Elvia Cardenas v. United of Omaha Life Ins Co.

731 F.3d 496, 2013 WL 5433487
CourtCourt of Appeals for the Fifth Circuit
DecidedOctober 1, 2013
Docket12-51295
StatusPublished
Cited by8 cases

This text of 731 F.3d 496 (Elvia Cardenas v. United of Omaha Life Ins Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Elvia Cardenas v. United of Omaha Life Ins Co., 731 F.3d 496, 2013 WL 5433487 (5th Cir. 2013).

Opinion

KING, Circuit Judge:

This case arises from Defendant-Appel-lee United of Omaha Life Insurance Company’s denial of Plaintiff-Appellant Elvia Cardenas’s claim for benefits from a life insurance policy taken out by Cardenas’s daughter, Elvia Sierra. The policy lapsed and was subsequently reinstated; Sierra died thirteen months after the reinstatement. As required by the Texas Insurance Code, the policy contained a provision that it would become incontestable if it remained in force “for two years from its date of issue during the lifetime of the insured.” Although the policy does not have a provision dealing with contestability following reinstatement, the parties agree there is such a period. They differ over how the death of the insured during the contestability period will affect the reinstatement. The district court found that the reinstated policy never became incon *498 testable because Sierra died before the two-year period ran. Cardenas appeals from the district court’s denial of her post-verdict motion for judgment as a matter of law. She argues that a section of the Texas Administrative Code controls and requires finding that the reinstated policy became incontestable. For the following reasons, we AFFIRM the district court’s judgment.

I. FACTUAL AND PROCEDURAL BACKGROUND

United of Omaha Life Insurance Company (“United of Omaha”) issued a life insurance policy to Elvia Cardenas’s daughter, Elvia Sierra, on March 26, 2001. The policy lapsed for nonpayment of premiums in June 2005. United of Omaha reinstated the policy on January 3, 2006, after Sierra submitted a reinstatement application. 1 - Sierra made several misstatements about her health in the reinstatement application. The application required Sierra to certify that she had not lost more than ten pounds in the prior year, and that in the prior five years, she had not undergone any blood tests, laboratory tests, or special examinations, been ill or injured, or received medical or surgical advice or treatment. In fact, Sierra suffered from Crohn’s disease and had been hospitalized for four weeks during June and July 2005. She lost thirty pounds between March and July 2005, including eighteen pounds in one week.

Sierra died on February 20, 2007. Her death certificate lists toxic megacolon, sepsis, cachexia, and Crohn’s disease as the causes of death. Cardenas filed a claim for benefits on March 26, 2007. United of Omaha denied the claim on May 14, 2007, and on May 23, 2007, informed Cardenas that it was rescinding the policy due to misrepresentations it found in the reinstatement application.

Cardenas filed suit in state district court on February 16, 2011, claiming that United of Omaha had failed to pay the $150,000 death benefit under the policy. United of Omaha removed the case to federal court based on diversity of citizenship. The parties filed cross-motions for summary judgment. In its motion, United of Omaha argued that it satisfied the requirements for rescinding an insurance policy procured by fraud, and that the policy remained contestable because Sierra died before the two-year period ran. Cardenas contended, inter alia, that the reinstated policy was incontestable because United of Omaha failed to contest it within the requisite two years, as provided by § 3.104(a) of the Texas Administrative Code, Title 28. The district court denied both motions in a memorandum opinion and order dated February 29, 2012, and found that fact issues remained regarding whether Sierra’s misrepresentations were material and intentional.

The case went to trial on October 22, 2012. Cardenas filed a motion for judgment as a matter of law at the close of evidence, which the court denied. The jury returned a verdict in favor of United of Omaha, finding that Sierra’s representations in the reinstatement application were material and intentional. Cardenas filed a renewed motion for judgment as a matter of law after the verdict, contending that: (1) the insurer could not contest the reinstatement because the policy did not provide for a contestability period after reinstatement; (2) § 3.104(a) of the Texas Administrative Code provides an absolute *499 two-year deadline for contesting the reinstatement; and (3) insufficient evidence supported the jury’s findings. The district court denied the motion and entered judgment for United of Omaha. Cardenas timely appealed.

II. DISCUSSION

Cardenas argues that the district court failed to correctly apply Texas law governing incontestability provisions in life insurance contracts and that the district court erred by expanding the interpretation of the insurance contract. We will address each argument in turn. 2 We note at the outset that we review de novo a district court’s ruling on a motion for judgment as a matter of law. Brennan’s Inc. v. Dickie Brennan & Co., 376 F.3d 356, 362 (5th Cir.2004).

A. Incontestability Provision

Cardenas’s challenge to the district court’s ruling turns on a question of statutory construction that we also review de novo. F.D.I.C. v. Shaid, 142 F.3d 260, 261 (5th Cir.1998) (per curiam). “[W]e interpret [a] state statute the way we believe the state Supreme Court would, based on prior precedent, legislation, and relevant commentary.” Id. (citing Transcon. Gas Pipe Line Corp. v. Transp. Ins. Co., 953 F.2d 985, 987-88 (5th Cir.1992)). We note that “[t]he text of an administrative rule must be construed under the same principles as if it were a statute.” Tex. Gen. Indem. Co. v. Tex. Workers’ Comp. Comm’n, 36 S.W.3d 635, 641 (Tex.App.-Austin 2000, no pet.).

At the heart of this case is the question whether a life insurance policy, after it has been reinstated, automatically becomes incontestable after two years, or whether the insured must survive that two-year period. The answer to this question depends on how we interpret two key statutory and regulatory provisions, one of which expressly requires that in order to become incontestable, a policy must be in force for two years “during the lifetime of the insured.” These provisions are Texas Insurance Code § 1101.006, and 28 Texas Administrative Code § 3.104(a), promulgated by the Texas Department of Insurance (“Department”).

Section 1101.006 states that “a life insurance policy must provide that a policy in force for two years from its date of issue during the lifetime of the insured is incontestable, except for nonpayment of premiums.” Tex. Ins.Code Ann. § 1101.006 (West 2003).

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731 F.3d 496, 2013 WL 5433487, Counsel Stack Legal Research, https://law.counselstack.com/opinion/elvia-cardenas-v-united-of-omaha-life-ins-co-ca5-2013.