Acquista v. N.Y. Life Ins. Co. - 285 A.D.2d 73, 730 N.Y.S.2d 272 (App. Div. 1st Dept. 2001)

Rule:

Upon review of a motion made pursuant to N.Y. C.P.L.R. 3211, an appellate court is required to accept as true the allegations of the complaint. While factual claims flatly contradicted by indisputable documentary evidence are not entitled to such consideration, where the pleaded facts state a cause of action, documentary evidence may result in dismissal only where it has been shown that a material fact as claimed by the pleader is not a fact at all and no significant dispute exists regarding it.

Facts:

In November 1995, plaintiff, Angelo Acquista, a physician with specialties in internal and pulmonary medicine, initially became ill. Dr. Acquista was ultimately informed of a possible diagnosis of myelodysplasia, a disease that might convert into leukemia. His treating physicians instructed him to avoid exposure to radiation. He suffered generally from easy fatigue, headaches, and diffuse muscle and joint pain.  However, his application for disability benefits under the three disability insurance policies was rejected by the defendant New York Life Insurance Company, on the ground that he can still perform some of "the substantial and material duties" of his regular job or jobs and therefore is not "totally disabled." The defendant filed a motion to dismiss. The IAS court concluded that even though plaintiff was unable to perform bronchoscopies and other procedures using radiology during the relevant time period, he remained able to practice internal medicine as well as aspects of pulmonary medicine that do not necessitate exposure to radiation.

Issue:

Did the court err in dismissing the case?

Answer:

Yes.

Conclusion:

Upon review of a motion made pursuant to N.Y. C.P.L.R. 3211, an appellate court is required to accept as true the allegations of the complaint. While factual claims flatly contradicted by indisputable documentary evidence are not entitled to such consideration, where the pleaded facts state a cause of action, documentary evidence may result in dismissal only where it has been shown that a material fact as claimed by the pleader is not a fact at all and no significant dispute exists regarding it.

The IAS court erred in dismissing plaintiff's breach of contract claims on the basis of documents submitted by defendant indicating that plaintiff remained able to practice internal medicine as well as certain aspects of pulmonary medicine that do not necessitate exposure to radiation. In order to prevail on its summary judgment motion, defendant's documents must conclusively establish, as a matter of law, that plaintiff is still able to perform "the substantial and material duties" of his regular job or jobs as they existed before he became ill. In view of plaintiff's showing that he earned 90% of his income as a pulmonologist and can no longer practice pulmonary medicine, a factual issue exists as to whether those tasks that plaintiff is still demonstrably able to handle, such as seeing a limited number of patients who can make office visits, are substantial enough to amount to the ability to perform "the substantial and material duties" of his regular job or jobs as they existed prior to the onset of his illness.