Eleventh Circuit Bars Unjust-Enrichment Claims Where Disability Policy Governs: MONY Life Insurance Co. v. Perez (2025)

Introduction

This appeal from the United States Court of Appeals for the Eleventh Circuit revolves around a high-stakes dispute between MONY Life Insurance Company and ophthalmologist Dr. Bernard R. Perez arising out of a 1988 disability income policy. After MONY ceased paying benefits in 2018, it sued Perez for unjust enrichment, alleging that he had deceitfully inflated his monthly disability claims. Perez counterclaimed for breach of contract and other causes of action. A jury awarded MONY almost $389,000 on its equitable claim and rejected Perez’s counterclaim. On appeal two core issues surfaced:

1. Whether Florida law permits an unjust-enrichment action when an express insurance contract covers the same subject matter;
2. Whether the district court’s refusal to interpret the ambiguous phrase “acceptable proof of loss” warranted reversal of the jury’s verdict on Perez’s breach-of-contract counterclaim.

The Eleventh Circuit answered the first question with a decisive “no,” vacating the unjust-enrichment award, yet affirmed the jury’s rejection of Perez’s breach claim and upheld a series of evidentiary rulings.

Summary of the Judgment

• Unjust Enrichment: Florida law bars quasi-contractual relief where an express contract governs. Because the policy explicitly covered disability benefits, the unjust-enrichment claim should never have reached the jury. The court vacated the $448,930.06 judgment (principal plus interest).
• Breach of Contract Counterclaim: Although the district court erred by allowing the jury to decide the meaning of the ambiguous term “acceptable proof of loss,” the error was harmless. Overwhelming evidence showed Perez repeatedly misrepresented his ownership status, earnings, hours worked, and medical condition, preventing him from proving that he had performed his contractual obligations.
• Evidentiary & Sanctions Rulings: No abuse of discretion occurred in admitting late-produced evidence, allowing two experts to testify, or denying Rule 37 sanctions.
• Disposition: Affirmed in part, vacated in part, and remanded with instructions to strike the unjust-enrichment award.

Analysis

A. Precedents Cited

The Court leaned heavily on longstanding Florida doctrine that an equitable unjust-enrichment remedy is unavailable when an express contract controls:

• Diamond “S” Dev. Corp. v. Mercantile Bank
• Ocean Communications, Inc. v. Bubeck
• Kovtan v. Frederiksen
• Hazen v. Cobb
• Global Network Mgmt., Ltd. v. CenturyLink Latin Am. Solutions, LLC (11th Cir.)

For contract interpretation and ambiguity, the panel cited Florida Supreme Court decisions:

• Washington National Insurance Corp. v. Ruderman
• State Farm Mutual Automobile Insurance Co. v. Menendez
• Jones v. Utica Mutual Insurance Co.

Procedural and harmless-error principles relied on:

• Fed. R. Civ. P. 50, 59, 61; Kotteakos v. United States
• United States v. Frazier (Daubert/harmless error)
• Carlucci v. Piper Aircraft Corp. (Rule 37 sanctions framework)

B. Legal Reasoning

1. Equitable Bar. Florida courts refuse to imply a contract (unjust enrichment/quantum meruit) when the parties have an express contract concerning the same subject. The disability policy squarely governed the payment of benefits; MONY’s claim merely alleged Perez received money “under the policy.” That the policy was silent on a claw-back mechanism does not create a gap large enough for quasi-contractual relief; instead, it reflects MONY’s drafting choice.
2. Alternative Remedies Not Taken. The Court observed that MONY could have (i) inserted a reimbursement clause at the drafting stage, or (ii) sued for fraud/misrepresentation in tort (a claim it unsuccessfully sought to add late in the litigation).
3. Ambiguous Term—“Acceptable Proof of Loss.”
   • Under Florida law, courts—not juries—interpret ambiguous insurance terms, construe them against the drafter (the insurer), and in favor of coverage.
   • The district court erred by punting this question to the jury.
   • Nevertheless, the error was harmless because Perez’s repeated misrepresentations meant he could not satisfy any plausible definition of “acceptable proof of loss.” Thus, he could not establish MONY’s breach as a matter of law.
4. Harmless-Error Doctrine. Applying Rule 61, the panel found no “substantial influence” on the verdict. Given the mountain of evidence that Perez fabricated or exaggerated key facts, the jury would necessarily conclude he failed to meet contractual prerequisites to payment.
5. Evidentiary & Sanction Decisions. Disputed materials (divorce records, cell-phone images, expert reports) were either timely produced, within the discovery window, or harmlessly late. The trial judge’s discretionary calls therefore stood.

C. Impact of the Decision

• Clear Message to Insurers: If you want the right to recoup overpayments, negotiate for and draft an explicit claw-back or reimbursement clause. Equitable work-arounds will be barred in Florida where a policy addresses the same benefits.
• Litigation Strategy Shift: Insurers may turn to fraud or rescission theories (where timely) rather than quasi-contract. Expect greater use of anti-fraud provisions and increased scrutiny during underwriting.
• Contract Drafting Practices: Disability and similar income-replacement policies issued in Florida will likely be revised to include (1) audit-cooperation clauses with teeth, and (2) restitution/offset provisions for overpayments obtained by misrepresentation.
• Procedural Guidance: The ruling underscores the need for trial judges to decide ambiguous policy terms pre-verdict to avoid post-trial motions and potential reversals.
• Harmless-Error Emphasis: Even clear instructional errors may not warrant retrial if a robust evidentiary record renders them non-prejudicial.

Complex Concepts Simplified

• Unjust Enrichment / Quasi-Contract: A legal theory that lets a court impose an obligation to return money when no real contract exists but fairness demands repayment. It cannot override an existing written contract covering the same topic.
• Claw-Back Provision: A clause allowing an insurer to reclaim benefits mistakenly or fraudulently paid.
• Proof of Loss: Documentation an insured must supply (medical reports, financial statements) to show entitlement to benefits.
• Residual Income Loss: Policy benefit payable when an insured can still work but earns less than a specified percentage of pre-disability income.
• Harmless Error (Rule 61): Even if a court makes a mistake, an appellate court will not order a new trial unless the error likely affected the outcome.
• Rule 26/37 Sanctions: Rules governing pre-trial disclosure of evidence and penalties for failure to do so. Sanctions are avoided if the delay is justified or causes no harm.

Conclusion

MONY Life Insurance Co. v. Perez lays down a bright-line rule in Florida insurance litigation: an insurer that has drafted a comprehensive disability policy cannot sidestep the contract and sue for unjust enrichment to claw back benefits—even when it believes the insured lied. The decision is a cautionary reminder to insurers to draft precise reimbursement language and to pursue timely fraud claims if misrepresentations surface. Simultaneously, the opinion demonstrates the power of the harmless-error doctrine; procedural missteps will not upset verdicts backed by overwhelming evidence. Going forward, expect policy revisions, sharper underwriting practices, and strategic use of fraud remedies rather than quasi-contract claims in the Sunshine State and across the Eleventh Circuit.