Roth

REVISED AND AMENDED MEMORANDUM & ORDER GRANTING MOTION FOR PARTIAL SUMMARY JUDGMENT

I.

INTRODUCTION

This insurance dispute arises out of two life insurance policies Plaintiff Paul David Roth purchased from Defendant Madison National Life Insurance Company (“Madison”). Both of the operative life insurance policies contain a “Critical Illness Benefit Rider” (the “Riders”), which provides that 10% of the policies’ death benefits would be advanced in the event the insured undergoes an angioplasty procedure so long as certain conditions were met before the procedure was performed. The condition relevant to this dispute is the requirement that the angioplasty be performed after Roth’s physician received evidence that Roth’s EKG showed significant electrographic changes.

In July 2004, Roth, whose EKG showed no such changes, underwent an angioplasty and subsequently submitted a claim for benefits under the Riders. However, finding that the underlying conditions of the Riders had not been satisfied, Madison denied Roth’s claim. After Roth contested Madison’s denial, Madison submitted Roth’s medical records for review by an independent medical services review organization. Because the…