Barbara Ramsey v. Penn Mutual Life Insurance Company

787 F.3d 813, 2015 FED App. 0106P, 91 Fed. R. Serv. 3d 1453, 2015 U.S. App. LEXIS 9019, 2015 WL 3448673
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 1, 2015
Docket14-3869
StatusPublished
Cited by26 cases

This text of 787 F.3d 813 (Barbara Ramsey v. Penn Mutual Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barbara Ramsey v. Penn Mutual Life Insurance Company, 787 F.3d 813, 2015 FED App. 0106P, 91 Fed. R. Serv. 3d 1453, 2015 U.S. App. LEXIS 9019, 2015 WL 3448673 (6th Cir. 2015).

Opinion

OPINION

BERNICE BOUIE DONALD, Circuit Judge.

In this case, Defendant-Appellee Penn Mutual Life Insurance Company (“Penn Mutual”) refused to pay death benefits to Plaintiff-Appellant Barbara Ramsey (“Plaintiff’) upon the death of her husband, John Ramsey (“Mr. Ramsey”). The district court concluded that Mr. Ramsey had failed to inform Penn Mutual of a change in the status of his health prior to the delivery of his life-insurance policy, thereby breaching a representation in the contract and permitting Penn Mutual to deny payment of benefits. Ramsey v. Penn Mut. Life Ins. Co., 36 F.Supp.3d 761, 770-71 (N.D.Ohio 2014). On that basis, the district court granted summary judgment to Penn Mutual. Id. at 773. We REVERSE.

I.

A.

The parties have stipulated to the following facts. On February 10, 2010, Mr. Ramsey applied for $2 million in life insurance from Penn Mutual. The application *816 consisted of two parts. Part I, completed and signed by Mr. Ramsey, indicated that he was a firefighter for the City of Cleveland for sixteen years, that his wife was his primary beneficiary, and that he had last seen his personal physician for a checkup in February 2006. Part I also contained the following representation:

I[ ], the Proposed Insured[ ], ... represent that the statements and answers in this part I of the application are written as made by me[ ] and are complete and true to the best-of my [ ] knowledge and belief. I[,] the Proposed Insured[ ], ... agree that they will be a part of the contract of insurance if issued; that I[ ] will be bound by such statements and answers, and that [Penn Mutual], believing them to be true, will rely and act upon them. I[] also understand and agree that:
1. Subject to the provisions of the temporary insurance agreement attached to this application, no insurance will be in force until the first premium is paid in full and the policy is delivered while the health, habits, occupation and other facts relating to the Proposed Insured[] ... are the same as described in this Part I of the application, any Part II required by [Penn Mutual] and any amendments or supplements to them.

Part II of the application, entitled “Medical Examiner’s Report,” involved a medical examination of Mr. Ramsey .at his home by a licensed professional nurse. The Medical Examiner’s Report contained a series of medical history questions. As relevant to this appeal, question 2(e) of the application asked whether Mr. Ramsey had “ever been treated for or had any indicator of ... [j]aundice, intestinal bleeding, ulcer, hernia, colitis, recurrent indigestion or other disorder of the stomach, intestines, liver or gall bladder?” Mr. Ramsey disclosed that he suffered from chronic ulcerative colitis, providing the following explanatory details: “1984. COLITIS. COLON — INTESTINAL RESECTION!.] HOSPITAL X 4 DAYS. FULL RECOVERY 6 MOS. IAN LAVERY ... LAST SEEN 2006. BX DONE. NORMAL FINDINGS[.]” Penn Mutual’s underwriting guidelines define ulcerative colitis as “[a]n inflammatory disease of the mucosa of the large bowel,” with symptoms including “[r]ectal bleeding, diarrhea, cramping, abdominal pain, anorexia arid weight loss.... ” Since at least 1981, Mr. Ramsey had suffered from chronic ulcera-tive colitis, which “occurs in a minority of patients.” In 1984, Dr. Ian Lavery — a co-lorectal surgeon at the Cleveland Clinic— surgically removed Mr. Ramsey’s colon in order to alleviate his colitis symptoms. According to Penn Mutual’s underwriting guidelines, that procedure — called a “resection” — “is now rarely performed as persistent or recurrent symptoms almost invariably occur, and there is a risk of cancer developirig in the rectal stump.”

As with Part I, Mr. Ramsey signed Part II of the application, which contained the following representation:

I represent that the statements and answers in this Part II are written as made by me and are full, complete and true to the best of my knowledge and belief. I agree that they will be a part of the contract of insurance if issued, that I will be bound by such statements and answers, and that Penn Mutual ..., believing them to be true, will rely and act upon them.

Penn Mutual then proceeded with its underwriting process. On February 19, 2010, one of Penn Mutual’s underwriters determined that, based on Mr. Ramsey’s disclosures in question 2(e), Penn Mutual could not immediately approve his applica *817 tion. With Mr. Ramsey’s authorization, Penn Mutual obtained various medical records, including biopsy reports prepared by Dr. Lavery in 2001 and 2004 that indicated the presence of chronic ulcerative colitis. In mid-April 2010, based on Mr. Ramsey’s history of ulcerative colitis, Penn Mutual offered him a $2 million policy with a “Table 2” rating, which is one of the lowest ratings Penn Mutual offers and which entails an above-average premium.

On April 28, 2010, Dr. Lavery examined Mr. Ramsey at the Cleveland Clinic. Dr. Lavery’s notes indicated that Mr. Ramsey suffered from ulcerative colitis “for 20 + yrs but has had no treatment for 10-12 yrs,” and that his April 28 visit was precipitated by “frequent bloody [bowel movements] and feel[ing] bad.” Dr. Lavery prescribed several medications in order to ease Mr. Ramsey’s symptoms. On May 17, 2010, Mr. Ramsey visited Dr. Lavery for a follow-up examination. Dr. Lavery’s notes indicated that Mr. Ramsey’s medications had brought about “some improvement in his symptoms,” but that he was “still having 15 + loose stools a day.”

On June 1, 2010, Penn Mutual drafted and Mr. Ramsey signed two amendments to his application. The amendments changed the value of Mr. Ramsey’s term-life policy to $500,000; added a whole-life policy of $400,000; and added a $150,000 “Benefit Increase Rider.” The June 1 amendments also altered Mr. Ramsey’s answer to question 2(e) as follows:

Have you ever been treated for or had any indication of: Jaundice, intestinal bleeding, ulcer, hernia, colitis, recurrent indigestion or other disorder of the stomach, intestines, liver or gall bladder? Yes, I had a colon resection in 1984 due to colitis. My last colonoscopy was in 2004. I have not had a colon[o]s-copy since 2004 and have had no gastrointestinal problems since that time.

On June 16, 2010, Mr. Ramsey visited Dr. Roop Kaw for an examination in anticipation of a proctectomy 1 by Dr. Lavery scheduled for June 24, 2010. Dr. Raw’s notes indicated that “[t]he condition requiring this surgery” was “[d]iarrhea and rectal bleeding [for] 5 months,” and Dr. Lavery testified that the surgery was not exploratory and was intended only to relieve Mr. Ramsey’s colitis symptoms. However, during the surgery on June 24, 2010, Dr. Lavery discovered peritoneal seeding in Mr. Ramsey’s pelvis, which Dr. Lavery determined was “a carcinoma that had probably come from the rectum.” Dr. Lavery aborted the proctectomy procedure after determining “that to proceed was inappropriate as [Mr. Ramsey] would need chemoradiotherapy for the rectal tumor.”

Mr. Ramsey was diagnosed with stage IV metastatic rectal cancer, which his doctors determined was incurable. He died on September 20, 2011, due to complications from that cancer.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Karen Frohn v. Globe Life and Accident Ins Co
99 F.4th 882 (Sixth Circuit, 2024)
William Clift v. RDP Company
702 F. App'x 385 (Sixth Circuit, 2017)
Parkhurst v. American Healthways Services, LLC
700 F. App'x 445 (Sixth Circuit, 2017)
Arrowood Indemnity Co. v. Lubrizol Corp.
695 F. App'x 842 (Sixth Circuit, 2017)
K-Tex, LLC v. Cintas Corporation
693 F. App'x 406 (Sixth Circuit, 2017)
Bryan Lamb v. Howe
677 F. App'x 204 (Sixth Circuit, 2017)
Mike Partin v. Floyd Davis
675 F. App'x 575 (Sixth Circuit, 2017)
Hackney v. Lincoln National Fire Insurance Co.
657 F. App'x 563 (Sixth Circuit, 2016)
Brenda Bickerstaff v. Vincent Lucarelli
830 F.3d 388 (Sixth Circuit, 2016)
Michael Dybowski v. VCE Company LLC
654 F. App'x 210 (Sixth Circuit, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
787 F.3d 813, 2015 FED App. 0106P, 91 Fed. R. Serv. 3d 1453, 2015 U.S. App. LEXIS 9019, 2015 WL 3448673, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barbara-ramsey-v-penn-mutual-life-insurance-company-ca6-2015.