Shaps v. Provident Life & Accident ( 2001 )


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  •                                                                                   [PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT                             FILED
    U.S. COURT OF APPEALS
    ________________________                  ELEVENTH CIRCUIT
    MAR 16 2001
    THOMAS K. KAHN
    Nos. 98-5500 & 99-4028                        CLERK
    ________________________
    D. C. Docket No. 95-08627-CV-DMM
    AUDREY SHAPS,
    Plaintiff-Appellant,
    versus
    PROVIDENT LIFE & ACCIDENT
    INSURANCE COMPANY, PROVIDENT
    LIFE AND CASUALTY INSURANCE COMPANY,
    a foreign corporation,
    Defendants-Appellees.
    ________________________
    Appeals from the United States District Court
    for the Southern District of Florida
    _________________________
    (March 16, 2001)
    Before EDMONDSON and MARCUS, Circuit Judges, and RESTANI*, Judge.
    MARCUS, Circuit Judge:
    *
    Honorable Jane A. Restani, Judge, U.S. Court of International Trade, sitting by designation.
    This is an appeal of a jury verdict in favor of Defendant Provident Life and
    Casualty Insurance Company (“Provident Casualty”) in a suit brought by Plaintiff
    Audrey Shaps alleging two breaches of a disability insurance contract. In a
    special verdict, the jury determined that Shaps was not continuously disabled
    within the terms of her Provident Casualty disability policy from September 10,
    1990 through October 23, 1994, and thereby rejected her first claim for relief.
    With respect to her second claim, the jury determined that Shaps was continuously
    disabled from September 8, 1995 through April 6, 1996, but denied relief because
    it found that she had failed to comply with certain conditions precedent. On
    appeal, Shaps argues that the district court committed multiple errors warranting a
    new trial.
    We find all of Shaps’ objections to be unpersuasive on this record, save one
    that cannot be decided at this time. Shaps contends that the district court erred by
    determining that a rule of Florida law placing the burden of proof on the insurer in
    this context was inapplicable because that rule is substantive and the substantive
    law of New York, not Florida, governs this case. Whether the Florida rule is
    substantive appears to turn in part upon proper characterization of the Florida
    Supreme Court’s decision in Aetna Life Insurance Co. v. Fruchter, 
    283 So. 2d 36
    (Fla. 1973). It is unclear, however, whether the opinion in Fruchter, which
    2
    discharged a writ of certiorari as improvidently granted, constitutes binding Florida
    precedent. Moreover, it is unclear to what extent the court’s remarks in Fruchter
    may be read to address the choice-of-law dispute now before us. Accordingly, we
    respectfully certify to the Florida Supreme Court the following two questions:
    1.    Is the burden of proof rule recognized in Aetna Life Insurance
    Co. v. Fruchter, 
    266 So. 2d 61
     (Fla. 3d Dist. Ct. App. 1972),
    cert. discharged, 
    283 So. 2d 36
     (Fla. 1973), part of the
    substantive law of Florida, such that it would not be applied in a
    case where under Florida’s doctrine of lex loci contractus the
    substantive law of another state (New York) governs the
    parties’ contract dispute?
    2.    Would requiring the insured to prove disability in this context
    violate the public policy of Florida, such that the burden of
    proof must be placed on the insurer? See Gillen v. United
    Services Automobile Ass’n, 
    300 So. 2d 3
     (Fla. 1974).
    I.
    The background to this appeal is as follows. In June 1987, Provident
    Casualty issued an individual disability insurance policy to Shaps, who at the time
    resided and worked in New York. The policy defines “Total Disability” in these
    terms:
    Total disability . . . means that due to Injuries or Sickness:
    1. you are not able to perform the substantial and material
    duties    of your Occupation; and
    2. you are under the care and attendance of a Physician.
    3
    The policy defines “Sickness” as “sickness or disease which is first
    manifested while your policy is in force.” The policy defines “Occupation” as “the
    occupation (or occupations, if more than one) in which you are regularly engaged
    at the time you become disabled.” The policy defines “Physician” as “any legally
    qualified physician.”
    The policy also contains the following relevant provisions:
    PROOF OF LOSS
    If the policy provides for a periodic payment for a continuing
    loss, you must give us written proof of loss within 90 days after
    the end of each period for which we are liable. For any other
    written loss, written proof must be given within 90 days after
    such loss. . . .
    TIME OF PAYMENT OF CLAIMS
    After receiving written proof of loss, we will pay monthly all
    benefits then due for disability. Benefits for any other loss
    covered by this policy will be paid as soon as we receive proper
    written proof.
    LEGAL ACTIONS
    No legal action may be brought to recover on this policy within
    60 days after written proof of loss has been given as required by
    this policy. No such action may be brought after three years
    from the time written proof of loss is required to be given.
    Shaps first submitted a claim for disability benefits to Provident Casualty’s
    New York office on or about July 29, 1989, asserting that the nature of her
    4
    sickness or injury was “TMJ syndrome” (temporal mandibular joint disorder) and
    that she last worked in July 1989. Shaps subsequently submitted additional claim
    forms to Provident Casualty’s New York office, and thereby continued to receive
    benefits.
    On September 7, 1990, Provident Casualty made a final payment to Shaps.
    Provident Casualty advised Shaps that it had determined that there was no evidence
    of continuous total disability as defined by her policy, and therefore it was
    discontinuing payments.
    On December 15, 1994, Provident Casualty received from Shaps notice of a
    new claim for disability benefits, dated December 1, 1994. Shaps now stated that
    the nature of her disabling sickness or injury was breast cancer and TMJ syndrome.
    Shaps’ claim form stated that her disabling illness began on October 24, 1994, and
    that she was disabled as of that date. Provident Casualty initially paid benefits on
    this claim. In May 1995, however, Provident Casualty stopped paying benefits on
    this claim. Provident Casualty explained that it stopped paying benefits based on a
    claim form from Shaps’ physician which indicated that Shaps was no longer totally
    disabled. After receiving additional information, Provident Casualty sent Shaps a
    benefit check representing benefits from May through September 1995. Shaps did
    5
    not submit claim forms to Provident Casualty for the period September 8, 1995 to
    April 6, 1996, and Provident in turn sent no payments for that period.
    Shaps filed this lawsuit on September 18, 1995. In her suit, originally filed
    in the Circuit Court for Palm Beach County, Florida, and subsequently removed to
    the Southern District of Florida, Shaps alleged breach of insurance contract,
    naming Provident Life and Accident Insurance Company (“Provident Accident”)
    as the defendant. As amended, Shaps’ complaint eventually alleged three separate
    counts for breach of contract and specific performance against Provident Accident
    and Provident Casualty, and a count for intentional infliction of emotional distress
    against both defendants. Provident Accident and Provident Casualty moved for
    summary judgment on all counts. The district court granted the motion in part,
    dismissing the count for intentional infliction of emotional distress, and ruling that
    in the event Shaps prevailed at trial she would have no claim for attorneys’ fees
    pursuant to Florida law. Shaps thereafter amended her complaint to seek disability
    benefits from October 1990 through the date of trial.
    As noted above, the policy at issue contains a clause providing that no action
    on the policy may be brought more than three years after the time proof of loss was
    required. Provident Casualty first discontinued payments in 1990, and Shaps
    brought suit five years later in 1995. Under New York law, which governs the
    6
    contract, the limitations period for an insurance policy such as this one begins upon
    the termination of the disability. Accordingly, the district court ruled that Shaps’
    breach of contract claim related to the cessation of benefits in September 1990
    would be time-barred unless she could prove that she was continuously disabled
    from October 1990 through October 24, 1994 (when Shaps alleged that a new
    period of disability, for breast cancer as well as TMJ syndrome, commenced).
    The case went to trial in August 1998 on the breach of contract and specific
    performance counts against Provident Accident and Provident Casualty. At trial,
    Provident Casualty presented evidence that Shaps was not continuously disabled
    during the 1990-94 period. In particular, Provident Casualty pointed to evidence
    that during this time Shaps moved to Florida, arranged a mortgage, sold an
    apartment in New York, filed tax returns that stated that she was “disabled” in
    1990, “unemployed” in 1991, “loan officer” in 1992, and “retired” in 1993 and
    1994. Provident Casualty also admitted into evidence Shaps’ March 20, 1991
    application to Federal Kemper Life Insurance Company for a life insurance policy.
    The application lists her occupation as a mortgage loan officer who was “between
    jobs.” The application stated that Shaps received disability payments in the past
    for TMJ as a result of stress, but also stated that she was “doing fine,” with respect
    to TMJ had “[n]o problems. Haven’t seen doctor for 2 years,” and that all of her
    7
    tests were “normal.” Shaps also affirmed on the forms that she had no “mental or
    physical impairment or disease.” The forms were signed by Shaps, although she
    testified at trial that she did not intend to make the statements contained in the
    forms.
    For her part, Shaps presented the testimony of two health care providers that
    she saw during the 1990-94 period. Ethel Green, a social worker who Shaps saw
    from 1990 to 1992, testified that Shaps exhibited the symptoms of general anxiety
    disorder, but stated that she could not testify as a medical expert as to whether
    Shaps was disabled as a result of TMJ syndrome. John Girard, an internist Shaps
    began seeing in 1992, also testified. He stated that he had no medical knowledge
    as to whether Shaps was disabled before he saw her in 1992. He also stated that
    Shaps was disabled from June 1992 through June 1995. Shaps also pursued at trial
    her separate claim that she was denied benefits between September 8, 1995, and
    April 6, 1996, in breach of her insurance contract. Among other things, Shaps
    presented the testimony of her oncologist, Gerald Spunberg, who testified that
    Shaps was totally disabled as a result of breast cancer. Shaps’ psychotherapist,
    Beth Kreakower, testified that it was her opinion that Shaps was unable to perform
    her duties as a loan officer from the time Shaps began seeing her in April 1995
    until Shaps moved to California in April 1996.        At the close of the evidence, the
    8
    trial court directed verdicts in favor of Provident Accident on the counts remaining
    against it -- breach of contract and specific performance -- and in favor of
    Provident Casualty on the count for specific performance. The remaining claims
    for the jury were the breach of contract allegations against Provident Casualty.
    The jury completed a special verdict form, finding that Shaps was not continuously
    disabled within the terms of her Provident disability policy from September 10,
    1990 through October 23, 1994. It then determined that Shaps was continuously
    disabled from September 8, 1995 through April 6, 1996. It also found, however,
    that Shaps failed to comply with the conditions precedent to her disability policy,
    so as to bar her claim for benefits during the second time frame. The district court
    entered final judgment in favor of Provident Accident and Provident Casualty, and
    awarded costs to the defendants.
    II.
    The primary and most complex issue in this appeal is whether the district
    court erred in determining what law applies to the question of which party bears
    the burden of proof on a breach of insurance contract claim when the insurer
    begins to pay total disability benefits to an insured, but later ceases to pay benefits
    because it believes that the insured is not disabled. This Court reviews choice of
    9
    law issues de novo. See Trumpet Vine Instruments, N.V. v. Union Capital Partners
    I, Inc., 
    92 F.3d 1110
    , 1115 (11th Cir. 1996).
    Because the basis of the district court’s jurisdiction was diversity and suit
    was filed in Florida, the district court was required to apply Florida’s conflict-of-
    law rules. See, e.g., Maryland Cas. Co. v. Williams, 
    377 F.2d 389
    , 392 (5th Cir.
    1967) (citing Klaxon Co. v. Stentor Elec. Mfg. Co., 
    313 U.S. 487
    , 496 (1941)).
    Under Florida’s conflict-of-law rules, the doctrine of lex loci contractus directs
    that, in the absence of a contractual provision specifying governing law, a contract,
    other than one for performance of services, is governed by law of the state in which
    the contract is made. See Fioretti v. Massachusetts General Life Ins. Co., 
    53 F.3d 1228
    , 1235 (11th Cir. 1995). The contract here was executed in New York. The
    parties do not dispute that New York law governs interpretation and application of
    the contract, although they vigorously disagree as to what law governs the burden
    of proof in this case.
    As Shaps sees it, Florida courts would not look to New York law in order to
    determine the proper allocation of the burden of proof in this situation. Rather,
    according to Shaps, the burden of proof is a procedural issue for conflict-of-law
    purposes and hence is governed by Florida law even if interpretation of the
    10
    contract is governed by substantive New York law.1 Shaps does not dispute that in
    most instances Florida law places the burden of proof on the insured in a coverage
    dispute. She maintains, however, that under the particular facts present in this
    case, Florida law switches the burden to the insurer -- i.e., Provident -- to prove
    that the insured was not disabled, because Provident had paid disability benefits to
    Shaps before it determined that she was not disabled and discontinued paying her
    benefits. See Aetna Life Ins. Co. v. Fruchter, 
    266 So. 2d 61
    , 63 (Fla. 3d Dist. Ct.
    App. 1972), cert. discharged, 
    283 So. 2d 36
     (Fla. 1973).2 Provident Casualty does
    1
    Whether the Florida courts would -- for conflict-of-law purposes -- view burden of proof
    in this context as a procedural issue, and hence not subject to the lex loci contractus rule applicable
    to substantive contract issues, is analytically distinct from whether the issue is procedural for
    purposes of a federal court applying state law as opposed to federal law in a diversity case. See
    Maryland Cas., 
    377 F.2d at
    393 n.1. With respect to the latter issue, we have ruled that the burden
    of proof in diversity cases must be allocated according to state, not federal, law. See, e.g., Coastal
    Plains Feeders, Inc. v. Hartford Fire Ins. Co., 
    545 F.2d 448
    , 450 n. 5 (5th Cir. 1977). Accordingly,
    when we speak of substance versus procedure in this opinion, we are referring only to how Florida
    law treats the burden of proof for purposes of applying its own choice-of-law rules.
    2
    Provident Casualty insists that Fruchter is not actually implicated here because
    Shaps was not claiming permanent disability; accordingly, says Provident, there is a
    false conflict between Florida and New York law because both would place the
    burden of proof on the insured. According to Provident Casualty, Shaps was not permanently
    disabled and was instead being paid under provisions of the policy that provided for monthly benefit
    checks to be paid after monthly submission of proof of loss. Provident Casualty asserts that in the
    two cases relied upon in Fruchter, Ewing and Lecks, the insureds were permanently disabled.
    Contrary to Provident Casualty’s argument, however, it is not clear to us that the Fruchter rule only
    applies to permanent disabilities and not to cases like Shaps’. Neither the Ewing court nor the
    Lecks court specifically limited the rule to permanent disability payments. Moreover, Fruchter
    itself involved a case of “total disability” (with no mention of permanent disability) and the court
    noted that “the language variation in the policy here and in Lecks and Ewing does not in our
    judgment change the principle applying.”          Notably, the policy provision under which Shaps
    claimed benefits provides: “We will pay the Monthly Benefit for Total Disability . . . .” See also
    11
    not disagree that the burden of proof is generally a procedural issue subject to
    Florida law regardless of the operation of lex loci contractus. It asserts, however,
    that the Fruchter’s unique burden-of-proof rule is substantive and therefore
    inapplicable in a case governed by the substantive law of another state. With
    Fruchter rendered inapplicable, says Provident Casualty, we must fall back on the
    “normal” Florida rule placing the burden of proof on the insured.
    We are not aware of any Florida case law specifically addressing to what
    extent Florida’s burden of proof rules are applicable in a case involving another
    state’s contract laws under the doctrine of lex loci contractus. The Florida
    Supreme Court has held that under lex loci contractus the law of the jurisdiction
    where the contract was executed governs substantive issues regarding the contract,
    such as the interpretation of its terms. See Lumbermens Mut. Cas. Co. v. August,
    
    530 So. 2d 293
    , 295 (Fla. 1988). Shaps maintains that the Florida Supreme Court
    must thereby have intended procedural issues to be governed by Florida law
    regardless of the effect of lex loci contractus. That is the approach taken by the
    Florida Supreme Court in related contexts. See, e.g., Colhoun v. Greyhound Lines,
    Inc., 
    265 So. 2d 18
    , 20 (Fla. 1972) (Florida law, as law of the forum, applied to
    Principal Mut. Life Ins. Co. v. Martin, 
    585 So. 2d 474
    , 475 (Fla. 3d Dist. Ct. App.
    1991) (Fruchter applied in case without mention of permanent disability). There is simply no
    indication that Fruchter is inapplicable because Shaps did not claim permanent disability.
    12
    procedural matters notwithstanding applicability of foreign law to substantive
    matters under lex loci delicti). As a general rule, for conflicts purposes a state will
    view procedural issues as subject to its own laws. See Maryland Cas., 
    377 F.2d at
    393 n.1 (“As a general rule, states will adhere to the law of a foreign state which is
    substantive, but will apply its own law on matters of procedure.”).
    Assuming this proposition to be true, the question then becomes whether
    Florida does in fact view the Fruchter burden of proof rule as procedural. Shaps
    argues that in Florida the burden of proof is generally regarded as a procedural
    issue, and the Fruchter rule is no exception. See Walker & LaBerge, Inc. v.
    Halligan, 
    344 So. 2d 239
    , 243 (Fla. 1977) (noting that “[b]urden of proof
    requirements are procedural”). Provident Casualty, by contrast, insists that the
    Fruchter rule switching the burden of proof to the insurer is a principle of
    substantive law applicable to a particular set of cases. The district court agreed,
    finding that Florida courts view the Fruchter burden of proof rule as substantive,
    not procedural, and that therefore the Fruchter rule must give way under lex loci
    contractus.3 The court explained that the Fruchter rule was “a substantive rule,”
    3
    The substantive law of New York does not contain any rule shifting the burden
    to the insurer in this context. In New York, as ordinarily would be the case in Florida,
    the burden-of-proof is on the insured. See Klein v. National Life of Vermont, 
    7 F. Supp. 2d 223
    , 226 (E.D.N.Y. 1998) (burden of proving total disability within the
    terms of a disability insurance policy falls upon the insured).
    13
    and “certainly not a general procedural rule. Florida doesn’t follow that rule across
    the board in terms of its burden of proof. As they point out, it is a special rule for
    that kind of case that departs from their usual rule and supersedes their standard
    jury instructions.” Accordingly, the district court found that Shaps had the burden
    of proof on the question of whether she was disabled.
    In reaching this conclusion, the district court relied on comments by the
    Florida Supreme Court in its opinion discharging the writ of certiorari in Fruchter.
    In that opinion, the Florida Supreme Court considered whether the trial court erred
    in refusing to give the plaintiff’s requested instruction that the defendant insurance
    company had the burden to show that the alleged total disability had ceased. The
    court noted that “[t]his Court’s standard jury instructions, [placing the burden on
    the plaintiff] while to be generally followed where applicable, are not intended to
    change the substantive law applicable to the case.” Fruchter, 
    283 So. 2d at 37
    (emphasis added). The court upheld the Third DCA’s reversal of the trial court,
    citing New York Life Insurance Co. v. Lecks, 
    122 Fla. 127
     (1936) and Mutual Life
    Insurance Co. v. Ewing, 
    151 Fla. 661
     (1942), both of which held that once the
    insurer has acknowledged a disability by proceeding to make disability payments
    under the policy, then in a suit to redress the discontinuance of payments and to
    force the resumption of them, the burden is cast upon the insurer to prove that the
    14
    disability no longer continues. The Fruchter court stated: “[W]e uphold the Third
    District’s correct application and continued viability as a matter of substantive law
    of the holdings in Lecks and Ewing and the district court’s reversal and remand of
    the cause for a new trial.” 
    283 So. 2d at 38
     (emphasis added).
    A state court’s characterization of an issue as substantive rather than
    procedural for choice-of-law purposes is binding on a federal court. See Maryland
    Cas., 
    377 F.2d at
    393 n.1 (the “characterization adopted by the state courts in this
    regard is conclusive upon the federal court”) (citing United Air Lines, Inc. v.
    Wiener, 
    335 F.2d 379
    , 391 (9th Cir. 1964)). We are unclear, however, whether the
    Florida Supreme Court’s opinion in Fruchter constitutes such a pronouncement.4
    First, the opinion simply discharged as improvidently granted a petition for
    certiorari. It is unclear whether such an opinion can constitute binding precedent.
    Several lower appellate courts in Florida have cited the Florida Supreme Court’s
    opinion as precedent. See, e.g., Mizrahi v. Provident Life & Accident Ins. Co., 
    748 So. 2d 1059
    , 1060 (Fla. 3d Dist. Ct. App. 1999); Principal Mut., 
    585 So. 2d at 475
    .
    On the other hand, Florida courts -- including the Supreme Court itself -- have
    suggested that “denial of certiorari by an appellate court cannot be construed as a
    4
    The parties have not made us aware of any Florida decision other than the Supreme Court’s
    opinion in Fruchter that addresses whether the burden of proof in this context is substantive or
    procedural.
    15
    determination of the issues presented in the petition therefor and cannot be utilized
    as precedent or authority for or against the propositions urged or defended in such
    proceedings.” Southern Bell Tel. & Tel. Co. v. Bell, 
    116 So. 2d 617
    , 619 (Fla.
    1959) (citing Collier v. City of Homestead, 
    81 So. 2d 201
     (Fla. 1955)); see also
    Carol City Utils., Inc. v. Dade County, 
    183 So. 2d 227
    , 231 (Fla. 3d Dist. Ct. App.
    1966).
    Second, it is unclear whether the Florida Supreme Court’s description in
    Fruchter of the burden-of-proof rule in that case as “substantive” was meant to
    establish that rule as an element of substantive Florida law for conflict-of-laws
    purposes. Although the opinion seems to mean just that, conflict-of-laws was not
    an issue in the case. For the foregoing reasons, and given the importance of the
    issue to proper resolution of this appeal, we think the most prudent course is to
    certify the question to the Florida Supreme Court.
    Shaps makes a related argument that even if the Fruchter burden of proof
    rule is a substantive component of Florida law that should be rendered inapplicable
    to this case by operation of lex loci contractus, the rule should nevertheless be
    applied here because Florida public policy supports placing the burden on the
    insured in this situation. See Gillen v. United Services Auto. Ass’n, 
    300 So. 2d 3
    ,
    6 (Fla. 1974). Because that argument may be inextricably intertwined with
    16
    resolution of the threshold choice-of-law issue, in an abundance of caution we shall
    certify that question as well.5
    Accordingly, we respectfully certify the following two questions to the
    Florida Supreme Court:
    1.     Is the burden of proof rule recognized in Aetna Life Insurance
    Co. v. Fruchter, 
    266 So. 2d 61
     (Fla. 3d Dist. Ct. App. 1972),
    cert. discharged, 
    283 So. 2d 36
     (Fla. 1973), part of the
    substantive law of Florida, such that it would not be applied in a
    case where under Florida’s doctrine of lex loci contractus the
    substantive law of another state (New York) governs the
    parties’ contract dispute?
    2.     Would requiring the insured to prove disability in this context
    violate the public policy of Florida, such that the burden of
    proof must be placed on the insurer? See Gillen v. United
    Services Automobile Ass’n, 
    300 So. 2d 3
     (Fla. 1974).
    We stress that our formulation of these questions is not meant to limit the
    scope of inquiry by the Supreme Court of Florida. As we have explained
    5
    Shaps argues that the Florida Supreme Court has clearly expressed Florida’s
    public policy that the insured be afforded benefits under her policy unless and until
    the insurer provides sufficient evidence to support its decision that the insured is no
    longer disabled. Provident Casualty responds, among other things, that the fact that
    the law differs between Florida and another jurisdiction does not in itself bar
    application of foreign law. See Herron v. Passailaigue, 
    110 So. 539
    , 542 (Fla. 1926)
    (public policy interest must be of “paramount importance” to warrant application of
    Florida law); see also Sturiano v. Brooks, 
    523 So. 2d 1126
     (Fla. 1988) (applying lex
    loci contractus and holding that New York law applied even though New York law
    precluded one spouse’s recovery in an action against the other spouse unless the
    insurance policy expressly provided for the claim, and Florida law did not have that
    limitation).
    17
    previously, “the particular phrasing used in the certified question is not to restrict
    the Supreme Court’s consideration of the problems involved and the issues as the
    Supreme Court perceives them to be in its analysis . . . . This latitude extends to
    the Supreme Court’s restatement of the issue or issues and the manner in which the
    answers are to be given. . . .” Martinez v. Rodriquez, 
    394 F.2d 156
    , 159 n.6 (5th
    Cir. 1968). To assist the Florida Supreme Court in its determination, the entire
    record in this case, together with copies of the briefs of the parties, are transmitted
    herewith.
    III.
    As for Shaps’ remaining objections, we find no merit in them, and therefore
    resolve them at this time.6
    First, Shaps contends that the district court erred by allowing Provident
    Casualty to maintain that the policy required Shaps to submit proof of loss forms
    every thirty days as a precondition to payment for each month of claimed
    disability. Shaps argues that there was nothing in the policy that required her to
    provide proof of loss claims every thirty days throughout the course of her total
    disability. She cites the language in her policy stating that “[i]f the policy provides
    for a periodic payment for a continuing loss, you must give us written Proofs of
    6
    These objections concern New York and federal law, not Florida law.
    18
    Loss within ninety (90) days after the end of each period for which we are liable.”
    She also cites Panepinto v. New York Mutual Life Insurance Co., 
    688 N.E.2d 241
    (N.Y. 1997), in which the court rejected an insurer’s argument that similar
    language in the policy before it meant that the insured must file proof of loss
    claims no later than ninety days after the end of each monthly time frame for which
    the policy is obligated to pay benefits. Shaps argues that reversal is required
    because Provident Casualty improperly argued that Shaps was required to file
    monthly proof of loss claims, and improperly questioned her about the fact that she
    did not always file monthly claims.
    Provident Casualty responds that Shaps’ trial counsel failed to object to
    Provident’s argument and cross-examination on this issue at trial, and cannot now
    raise the issue on appeal. Provident also argues that the Panepinto court’s analysis
    only concerned the timing of proof of loss forms as they affected the relevant
    statute of limitations. Provident Casualty quotes from the opinion:
    Concededly, the construction of the language that we embrace here
    could postpone the commencement of the limitations period
    indefinitely while the insured remains continuously disabled. . . . We
    reject New York Life’s contention that this interpretation will open
    the floodgates to stale claims. In this respect, we agree with the
    analysis of the Supreme Court of Minnesota: “An insured is not likely
    to wait years before filing proof of loss because he would want to
    receive benefits as soon as possible.”
    19
    Id. at 388. Even under Panepinto, according to Provident Casualty, submission of
    proof of loss is still a condition precedent for payment of a claim. In addition,
    Provident Casualty highlights unique language in Shaps’ policy providing: “Time
    of Payment of Claims -- After receiving written proof of loss, we will pay monthly
    all benefits then due you for your disability.”
    Shaps did not object in the district court to the argument and cross-
    examination she now argues was erroneous. Moreover, Shaps has not provided
    any record citations for the argument and cross-examination questions to which she
    now objects. This Court has held that “[w]hen no objections are raised, we review
    the arguments for plain error, but a finding of plain error ‘is seldom justified in
    reviewing argument of counsel in a civil case.’” Oxford Furniture Companies,
    Inc. v. Drexel Heritage Furnishings, Inc., 
    984 F.2d 1118
    , 1128 (11th Cir. 1993).
    A new trial may be ordered only “when the interests of substantial justice are at
    stake.” 
    Id.
    Shaps has failed to demonstrate that Provident Casualty’s argument and
    cross-examination were plainly erroneous. The court in Panepinto did hold, in the
    context of determining the limitation period on the plaintiff’s claim, that “‘period
    of disability’ does not mean a monthly segment of the disability, but rather the
    entire period of disability for which benefits are available under the policies.” 688
    20
    N.E.2d at 244. The Panepinto court did not, however, consider a provision like the
    one in Shaps’ policy providing that “[a]fter receiving written proof of loss, we will
    pay monthly all benefits then due you for your disability” (emphasis added). This
    language in Shaps’ policy is ambiguous, and could fairly be interpreted to mean
    that written proof of loss is indeed required in the manner Provident suggests.
    Given this ambiguous language, we cannot conclude that the district court plainly
    erred by allowing Provident Casualty to propose that the policy required Shaps to
    submit proof of loss claims every thirty days.
    Second, Shaps argues that the District Court erred by admitting
    hearsay evidence. Specifically, she asserts that the district court should not have
    allowed Provident’s counsel to cross-examine her regarding her applications for
    life insurance policies. Shaps contends that the documents contain hearsay and
    double hearsay because the statements made in the documents were not made by
    her.
    A “district court’s evidentiary rulings are not subject to disturbance on
    appeal absent a clear abuse of discretion.” United States v. Sellers, 
    906 F.2d 597
    ,
    601 (11th Cir. 1990). Shaps has failed to demonstrate that the district court clearly
    abused its discretion in admitting this evidence. The documents about which
    Shaps complains include Kemper Life insurance policy and application file, which
    21
    included five documents that were signed by her. The documents contained
    statements indicating that Shaps was not continuously disabled from 1990 through
    1994. Provident Casualty’s counsel cross-examined Shaps about the documents
    after Shaps’ counsel questioned her about preparation of the documents. Shaps
    suggests that the documents were hearsay simply because she did not fill them out.
    But there is no question here that the life insurance policy and application about
    which Shaps was questioned were signed by her and prepared as part of her
    application for a life insurance policy. Moreover, Shaps’ counsel initiated the
    discussion of the documents on direct examination, opening the door to further
    inquiry. Accordingly, the district court did not abuse its discretion in allowing
    Shaps to be cross-examined about statements contained in the Kemper life
    insurance policy that she admittedly took out and signed.
    Third, Shaps argues that the district court erred by allowing Provident
    Casualty to admit evidence of Shaps’ financial condition. Shaps argues that under
    this Court’s law, as well as the laws of Florida and New York, a jury may not be
    informed of the wealth or poverty of the parties, and Provident’s attempt to portray
    Shaps as someone who is not in financial need of disability benefits was a
    prejudicial attempt to sway the jury against her.
    22
    Provident Casualty responds that Shaps opened the door to cross-
    examination on her financial condition when her counsel remarked in his opening
    statement that Shaps “had been expecting to receive her check from Provident that
    she had been relying upon to meet her needs, her financial needs.” In addition, on
    direct examination, Shaps testified about her income tax returns, a life insurance
    policy and a trust established for her sons, and her inability to pay for treatment
    because her COBRA insurance had run out. Provident Casualty argues that it
    cross-examined Shaps on statements she made in her income tax returns as to her
    occupation, and also to counteract her assertion on direct examination that she
    could not afford therapy when she contemporaneously made a lump sum payment
    of $95,000 on her mortgage.
    The district court did not abuse its discretion in allowing Provident
    Casualty to question Shaps about the statements on her tax returns about her
    occupation and about her mortgage payment. This Court has held that a jury
    should not be advised about the wealth or poverty of the parties, although it noted
    that there are exceptions to this general rule. See Warren v. Ford Motor Credit
    Co., 
    693 F.2d 1373
    , 1378 (11th Cir. 1982). Here, however, Shaps initiated the
    discussion of her financial condition, through her counsel’s claim that she was
    financially dependent on the benefits as well as her own testimony that she could
    23
    not afford therapy. Although Shaps argues that Provident Casualty questioned her
    about these issues in an attempt to portray her as someone who is not in financial
    need of disability benefits as a prejudicial attempt to sway the jury against her,
    Shaps’ opening statement and testimony on direct that she was in financial need of
    the benefits was itself an attempt to sway the jury. Provident Casualty was
    essentially responding to Shaps’ assertions.   Accordingly, the district court did
    not abuse its discretion in admitting this evidence.
    Finally, Shaps argues that the district court erred by rejecting her proposed
    jury instruction on her theory of waiver. In essence, Shaps contends that Provident
    Casualty waived its right to insist on compliance with any asserted condition
    precedent regarding continuous submission of monthly proof of loss forms, by
    wrongfully terminating her disability benefits in 1990 and thereby committing an
    anticipatory breach of contract. Shaps cites to both New York and Florida
    caselaw holding that once an insurer disclaims liability the insured is excused from
    fulfilling any obligations under the policy and the insurer otherwise waives
    its rights under the policy. See Reed v. Commercial Union Ins. Co., 
    468 N.Y.S.2d 738
    , 739 (N.Y. 1983); Leonardo v. State Farm Fire and Cas. Co., 
    675 So. 2d 176
    ,
    178 (Fla. 4th Dist. Ct. App. 1996); Wegener v. International Bankers Ins. Co., 
    494 So. 2d 259
     (Fla. 3d Dist. Ct. App. 1986).
    24
    Shaps’ proposed jury instruction stated:
    If, however, you find that by the greater weight of the evidence the
    Defendants, Provident Life and Accident Insurance Company and/or
    Provident Life and Casualty Insurance Company, did have clean
    hands, then you must next decide whether the Defendants, Provident
    Life and Accident Insurance Company and/or Provident Life and
    Casualty Company, by their own conduct have waived the provisions
    of the policy requiring the Plaintiff, Audrey Shaps, to be under the
    care and attendance of a physician, and submit proofs of loss. Waiver
    is the voluntary and intentional relinquishment of a known right. If
    the greater weight of the evidence shows that Defendants, Provident
    Life and Accident Insurance Company and/or Provident Life and
    Casualty Company, have waived its right to require that Plaintiff,
    Audrey Shaps, be under the care and attendance of a physician and to
    submit proofs of loss then you should rule against the Defendants on
    their defense that Plaintiff, Audrey Shaps, failed to comply with
    conditions precedent to the policy. If, however, you find that the
    Defendants, Provident Life and Accident Insurance Company and/or
    Provident Life and Casualty Insurance Company, did not waive their
    rights you must determine whether the Plaintiff, Audrey Shaps,
    complied with the conditions precedent to the policy.
    Provident Casualty responds that the cases cited by Shaps are inapposite
    because none involve disability insurance and all involve an attempt by the insurer
    to void, cancel, or rescind the policy at issue; that is, a repudiation. Provident
    Casualty argues that the evidence at trial was inconsistent with a repudiation
    because it advised Shaps that it would review the claim further if she supplied
    additional medical facts, because Shaps continued to pay premiums, and because
    Provident Casualty paid benefits on Shaps’ December 1994 claim. Provident
    Casualty also observes that Shaps did receive a jury instruction on waiver based on
    25
    a request by Shaps’ counsel on the morning of closing arguments. That jury
    instruction stated:
    [A] policyholder may not be required to perform conditions on time
    which are futile. If you find that Provident refused to honor Shaps’
    claims in an unconditional way, you may find that any subsequent
    omission in filing proofs of claim for the continuance of the same
    disability was waived by the conduct of Provident.
    Jury instructions are reviewed only for abuse of discretion. See Roberts &
    Schaefer Co. v. Hardaway Co., 
    152 F.3d 1283
    , 1295 (11th Cir. 1998). The
    instructions and the verdict form will be affirmed so long as they are sufficiently
    instructed and do not mislead the jury, even if an isolated clause is inaccurate,
    ambiguous, or incomplete. See Watkins v. Bowden, 
    105 F.3d 1344
    , 1356 (11th
    Cir. 1997). A district court’s refusal to give a requested instruction “is error only if
    the requested instruction is correct, not adequately covered by the charge given,
    and involves a point so important that failure to give the instruction seriously
    impaired the party’s ability to present an effective case.” See Wood v. President
    and Trustees of Spring Hill College, 
    978 F.2d 1214
    , 1222 (11th Cir. 1992).
    We find no reversible error. As Provident Casualty points out, the decisions
    cited by Shaps are inapplicable to her case. For example, in Reed, the plaintiff
    obtained an insurance policy covering an apartment building she owned against
    loss due to fire. The building suffered fire damage and the insurance company
    26
    disclaimed liability on the ground that the policy had been cancelled a month
    before the fire. The court held that once an insurer disclaims liability, an insured
    is excused from fulfilling any of the obligations under the policy. 468 N.Y.S.2d at
    739. In this case, however, Provident Casualty did not repudiate the policy.
    Instead, Provident Casualty found that Shaps was no longer disabled at that
    particular time, and it stated that it would reconsider the claim if Shaps had
    additional evidence. Shaps continued to pay on the policy, and Provident Casualty
    paid benefits on her later claim. Accordingly, there was no repudiation and Shaps
    was not necessarily excused from complying with the policy’s conditions
    precedent.
    Moreover, the district court did instruct the jury that a policyholder may not
    be required to perform conditions which are futile. Because the law cited by Shaps
    applies only in cases where a contract is repudiated, and also because the
    instruction on futility adequately covered the issue of waiver and Shaps’ obligation
    to fulfill conditions precedent, on the record before us we cannot say that the
    district court abused its discretion in declining to give Shaps’ requested jury
    instruction. Accordingly, on this issue as well, the district court did not commit
    reversible error.
    27
    To summarize, we find all of Shaps’ objections to be insufficient on this
    record, save one regarding the burden of proof. With respect that issue, we certify
    to the Florida Supreme Court a pair of questions relating to the proper allocation of
    the burden of proof. We therefore withhold final decision about the district
    court’s entry of judgment in Provident Casualty’s favor until we receive the answer
    to these questions.
    QUESTIONS CERTIFIED.
    28
    

Document Info

Docket Number: 98-5500

Filed Date: 3/16/2001

Precedential Status: Precedential

Modified Date: 12/21/2014

Authorities (28)

Eusebio M. Martinez, Father of Jacqueline M. Martinez, a ... , 394 F.2d 156 ( 1968 )

Klein v. National Life of Vermont , 7 F. Supp. 2d 223 ( 1998 )

Jennifer Wood Carol Wood W.B. Wood v. The President and ... , 978 F.3d 1214 ( 1992 )

Gillen v. United Services Automobile Association , 1974 Fla. LEXIS 4731 ( 1974 )

Sturiano v. Brooks , 523 So. 2d 1126 ( 1988 )

Southern Bell Telephone & Telegraph Co. v. Bell , 116 So. 2d 617 ( 1959 )

Glen Warren and Peggy Warren v. Ford Motor Credit Company ... , 693 F.2d 1373 ( 1982 )

Klaxon Co. v. Stentor Electric Manufacturing Co. , 61 S. Ct. 1020 ( 1941 )

Walker & LaBerge, Inc. v. Halligan , 344 So. 2d 239 ( 1977 )

vincent-fioretti-plaintiff-counter-defendant-appellant-cross-appellee-v , 53 F.3d 1228 ( 1995 )

Principal Mut. Life Ins. Co. v. Martin , 585 So. 2d 474 ( 1991 )

Lumbermens Mut. Cas. Co. v. August , 13 Fla. L. Weekly 516 ( 1988 )

Coastal Plains Feeders, Inc., Cross v. Hartford Fire ... , 545 F.2d 448 ( 1977 )

Perez v. State , 81 So. 2d 201 ( 1955 )

United Air Lines, Inc. v. Janice Wiener and Catherine B. ... , 335 F.2d 379 ( 1964 )

Trumpet Vine Investments, N v. v. Union Capital Partners I, ... , 92 F.3d 1110 ( 1996 )

Wegener v. International Bankers Ins. Co. , 11 Fla. L. Weekly 1927 ( 1986 )

Roberts & Schaefer v. Hardaway Co. , 152 F.3d 1283 ( 1998 )

maryland-casualty-company-and-united-services-automobile-association-v , 377 F.2d 389 ( 1967 )

United States v. Danny Sellers and Terry Roach , 906 F.2d 597 ( 1990 )

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