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METROPOLITAN LIFE INSURANCE COMPANY v. COTTER

SJC-11135

464 Mass. 623 (2013)

METROPOLITAN LIFE INSURANCE COMPANY v. JAMES M. COTTER.

Supreme Judicial Court of Massachusetts, Middlesex.

March 15, 2013.

Attorney(s) appearing for the Case

Praven Shenoy for the defendant.

Joseph M. Hamilton ( David L. Fine with him) for the plaintiff.

Julie Simon Miller , of the District of Columbia, & Jeffrey L. Williams , for America's Health Insurance Plans, amicus curiae, submitted a brief.

Present: IRELAND, C.J., SPINA, CORDY, BOTSFORD, GANTS, DUFFLY, & LENK, JJ.

LENK, J.

After paying disability benefits to the defendant, James M. Cotter, for several years, the plaintiff, Metropolitan Life Insurance Company (MetLife), determined that Cotter had failed to satisfy a clause in his "own occupation" disability insurance policy that required him to receive care by a physician that "is appropriate for the condition causing the disability."1 Interpreting this...

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