United States District Court, D. Colorado
GENE E. BOLLES, M.D., Plaintiff,
PRINCIPAL LIFE INSURANCE COMPANY, Defendant.
A. BRIMMER UNITED STATES DISTRICT JUDGE.
matter comes before the Court on Defendant Principal Life
Insurance Company's Motion to Dismiss Plaintiff's
Complaint in Its Entirety with Prejudice Pursuant to Rule
12(B)(6) [Docket No. 10] and Defendant Principal Life
Insurance Company's Amended Memorandum of Law in Support
of Its Motion to Dismiss [Docket No. 15]. This Court has
subject matter jurisdiction pursuant to 28 U.S.C. §
case arises out of a dispute over long term disability
benefits. Plaintiff is a neurosurgeon employed by the Denver
Health and Hospital Authority. Docket No. 4 at 4-5, ¶ 2.
On November 21, 2016, plaintiff became disabled when he was
no longer able to perform the duties of his job. Id.
at 5, ¶ 3. At the time plaintiff became disabled, the
Denver Health and Hospital Authority had an insurance policy
with Principal Life Insurance Company that provided plaintiff
with short term and long term disability benefits.
Id., ¶ 4. Plaintiff was approved for short term
disability benefits through May 20, 2017.
March 24, 2017, plaintiff received a letter from defendant
approving his application for long term disability benefits.
Id., ¶ 5; see also Id. at 9 (Exhibit
A). The letter stated that “[s]ince [plaintiff was]
over the age of 72 when [he] ceased work the Long Term
Disability policy limit[ed] the maximum duration of benefits
to 12 months.” Id. at 9-10. In an email to the
adjuster, plaintiff challenged the one-year limitation on the
ground that the “own occupation” provisions of
the insurance policy entitled plaintiff to long term
disability benefits for two years. Id. at 5, ¶
6. The policy defines “own occupation” as
“[t]he occupation you are routinely performing when
Disability begins” and “Own Occupation
Period” as “[t]he first two year(s) of the
Benefit Payment Period.” Id. at 6,
¶¶ 8, 10. “Own Occupation Period” is
further listed in the “Long Term Disability Insurance
Summary” next to the phrase “two year(s).”
Id. at 5-6, ¶ 7; see also Id. at
April 3, 2017, the adjuster sent plaintiff a letter rejecting
his appeal. Id. at 5, ¶ 6; see also
Id. at 22. The letter did not address the “own
occupation” language of the policy. Id. at 5,
¶ 6; see also Id. at 22.
filed this lawsuit in the District Court for the City and
County of Denver, Colorado on or about April 24, 2017. Docket
No. 1 at 1; see also Docket No. 1-1 at 2-3. On May
17, 2017, defendant removed the case to this Court on the
basis of diversity jurisdiction. Docket No. 1 at 2-3. In his
complaint, plaintiff seeks a declaratory judgment that he is
entitled to long term disability benefits for a period of two
years under the terms of defendant's insurance policy.
Docket No. 4 at 4. On May 24, 2017, defendant filed a motion
to dismiss the complaint for failure to state a claim under
Fed.R.Civ.P. 12(b)(6). Docket No. 10. Defendant filed an
amended memorandum of law in support of that motion on June
7, 2017. Docket No. 15. Plaintiff filed a response on June
13, 2017, Docket No. 18, to which defendant replied on June
27, 2017. Docket No. 22.
survive a motion to dismiss under Rule 12(b)(6), a complaint
must allege enough factual matter that, taken as true, makes
the plaintiffs' “claim to relief . . . plausible on
its face.” Bryson v. Gonzales, 534 F.3d 1282,
1286 (10th Cir. 2008) (citing Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 570 (2007)). “[W]here the
well-pleaded facts do not permit the court to infer more than
the mere possibility of misconduct, the complaint has alleged
- but it has not shown - that the pleader is entitled to
relief.” Ashcroft v. Iqbal, 556 U.S. 662, 679
(2009) (internal quotation marks and alteration marks
omitted). Thus, even though modern rules of pleading are
somewhat forgiving, “a complaint still must contain
either direct or inferential allegations respecting all the
material elements necessary to sustain a recovery under some
viable legal theory.” Bryson, 534 F.3d at 1286
(alteration marks omitted).
argues that plaintiff has failed to state a claim for which
relief can be granted under Rule 12(b)(6) because the
insurance policy unambiguously limits the duration of long
term disability benefit payments to 12 months for a person of
plaintiff's age. Docket No. 15 at 1. In response,
plaintiff contends that his long term disability benefits
were governed by the “own occupation” provisions
of the insurance policy, which provide for a benefits period
of two years. Docket No. 18 at 5-8.
Colorado, “[t]he interpretation of an insurance
contract is a question of law” to which traditional
principles of contract interpretation apply. USAA Cas.
Ins. Co. v. Anglum, 119 P.3d 1058, 1059 (Colo. 2005);
Chacon v. Am. Family Mut. Ins. Co., 788 P.2d 748,
750 (Colo. 1990). Thus, courts construing the terms of an
insurance policy must “give effect to the intent and
reasonable expectations of the parties.” Hoang v.
Assurance Co. of Am., 149 P.3d 798, 801 (Colo. 2007).
This means affording words in the policy “their plain
meaning according to common usage” and avoiding
“strained constructions.” Allstate Ins. Co.
v. Starke, 797 P.2d 14, 18 (Colo. 1990). When policy
language is ambiguous - i.e., when it is “reasonably
susceptible on its face to more than one
interpretation” upon evaluation of the policy as a
whole, State Farm Mut. Auto Ins. Co. v. Stein, 940
P.2d 384, 387 (Colo. 1997) - it must be “construed
against the insurer . . . and in favor of the insured.”
Id. at 390.
parties' dispute centers on the relationship between two
sets of provisions in the insurance policy - the
“Benefit Payment Period” provisions and the
“Own Occupation” provisions. The policy
defines “Benefit Payment Period” as “[t]he
period of time during which benefits are payable.”
Docket No. 18-1 at 8. Section M, Article 1 of the policy,
which is entitled “Benefit Payment Period, ”
further provides that, “if Disability begins at or
after age 65, ” benefits are payable “until the
later of the date of Social ...