 (1996); Engalla v.

Permanente Medical Group, Inc., 15 Cal. 4th 951, 974 (1997);

Glenn K. Jackson Inc. v. Roe, 273 F.3d 1192, 1201 (9th Cir.

2001). 

The elements of a cause of action for negligent

misrepresentation are similar, except that plaintiff need not

prove the element of scienter. Gagne v. Bertran, 43 Cal. 2d

481, 487-88 (1954). Rather, plaintiffs need only prove that the

representation was made without a reasonable basis. Glenn K.

Jackson Inc., 273 F.3d at 1201 n.2. 

For both claims, plaintiff identifies the same four alleged

misrepresentations. First, plaintiff argues that MassMutual

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represented that it would pay for disability benefits if

plaintiff satisfied the terms and conditions of the policy.

Second, plaintiff maintains that defendant should have discussed

Erreca in the policy. Third, plaintiff claims that defendant

represented that it would schedule an IME when the claim was

pending. Finally, plaintiff avers that defendant misrepresented

that her appeal would be timely resolved.

The latter three alleged misrepresentations can be resolved

summarily. Plaintiff’s contention that defendant should have

discussed Erreca is moot, given the interpretation of the policy

adopted above. Plaintiff’s argument that defendant should have

scheduled an earlier IME is also unavailing, because plaintiff

indicated that she would consent to an FCE so long as it was

conducted by a doctor. Furthermore, there is no explanation as

to how plaintiff relied upon or otherwise changed her conduct in

response to defendant’s alleged representation that it would

schedule an FCE. Similarly, even if the court agreed that

defendant failed to resolve plaintiff’s appeal in a timely

fashion, there is no allegation that plaintiff relied upon this

representation to her detriment.

Plaintiff’s primary claim is that defendant intentionally

or negligently promised her benefits that she did not receive,

but was entitled to receive. In other words, the representation

at issue is the very definition of disability employed in the

policy. Whether this representation was false turns on

plaintiff’s entitlement to benefits, which, as discussed above

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 Defendant relies on an unpublished case, Brewer, for the 11

proposition that “intent cannot be inferred merely from a

defendant’s claim processing procedures, even if such procedures

result in an interpretation of the policy terms that is

unreasonable.” Brewer v. Fortis Ins. Co., No. C 03-05150 SI, 2005

WL 645414, at *6 (N.D. Cal. March 21, 2005). However, Brewer says

nothing of the sort. Rather, the court in Brewer merely held that

the plaintiff, who sued his insurance company, failed to allege a

misrepresentation whatsoever, given that the parties never

discussed the alleged misrepresentation, and that the

misrepresentation was not material. Here, however, the alleged

misrepresentation goes to the heart of plaintiff’s disability

policy.

 Moreover, this conclusion would not contradict the court’s 12

ruling with respect to the bad faith claim. For example, an

insurer may be liable for intentional misrepresentation because it

had the subjective intent to defraud the insured but not liable for

bad faith because its actions were objectively reasonable. See

Morris, 109 Cal. App. 4th at 973 (holding, in the context of a bad

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with regard to the breach of contract claim, is the subject of

a genuine dispute. However, defendant may still prevail on

summary judgment if it can demonstrate that there is no genuine

dispute that it did not know, and should not have known, that

plaintiff was entitled to benefits.

Defendant has failed in meeting its burden on summary

judgment with regard to the knowledge/scienter element. Intent

may be inferred from a defendant’s subsequent conduct after

making an alleged misrepresentation. Wetherbee v. United Ins.

Co. of America, 265 Cal. App. 2d 921, 932 (1st Dist. 1968).

Here, defendant argues that intent may not be inferred from the

circumstances, but fails to engage the factual record, or even 11

cite to it. One could infer that defendant intentionally

terminated plaintiff’s benefits, even though it knew that she

was entitled to the these benefits. A fortiori, a reasonable 12

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faith claim, that “if the conduct of [the insurer] in defending

this case was objectively reasonable, its subjective intent is

irrelevant.”). In addition, while the genuine dispute doctrine may

immunize an insurer from liability for bad faith, there is no

analogous defense in the context of intentional misrepresentation.

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jury could also conclude that defendant was negligent in

terminating plaintiff’s benefits because the weight of the

evidence indicated that she was disabled within the meaning of

the policy. The issue of scienter is a question reserved for

the jury.

Accordingly, the court denies summary judgment with respect

to the intentional and negligent misrepresentation claims.

E. Intentional Infliction of Emotional Distress

Defendant also moves for summary judgment on plaintiff’s

intentional infliction of emotional distress claim. In

California, the elements of a prima facie case for the tort of

intentional infliction of emotional distress are (1) outrageous

conduct, (2) intent or recklessness, (3) severe emotional

distress, and (4) actual and proximate causation. Austin v.

Terhune, 367 F.3d 1167, 1172 (9th Cir. 2004). As set forth

below, the court grants summary judgment with respect to this

claim.

Plaintiff’s claim fails because she cannot prove the first

element. Conduct is outrageous if it exceeds all bounds of that

usually tolerated in a civilized society. Newberry v. Pacific

Racing Ass’n, 854 F.2d 1142, 1150 (9th Cir. 1988); see also

Schneider v. TRW, Inc., 938 F.2d 986, 992 (9th Cir. 1991)

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(holding that summary judgment is proper if a claim cannot

"reasonably be regarded as so extreme and outrageous as to

permit recovery") (internal quotations omitted).

Here, defendant’s surveillance of plaintiff does not exceed

all bounds of that usually tolerated in a civilized society. To

the contrary, surveillance in disability insurance cases is

“commonplace.” See Teague v. Home Ins. Co., 168 Cal. App. 3d

1148, 1153 (2d Dist. 1985). Barring exceptional circumstances,

surveillance is not the kind of conduct that can be deemed

outrageous. The facts here are unlike cases in which courts

have found that surveillance, in combination with other factors,

crosses the line into outrageous conduct. See, e.g., Unruh v.

Truck Ins. Exchange, 7 Cal. 3d 616 (1972) (finding

outrageousness where investigator tricked plaintiff into

romantic relationship and shook rope bridge that plaintiff was

standing on in order to obtain pictures of her reaction). 

Even if plaintiff had psychological problems such as

obsessive-compulsive behavior and paranoia, Pohls Decl. at ¶ 32,

Ex. 31, and defendant was on notice about these problems,

reasonable surveillance under such circumstances would still not

rise to the level of outrageous conduct. See Teague, 168 Cal.

App. 3d at 1152 (“The knowledge that surveillance might

exacerbate a claimant's psychological or emotional problems does

not preclude the use of reasonable surveillance techniques by

compensation carriers.”).

Accordingly, the court grants summary judgment with respect

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to the intentional infliction of emotional distress claim.

F. Negligent Infliction of Emotional Distress

Defendant also moves for summary judgment with respect to

plaintiff’s negligent infliction of emotional distress claim.

While defendant’s conduct may not have been outrageous, that

does not negate the possibility that it was negligent,

particularly in light of plaintiff’s psychological condition.

Because defendant has failed to establish the absence of a

genuine issue with respect to any of the element of the

negligent infliction of emotional distress claim, summary

judgment must be denied.

Under California law, a cause of action for negligent

infliction of emotional distress requires that a plaintiff

demonstrate (1) serious emotional distress, (2) actual and

proximate causation, (3) wrongful conduct by the defendant, and

(4) foreseeability. Austin, 367 F.3d at 1172. The claim is not

an independent tort but simply a species of negligence. Lawson

v. Mgmt. Activities, Inc., 69 Cal. App. 4th 652, 656 (4th Dist.

1999) (“[T]here is no such thing as the independent tort of

negligent infliction of emotional distress.”). Accordingly, the

elements of duty, breach, causation, and damages apply to a

claim for negligent infliction of emotional distress. Macy’s

California, Inc. v. Superior Court, 41 Cal. App. 4th 744, 747

(1st Dist. 1995).

Defendant’s only argument against the negligence claim is

that plaintiff’s emotional distress is not severe. Severe

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emotional distress exists if the distress is “of such

substantial quantity or enduring quality that no reasonable

[person] in civilized society should be expected to endure it.”

Fletcher v. W. Nat’l Life Ins. Co., 10 Cal. App. 3d 376, 397

(4th Dist. 1970). Plaintiff has tendered the psychological

evaluation of Dr. Albert Globus, who noted that defendant’s

surveillance led to “an aggravation of her signs and symptoms of

anxiety, obsessive compulsive behaviors, hypervigilance, and

mildly paranoid interpretation of her social environment.”

Globus Aff. at ¶¶ 12-16. Although a close issue, reasonable

jurors could disagree as to whether this constitutes “severe”

distress, particularly given Dr. Globus’ suggestion that her

recovery would be significantly prolonged. In response,

defendant merely distinguishes cases in which the insured’s

emotional distress was deemed severe; however, those cases do

not indicate the threshold at which emotional distress becomes

severe.

Because there is a genuine dispute as to whether

plaintiff’s emotional distress is severe, summary judgment as to

the negligent infliction of emotional distress claim must be

denied.

G. Punitive Damages

Finally, defendant moves for summary judgment on the issue

of punitive damages. Under California law, a plaintiff may

recover punitive damages if it is proven “by clear and

convincing evidence that the defendant has been guilty of

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oppression, fraud, or malice.” Cal Civ. Code § 3294(a);

Hangarter v. Provident Life and Accident Ins. Co., 373 F.3d 998,

1013 (9th Cir. 2004). Plaintiff must show that defendant

“engaged in despicable conduct with a conscious disregard of the

rights or safety of others.” Kransco v. Am. Empire Surplus

Lines Ins. Co., 23 Cal. 4th 390, 398-99 (2000). 

Given the court’s ruling with respect to the intentional

misrepresentation claim, defendant’s motion must be denied.

See, e.g., R&B Auto Center v. Farmers Group, Inc., 140 Cal. App.

4th 327, 347 n.9 (4th Dist. 2006) (permitting punitive damages

based on intentional misrepresentation claim). However, the

court may not award punitive damages based on any of the other

claims, such as the breach of contract claim, the individual UCL

claim, or the negligent infliction of emotional distress claim.

See Cates Constr. v. Talbot Partners, 21 Cal. 4th 28, 980 P.2d

407, 427 (1999) (holding that punitive damages are not available

for breach of contract absent some independent tort).

Because punitive damages are available for an intentional

misrepresentation claim, summary judgment must be denied.

V. CONCLUSION

1. Defendant’s motion for summary judgment as to the

representative UCL claim is GRANTED.

2. Defendant’s motion for summary judgment as to the

breach of contract claim is DENIED.

3. Defendant’s motion for summary judgment as to the bad

faith claim is GRANTED.

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4. Defendant’s motion for summary judgment as to the

intentional misrepresentation claim is DENIED.

5. Defendant’s motion for summary judgment as to the

negligent misrepresentation claim is DENIED.

6. Defendant’s motion for summary judgment as to

plaintiff’s intentional infliction of emotional

distress claim is GRANTED.

7. Defendant’s motion for summary judgment as to

plaintiff’s negligent infliction of emotional distress

claim is DENIED.

8. Defendant’s request that the court bar recovery for

punitive damages is DENIED.

IT IS SO ORDERED.

DATED: November 6, 2006.

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