Metropolitan Life Ins. Co. v. McCarson
467 So.2d 277, 1985 Fla. LEXIS 3223, 10 Fla. L. Weekly 154 (1985)
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Rule of Law:
Florida recognizes the tort of intentional infliction of emotional distress, requiring conduct so outrageous and extreme as to be utterly intolerable in a civilized community. However, an actor's conduct is privileged and does not meet this standard when they do no more than insist upon their legal rights in a permissible way, even if aware that doing so will cause severe emotional distress.
Facts:
- Ernest McCarson held a group health insurance policy from Metropolitan Life Insurance Company that covered his wife, Lucille McCarson.
- Lucille McCarson became incapacitated with Alzheimer's disease and required round-the-clock nursing care.
- The policy obligated Metropolitan to pay for this care until the policy lapsed or Mrs. McCarson became eligible for Medicare.
- Metropolitan requested that the McCarsons provide proof of Mrs. McCarson's ineligibility for Medicare, as permitted by the policy.
- After receiving no response to its request, Metropolitan discontinued payments for the nursing care.
- Consequently, the at-home, round-the-clock nursing care for Mrs. McCarson ceased.
- Mrs. McCarson was then removed from her home and placed in a total care nursing facility.
- Her condition deteriorated significantly after the move, and she died of a heart attack a few months later; medical testimony indicated the stress of the move likely contributed to her death.
Procedural Posture:
- Ernest McCarson, as personal representative for his late wife Lucille, sued Metropolitan Life Insurance Company in a Florida trial court for wrongful death, predicated on a theory of intentional infliction of emotional distress.
- A jury returned a verdict for McCarson, awarding damages for wrongful death.
- The trial court denied Metropolitan's post-trial motions and upheld the wrongful death award.
- Metropolitan (appellant) appealed the judgment to the Florida Fourth District Court of Appeal.
- The Fourth District Court of Appeal affirmed the trial court's judgment, holding there was a sufficient cause of action for intentional infliction of emotional distress to support the wrongful death claim.
- Metropolitan (petitioner) sought review from the Supreme Court of Florida, which granted review based on a direct conflict with a decision from another district court.
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Issue:
Does an insurer's discontinuation of benefits, in order to insist upon its contractual right to receive proof of a beneficiary's ineligibility for other coverage, constitute extreme and outrageous conduct sufficient to support a claim for intentional infliction of emotional distress?
Opinions:
Majority - Ehrlich, J.
No. An insurer's conduct does not rise to the level of extreme and outrageous when it does no more than assert its legal rights in a legally permissible way. While Florida recognizes the tort of intentional infliction of emotional distress as defined in the Restatement (Second) of Torts § 46, liability is found only for conduct that is 'so outrageous in character, and so extreme in degree, as to go beyond all possible bounds of decency.' Metropolitan's demand for proof of Medicare ineligibility and subsequent withholding of benefits was an assertion of its legal rights under the policy. Such actions are 'privileged under the circumstances' and cannot, as a matter of law, be considered outrageous. Furthermore, the wrongful death claim fails because Lucille McCarson, as a dependent, was only an incidental third-party beneficiary of the contract, not an intended beneficiary, and therefore could not have maintained her own cause of action for breach of contract had she lived.
Concurring in part and dissenting in part - Boyd, C.J.
I concur that the wrongful death recovery cannot stand, but not only because the conduct was not outrageous, but also because there was insufficient evidence of causation between the denial of benefits and Mrs. McCarson's death. However, I dissent from the majority's conclusion that Mrs. McCarson was merely an incidental beneficiary; she was clearly a direct beneficiary of the group health insurance policy.
Concurring in part and dissenting in part - Shaw, J.
I agree that Florida recognizes the tort of intentional infliction of emotional distress, but I dissent from the majority's conclusion that Metropolitan's conduct was not outrageous. A jury, trial judge, and district court all found it to be so, and this Court should not substitute its judgment. I also strongly dissent from the holding that Lucille McCarson was an incidental beneficiary. As a covered dependent for whom the insurance was purchased, she was an intended beneficiary under the Restatement of Contracts and should have had the right to enforce the policy. The majority's holding sets a dangerous precedent for millions of dependents covered by medical insurance policies.
Analysis:
This case is significant for formally recognizing the tort of intentional infliction of emotional distress (IIED) in Florida and adopting the high 'extreme and outrageous' standard from the Restatement. More critically, it establishes a powerful 'privilege' defense for parties, particularly insurers, who are merely insisting on their contractual rights. This creates a significant legal shield, making it very difficult to bring an IIED claim against a company for actions permitted by a contract, regardless of the foreseeable emotional harm. The court's controversial classification of a covered spouse as an 'incidental beneficiary' also severely limited the ability of dependents to sue insurers directly for breach of contract, a ruling with broad implications for health insurance law.
