Allianz Life Insurance Company of North America v. Muse

District Court, W.D. Oklahoma·Decided October 26, 2020·No. 5:17-cv-01361·Unknown

Opinion

UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF OKLAHOMA

ALLIANZ LIFE INSURANCE ) COMPANY OF NORTH AMERICA, ) ) Plaintiff/Counterclaim Defendant, ) ) v. ) No. CIV-17-1361-G ) GENE L. MUSE, M.D., ) ) Defendant/Counterclaimant; ) ) and ) ) PATIA PEARSON, ) ) Defendant. )

ORDER Now before the Court is the Motion for Post-Trial Relief Under Rules 50(b), 59(a), and 52(a) (Doc. No. 219) filed through counsel by Plaintiff/Counterclaim Defendant Allianz Life Insurance Company of North America (“Allianz”). Defendant/ Counterclaimant Gene L. Muse, MD, and Defendant Patia Pearson have filed a Response (Doc. No. 227), to which Allianz has replied (Doc. No. 229). For the reasons discussed below, Allianz’s Motion is denied. I. Background Allianz issued a long-term care insurance policy (the “Policy”) to Muse in 2000 and, after Muse claimed that he became “chronically ill” within the meaning of the Policy following a fall from a ladder, paid Muse benefits for services he claimed were received between July 1, 2015, and April 21, 2017. See Final Pretrial Report (Doc. No. 177) at 2- 4; Order Approving Final Pretrial Report (Doc. No. 181) at 1 (collectively referred to herein at the Final Pretrial Order or FPO). Allianz stopped paying benefits effective April 22, 2017, and brought suit in this Court on December 20, 2017.

Allianz has alleged that Muse and his caregiver, Pearson, fraudulently represented Muse’s health as well as details regarding Pearson’s arrangements with Muse and with the home health care company AdLife HomeCare, LLC (“AdLife”) that affected Muse’s eligibility to receive benefits for services provided by Pearson. Allianz asserted claims of fraud and conspiracy to commit fraud against Muse and Pearson, seeking recovery of

damages for benefits improperly paid prior to April 22, 2017, and a judicial declaration that Muse was not entitled to additional Policy benefits in connection with care provided to him from April 22, 2017, to the present. Allianz also sought to have the Policy rescinded. Muse and Pearson have denied these allegations and contested Allianz’s entitlement to damages or the other relief requested. Additionally, Muse asserted counterclaims

against Allianz for breach of contract and breach of the duty of good faith and fair dealing. The Court’s orders prior to trial narrowed the claims and issues to be presented. By Order dated December 18, 2019, the Court granted partial summary judgment to Allianz, determining that Allianz was entitled to a declaratory judgment that Muse was not entitled to benefits under the Policy in connection with services performed by Pearson from April

22, 2017, through March 30, 2018. Order of Dec. 18, 2019 (Doc. No. 128) at 17. Specifically, as to the period from April 22, 2017, to December 31, 2017, the Court found that there was no genuine factual dispute that a provision in the Policy excluding payment of benefits for “service(s) . . . for which you have no financial liability or that is provided at no charge in the absence of insurance” applied and precluded payment of benefits to Muse. Id. at 11-13 (finding it undisputed that “Muse’s obligation to pay Ad[L]ife was contingent upon his receipt of benefits from Allianz” and that “there is no evidence [in the

summary judgment record] from which to reasonably infer that Muse was financially liable for the services rendered [by Pearson] during this time or that Muse would be held liable for these services in the absence of insurance”). As to the period from January 1, 2018, to March 30, 2018, the Court found that there was no genuine factual dispute that Muse’s claim fell outside a provision in the Policy whereby Allianz is only obligated to pay benefits

if Muse receives services from a “Home Health Aide” working “‘under the supervision of a Home Health Care Agency.’” Id. at 13-14 (finding it undisputed that Pearson was not working for AdLife or any other Home Health Care Agency, as defined by the Policy, during that period). The Court also determined that Allianz was entitled to summary judgment on

Muse’s counterclaim for breach of the implied duty of good faith and fair dealing, in which Muse challenged Allianz’s failure to pay benefits beginning April 22, 2017. Id. at 14-16 (finding that, in light of prior determination that Muse was not entitled to benefits for the period from April 22, 2017, to March 30, 2018, no bad faith claim could be premised on a failure to pay such benefits). Further, in deciding a subsequent motion in limine, the Court

precluded Muse from presenting evidence of damages on his counterclaim for breach of contract as it related to three time periods: “(1) from April 22, 2017, through March 30, 2018; (2) from March 31, 2018, through the present date; and (3) beyond the present date.” Order of Jan. 9, 2020 (Doc. No. 167) at 2. As to the first period, the Court reiterated its previous decision that Muse was not entitled to benefits for services rendered by Pearson from April 22, 2017, to March 30, 2018. Id. at 2. As to the second period, the Court determined that Muse was precluded by law from offering evidence of damages because it

was undisputed that Muse had not timely submitted any claim for benefits for services rendered from March 31, 2018, to “present” and Muse could not rely on a theory of anticipatory repudiation to excuse his compliance with that requirement. Id. at 2-4. As to the third period, the Court determined that Muse was precluded by law from offering evidence of damages because Muse likewise could not rely on a theory of anticipatory

repudiation and the claim for such damages was improperly contingent and speculative under Oklahoma law. Id. at 4-5 (citing Okla. Stat. tit. 23, § 21). Following these rulings, Muse acknowledged that nothing remained of his contract counterclaim and that “the Court has effectively granted judgment to Allianz on” that claim. Defs.’ Mot. (Doc. No. 173) at 8.1

Remaining for disposition were Allianz’s claims of fraud and conspiracy to commit fraud against Muse and Pearson, seeking recovery of damages for benefits improperly paid prior to April 22, 2017, as well as Allianz’s requested remedy that the Policy should be rescinded pursuant to title 36, section 4426.1(C) of the Oklahoma Statutes (allowing rescission of long-term care insurance policy as relevant here “only upon a showing that

the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health”) or as a result of “fraud committed by Muse.” FPO at 3-4. Prior to trial,

1 Accordingly, Muse omitted the contract counterclaim from the Final Pretrial Report. See FPO at 2-5. the Court determined that while the claims of fraud and conspiracy to commit fraud—and the more specific issue of whether Muse misrepresented relevant facts relating to his health—must be determined by the jury, the requested remedy of rescission is purely

equitable in this context and would be determined by the Court as necessary. Tr. of Jan. 14, 2020 (Doc. No. 232). Following a six-day trial, the jury returned its verdict in favor of Defendants on Allianz’s fraud and conspiracy to commit fraud claims. Verdict (Doc. No. 203) at 1-4. Further, the jury found, in answer to an interrogatory, that Muse had not knowingly and

intentionally misrepresented relevant facts relating to his health. See id. at 5. The Court entered final judgment on January 31, 2020. See J. (Doc. No. 207). II. Discussion Allianz now seeks judgment as a matter of law or, alternatively, a new trial on one of the theories of fraud presented to the jury: that Muse and Pearson made fraudulent

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