Source: https://law.justia.com/cases/federal/appellate-courts/F2/690/595/107749/
Timestamp: 2020-07-09 13:04:38
Document Index: 55128080

Matched Legal Cases: ['§ 310', '§ 312', '§ 310', '§ 310', '§ 3001', '§ 3311', '§ 4004']

William Edwards, Plaintiff-appellant, v. Aetna Life Insurance Company, Defendant-appellee, 690 F.2d 595 (6th Cir. 1982) :: Justia
Justia › US Law › Case Law › Federal Courts › Courts of Appeals › Sixth Circuit › 1982 › William Edwards, Plaintiff-appellant, v. Aetna Life Insurance Company, Defendant-appellee
William Edwards, Plaintiff-appellant, v. Aetna Life Insurance Company, Defendant-appellee, 690 F.2d 595 (6th Cir. 1982)
US Court of Appeals for the Sixth Circuit - 690 F.2d 595 (6th Cir. 1982) Argued April 21, 1982. Decided Oct. 18, 1982
In April, 1970, Edwards applied for disability benefits from the Veterans Administration pursuant to 38 U.S.C. § 310, which allows compensation to be paid to those veterans who suffer a "disability resulting from personal injury suffered or disease contracted in (the) line of duty." Although Edwards could not establish that his illness was contracted in the line of duty, he was able to obtain disability benefits from the Veterans' Administration by relying upon a rebuttable presumption that "active tuberculosis disease developing ... within three years from the date of separation from such service" was contracted while the applicant was a member of the armed forces. 38 U.S.C. § 312. Thus, Edwards was able to obtain benefits by proving that he contracted tuberculosis within three years of leaving the service.1 The Veterans' Administration concluded that Edwards was entitled to benefits under 38 U.S.C. § 310 and awarded him disability benefits. Apparently, Edwards never made an unequivocal assertion that he contracted tuberculosis as a result of his service in the armed forces.2
In February, 1971, Edwards applied to Aetna for extended disability benefits and submitted to Aetna a notice of claim. He asserted that Aetna was required to pay him disability benefits pursuant to Aetna's group insurance policy issued as part of Chrysler's benefit package. In his application for benefits, Edwards indicated that he was receiving disability benefits pursuant to 38 U.S.C. § 310. Aetna concluded that Edwards was not entitled to benefits, relying on the exclusion clause contained in the group policy:
The policies supporting judicial estoppel are different from those that support the more common doctrines of issue preclusion, equitable and collateral estoppel. Courts apply equitable estoppel to prevent a party from contradicting a position taken in a prior judicial proceeding. See, e.g., Davis v. Wakelee, 156 U.S. 680, 689, 15 S. Ct. 555, 558, 39 L. Ed. 578 (1895). Equitable estoppel enables a party to avoid litigating, in the second proceeding, claims which are plainly inconsistent with those litigated in the first proceeding. Because the doctrine is intended to ensure fair dealing between the parties, the courts will apply the doctrine only if the party asserting the estoppel was a party in the prior proceeding and if that party has detrimentally relied upon his opponent's prior position. See Id. at 689-90, 15 S. Ct. at 558. Collateral estoppel prevents relitigation of factual matters that were fully considered and decided in a prior proceeding. Thus, collateral estoppel operates to prevent repetitive litigation. Tipler v. E. I. du Pont de Nemours and Co., 443 F.2d 125, 128 (6th Cir. 1971).
An application for benefits must be filed with the administrator of the Veterans Administration. 38 U.S.C. § 3001. The administrator, in order to ascertain the validity of a particular claim, may investigate the validity of the claim. 38 U.S.C. § 3311; 38 C.F.R. Sec. 3.103(c). If the administrator determines that the claimant is not entitled to benefits, the claimant may seek administrative review of this decision by the board of veterans' appeals, a quasi-judicial body within the Veterans' Administration. See 38 U.S.C. § 4004; 38 CFR Sec. 19.3. Review on appeal is de novo; witnesses are heard, 38 C.F.R. Sec. 19.135, and evidence may be submitted, 38 C.F.R. Sec. 19.141.
The presumption created by Sec. 312 is of great advantage to a claimant such as Edwards. For example, a person may prove that his disease is service connected by submitting an x-ray negative, taken within three years of discharge from the service, which contains evidence of active pulmonary tuberculosis. 38 C.F.R. Sec. 3.371(a) (1) (1981)
Although this is a diversity case, we believe that federal, rather than state, principles provide the rule of decision in this case. Allen v. Zurich Ins. Co., 667 F.2d 1162, 1167 n.4 (4th Cir. 1982). Judicial estoppel is a rule designed to protect the integrity of judicial institutions. The question primarily concerns federal interests, and, consequently, federal courts must be free to develop principles that most adequately serve their institutional interests. Allen v. Zurich Ins. Co., 667 F.2d at 1167 n.4 See Byrd v. Blue Ridge Rural Electric Co-op., 356 U.S. 525, 535-39, 78 S. Ct. 893, 899-901, 2 L. Ed. 2d 953 (1958). See also 18 Wright, Miller & Cooper, Fed.Practice and Procedure, Sec. 4477, p. 787
Edwards also asserts that this court should enter summary judgment in his favor, arguing that no issue of material fact remains because Aetna has failed to introduce any medical evidence that indicates that Edwards is not disabled or that his condition is the result of his service in the armed forces. We believe, however, that the record before us indicates that several issues of material fact remain, and thus we may not enter summary judgment on behalf of Edwards. Fed. R. Civ. P. 56(c)