Metropolitan Life Insurance Co. v. Gary P. Kase

In this case, of which we have diversity jurisdiction under 28 U.S.C. § 1332 , Ease appeals from a summary judgment against him and in favor of Metropolitan Life Insurance Co. We reverse.

I. Facts.

Ease was a civil service employee of the U.S. Navy. Metropolitan had issued to the Civil Service Commission a group policy, which contained certain disability provisions. In April 1974, while working as a rigger at the Mare Island Naval Shipyard at Vallejo, California, Ease suffered a severe eye injury. He was examined by an ophthalmologist, who concluded that “there is no possibility of useful vision being restored to the right eye as a result of further treatment or surgery or both, and in my opinion the loss is irrecoverable.” CR 12, Ex. 1. Metropolitan’s policy provided for a lump sum payment if an employee suffered “Total and Irrecoverable Loss of Sight of One Eye.” The company accepted the doctor’s report and paid Ease the appropriate lump sum, $12,500, in December 1974. It does not now contend that the doctor’s report was fraudulent and does not attack the doctor’s qualifications.

In 1977, for reasons that neither party can explain, sight returned to Ease’s right eye. When…