Gallien v. Connecticut General Life Insurance

49 F.3d 878
CourtCourt of Appeals for the Second Circuit
DecidedMarch 1, 1995
DocketNo. 956, Docket 94-7742
StatusPublished
Cited by1 cases

This text of 49 F.3d 878 (Gallien v. Connecticut General Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gallien v. Connecticut General Life Insurance, 49 F.3d 878 (2d Cir. 1995).

Opinion

JOSÉ A. CABRANES, Circuit Judge:

This is an appeal from an order granting summary judgment in favor of defendant Connecticut General Life Insurance Co. (“Connecticut General”) in the United States District Court for the Southern District of New York (Shirley Wohl Kram, Judge), reported at 851 F.Supp. 547 (S.D.N.Y.1994). The plaintiff, Adele Gallien, brought the action to obtain payment under a life insurance policy issued as part of an employer-provided group plan after Connecticut General denied coverage upon the plaintiffs husband’s death. Connecticut General claimed that the decedent, Paul Gallien, died without life insurance coverage because the employer had stopped paying premiums for Gallien three months before he died.1

The district court agreed with Connecticut General and found that the policy unambigu[880]*880ously stated that life insurance coverage for employees in Gallien’s circumstances ceased when the employer stopped- paying premiums.. The district court held further that the plaintiff could not prevail on a theory of waiver because, under New York law, “defenses relating to the issue of ... coverage ... are not waivable.” 851 F.Supp. at 555 (quoting Taft v. Equitable Life Assurance Soc’y, 173 A.D.2d 267, 269, 569 N.Y.S.2d 660 (1st Dep’t 1991)).

The group insurance policy, however, is ambiguous. It could reasonably be read to provide that cessation of premium payments did not result in irreversible termination of Gallien’s life insurance coverage, but rather afforded the insurer a unilateral right to terminate coverage. Moreover, New York law does recognize that an insurer may waive its right to terminate a policy. Although the district court correctly held that under New York law an insurer cannot waive the defense of non-coverage, New York does provide that an insurer may waive its right to claim that an insured forfeited a policy that would otherwise have afforded coverage. Because we find that the plaintiff has raised a genuine issue of material fact as to whether Connecticut General waived any right it might have had to terminate coverage, we reverse the judgment entered by the district court.

I. Background '

A. Facts

Carey Energy Corp. (“Carey”), Paul Gal-lien’s employer, entered into an insurance agreement with Connecticut General under which Carey’s employees received various types of group insurance, including accidental death, disability, medical expense, and term life insurance (collectively, the “policy” or the “group policy”). On January 20, 1989, at age 60, Gallien left “active service” with Carey and went on temporary, disability status. In July 1989, Gallien became eligible for permanent disability benefits, which he received until his death on October 25, 1989. Shortly after Gallien’s death, the plaintiff applied to Connecticut General for death benefits. Connecticut General disclaimed coverage.

Connecticut General’s contention that no death benefits were owed rested on its view that the status of Gallien’s life insurance coverage differed from that of all other kinds of coverage for all' other Carey employees because Gallien was a disabled employee age 60 or over. Carey had ceased paying premiums for its employees, including Gallien, on July 1, 1989. Despite this cessation in premium payments, Connecticut General did not cancel the group policy for all Carey employees until October 18, 1989. It continued coverage during this period despite the lack of premium, payments. Had Gallien been a typical employee, it is uncontroverted that he would have had life insurance coverage under these circumstances, even though he died a week after the policy was cancelled. Under the policy, the insurer agreed to pay death benefits to the insured’s beneficiary if the insured died within thirty-ione days after life insurance coverage ended.

Connecticut General, however, claimed that Gallien’s case posed a special circumstance. The insurer maintained that under a specific provision in the policy, life insurance benefits for disabled individuals age 60 or over ceased immediately upon the employer’s failure to pay premiums. That meant that Gallien, while eligible for all other forms of insurance until the October 18 cancellation, became ineligible for life insurance coverage in July, when Carey first failed to pay premiums.

The group policy provides:

Termination of Insurance — Employees Your insurance will cease on the earliest date below
• the date the policy is cancelled.
• the date your Active Service ends. except
as described below_
If your Active Service ends due to an Inj'ury or Siekness, your insurance will be continued while you remain totally and continuously disabled as a result of the Inj'ury or Sickness. However, your insurance will not continue past the earlier of: (a) one year from the date your Active Service ends unless your Employer obtains CG’s consent in writing to a longer period; [881]*881or (b) the date your Employer stops paying premium for you or otherwise cancels the insurance.
If you are totally disabled, your Life Insurance will terminate when you attain your normal date of retirement. If you are age 60 or over when you become disabled, your Life Insurance mil terminate at the earlier of (a) the date you attain your normal date of retirement, or (b) the date the Policyholder stops paying premium for you.

(Emphasis added). Connecticut General maintains that under the underscored exception, which indisputably applied to Gallien, his life insurance coverage ceased when Carey stopped paying premiums.

The “grace period” provision in the policy provides for a thirty-one day grace period as follows:

If a premium is not paid when due, the policy will automatically be cancelled as of the Premium Due Date, except as set forth below.
GRACE Period .... If any premium is not paid by the end of the [thirty-one day] Grace Period, the policy will automatically be cancelled at the end of the Grace Period....

Despite’ the “automatic cancellation” language of the grace period, Connecticut General provided coverage on all aspects of the group policy until October 18 — excluding Gal-Hen’s life insurance, according to Connecticut General — even . though premium payments ceased in July.

B. Procedural History

When Connecticut General disclaimed life insurance coverage for Gallien, the plaintiff filed suit against the insurer to obtain death benefits. She also sued Carey under § 409 of the Employee Retirement Income Security Act of 1974, (codified at 29 U.S.C. § 1109 (1985)), claiming that Carey, as administrator of the insurance plan, breached its fiduciary duty by failing to advise GalHen that it had ceased paying premiums and that Connecticut General had terminated coverage.2 Connecticut General cross-claimed against Carey for the recovery of allegedly unpaid premiums for the months of July through October 1989.

The plaintiff moved for summary judgment on its claim against Carey.

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Related

Gallien v. Connecticut General Life Insurance Co.
49 F.3d 878 (Second Circuit, 1995)

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Bluebook (online)
49 F.3d 878, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gallien-v-connecticut-general-life-insurance-ca2-1995.