The defendant insurer, SSQ, Life Insurance Company Inc., brought a motion for summary judgment to dismiss the plaintiff's action for long-term disability benefits.
SSQ argued that the plaintiff, Judith Marlen Fricke, had waived her right to sue by agreeing to a Medical Appeals Process (MAP) which resulted in a binding decision that she was not totally disabled.
The plaintiff contended that the MAP agreement was not valid or enforceable because SSQ failed to apply the correct legal test for total disability and the independent physician may have exceeded his expertise.
The court dismissed SSQ's motion for summary judgment, finding a genuine issue requiring a trial regarding whether the correct test for total disability was applied during the MAP process and the enforceability of the MAP agreement given potential issues of bias and fairness.