Delapp v. Union Central Life Insurance Co
2:17-cv-00042
W.D. La.Sep 27, 2017Background
- Dr. John David DeLapp purchased and maintained disability insurance with Ameritas (formerly Union Central) beginning in 2006.
- He suffered a severe injury in a skiing accident on December 23, 2013, requiring emergency aortic surgery.
- Policy required written proof of loss within 90 days after the end of the first month benefits are due, with an additional extension not to exceed one year unless legally incapacitated.
- Ameritas provided a disability packet December 27, 2013; forms were re-sent September 23, 2015; DeLapp submitted Notice of Claim and Proof of Loss on September 29, 2016.
- Ameritas moved for partial summary judgment to bar recovery for benefits accruing before June 29, 2015 as untimely; DeLapp argued the insurer must show actual prejudice from the late filing.
- The court denied the motion, concluding Ameritas did not prove actual prejudice from the untimely proof of loss.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether benefits accruing before June 29, 2015 are barred for failure to timely submit Proof of Loss | DeLapp: insurer must prove actual prejudice to deny claim for late notice/proof | Ameritas: policy limits filing to 90 days + 1-year extension; Proof of Loss due by June 29, 2015; late filing bars earlier benefits | Court: denied summary judgment — Ameritas did not show actual prejudice from late filing |
| Whether the policy’s one-year extension (absent legal incapacity) is enforceable without proof of prejudice | DeLapp: insurer must show prejudice despite clear time limits | Ameritas: policy language allows fixed extension and enforces deadlines | Court: applied Louisiana precedent requiring insurer to prove actual prejudice; Ameritas failed to do so |
Key Cases Cited
- Anderson v. Liberty Lobby, 477 U.S. 242 (summary judgment standard)
- Celotex Corp. v. Catrett, 477 U.S. 317 (summary judgment burden-shifting)
- Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (probative evidence standard for summary judgment)
- Lujan v. Nat'l Wildlife Fed'n, 497 U.S. 871 (viewing evidence in light most favorable to nonmovant)
- Deville v. Life Ins. Co. of Va., 560 So.2d 690 (La. Ct. App.) (insurer must prove actual prejudice for late notice/proof)