APRIL 2008 BAD FAITH CASES COURT ALLOWS INSURED’S CLAIM TO STOP APPLICATION OF SETOFF PROVISION TO PROCEED, DESPITE CLEAR & UNAMBIGUOUS POLICY LANGUAGE TO THE CONTRARY (Philadelphia Federal)

In Romeo v. Unumprovident, the insured was unable to return to her job due to a motor vehicle accident.  Consequently, she began receiving benefits under a disability insurance policy.  The policy provided that her benefits would be reduced, or setoff, against any government retirement and disability fund benefits she may receive.  Sometime later, a representative for the insurer contacted her and inquired whether she received any such government benefits.  When she stated she did receive government benefits, the insurer’s representative promised her that no setoff would be taken.  The insured filed a claim for “equitable estoppel,” arguing that the insurer should be estopped from applying the setoff due to the promises of the insurer’s agent.  The insurer argued that, as a matter of law, the insurance policy unambiguously provided that the setoff will apply to her benefits.  The Court treated her claim as one for “promissory estoppel,” and found that she could conceivably prove that she had a reasonable expectation of coverage due to the promises and representations of the insurer’s agent.  Despite the clear and unambiguous language in the policy, therefore, the Court declined to enter judgment as a matter of law.
Date of Decision:  February 11, 2008
Romeo v. Unumprovident Corp., United States District Court for the Eastern District of Pennsylvania, No. 07-1211, 2008 U.S Dist. LEXIS 10199 (E.D. Pa. February 11, 2008) (Yohn, J.)
J.H.