People For the American Way

Biden Judge Gives Victim of Cancelled Policy the Opportunity to Recover Damages from Insurance Company

News and Analysis
Biden Judge Gives Victim of Cancelled Policy the Opportunity to Recover Damages from  Insurance Company

Judge Julie Rikelman,  nominated by President Biden to the First Circuit, wrote a unanimous opinion that stayed a lower court ruling and gave a person whose disability insurance policy was cancelled the chance to recover damages from the insurance company for improperly cancelling the policy.  The December 2023 decision was in  Smith v Prudential Insurance Co.


What happened in this case?

 Brian Smith, a Rhode Island accountant, and vice president at a technology company, began experiencing cognitive decline and was diagnosed with cognitive impairment. Physicians determined that he could “no longer work as a tax professional”, so he left his job. He sought benefits under a long-term disability policy he had obtained from Prudential Insurance Co. Prudential paid him benefits for more than two years, and then abruptly told him it would cancel his policy the next day on May 4, 2018. He pursued required administrative appeals and got a final denial on August 28, 2019. He filed suit against Prudential in federal court within three years of when it stopped paying his benefits on March 12, 2021.

 Prudential asserted, however, that under a complex “limitations scheme” that Judge Rikelman characterized as “mystifying,”  Smith  was required to file the lawsuit before it actually cancelled the policy and thus moved for summary judgment against him. Without considering several of Smith’s arguments, including the contention that applying Prudential’s complex scheme would violate Rhode Island law,  the district judge granted Prudential’s motion and dismissed the case. Smith appealed to the First Circuit.

How did Judge Rikelman and the First Circuit Rule and Why is it Important?

 Judge Rikelman wrote a unanimous opinion that stayed the ruling below and certified to the Rhode Island Supreme Court the question of whether state law and public policy would preclude the application of Prudential’s complex scheme concerning filing suit against it for cancelling the policy.  After carefully explaining the “byzantine” Prudential limitations scheme, Judge Rikelman recognized that state law should govern on whether the scheme could apply to bar Smith’s claims. She noted that the state supreme court had “condemned” the “Alice in Wonderland effect” of allowing a limitations period to “begin to run” before the breach of contract had even occurred, which was Prudential’s assertion here. The state supreme court, she went on, has held that doing so would be “palpably unjust.”  Following First Circuit and Rhode Island precedent, the court certified the issue to the state supreme court and kept jurisdiction over the case so that, after receiving an answer to the question, it could apply it to Smith’s case.  Judge Rikelman wrote that there are “compelling reasons” for concluding that the Prudential’s scheme “would violate Rhode Island public policy.”

 Judge Rikelman’s ruling is obviously important to provide Brian Smith the opportunity to get justice for the abrupt cancellation of his disability insurance policy from Prudential. It is also significant in future cases, particularly in Rhode Island and the First Circuit, where big corporations try to use complex and technical statute of limitations and other clauses unfairly against consumers. In addition,  the ruling is an important reminder of the significance of promptly confirming high-quality Biden nominees like Judge Rikelman to our federal courts.