Garcia v. Dawahare

608 F. Supp. 2d 1228, 2008 U.S. Dist. LEXIS 108448, 2008 WL 5863695
CourtDistrict Court, D. Nevada
DecidedMarch 26, 2008
DocketCase 2:06CV-00695-KJD-LRL
StatusPublished
Cited by2 cases

This text of 608 F. Supp. 2d 1228 (Garcia v. Dawahare) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Garcia v. Dawahare, 608 F. Supp. 2d 1228, 2008 U.S. Dist. LEXIS 108448, 2008 WL 5863695 (D. Nev. 2008).

Opinion

ORDER

KENT J. DAWSON, District Judge.

Currently before the Court is Defendant Farmers New World Life Insurance Company’s (FNWL) Motion for Summary Judgment (# 28), filed June 18, 2007. Also before the Court is Defendant’s Motion for Judicial Notice (# 32), listed on the Court’s docket incorrectly, as a Request for Review of Magistrate Decision, filed July 19, 2007. Plaintiff filed a Response (#29) to Defendant’s Motion for Summary Judgment on July 6, 2007, to which Defendant filed a Reply (# 31) on July 19, 2007. Additionally, Plaintiff filed a Supplemental Opposition to FNWL’s Motion for Summary Judgment (# 37), on January 11, 2008, to which FNWL filed a Reply (#40) on January 25, 2008. To date, no opposition has been filed to Defendant’s Motion for Judicial Notice.

I. Background

This action was initiated by Myriam Garcia, as a result of Defendant FNWL’s initial denial of her claim under a life insurance policy issued by FNWL on the life of her late husband Loreto Garcia. Mr. Garcia died as a result of cardiopulmonary arrest caused or contributed to by *1230 cardiomyopathy and/or chronic obstructive pulmonary disease. The policy was issued in reliance on an application and medical statement showing that Mr. Garcia’s had a healthy medical history showing only a history of high blood pressure and a bout with the flu. After Mr. Garcia’s death, however, a claim investigation conducted by FNWL revealed that Mr. Garcia’s medical history showed he had a history of cardiomyopathy, congestive heart failure, and chronic obstructive pulmonary disease among other things, for a period of years up to and including the time he applied for the FNWL policy.

On or about May 30, 2003, Mr. Garcia initiated the purchase of a life insurance policy benefit of $100,000 by executing a Life Application with FNWL (Def.’s.’ Mot. For Summ. J. Ex 1.) The application was completed with the assistance FNWL agent Mark Dawahare. 1 Mr. Garcia’s responses to the questions on the Life Application indicated inter alia that he had never been diagnosed with high blood pressure, heart attack, chest pain, or any disorder of the heart or vascular system, had never been treated for or diagnosed with any disease or disorder of the lungs or respiratory system, that he was not currently, and had not been taking any treatments or medications within the past year, and that he had not seen a medical professional or been evaluated or treated in an urgent care center, emergency room, hospital, or other treatment facility, nor had been advised to have urine or blood tests, x-rays, scans, EKG’s. or other tests. (Def.’s Mot. Fro Summ. J. Ex. 1.) The application’s Certification, Acknowledgment and Authorization section was signed by Mr. Garcia, stating “I (we) declare that the statements and answers to the questions in this application are true and complete.” (Def.’s Mot. For Summ. J. Ex. 1.)

After completing the Life Application, a separate examination was conducted by paramedical examiner, Devan Powell, employed by an independent company, Portamedic. As part of the paramedical examination, Mr. Garcia was again asked a series of questions regarding his health and medical history. Specifically, the examination involved a questionnaire in which Mr. Garcia indicated that he had never consulted a physician or other healthcare provider, been treated, hospitalized, or taken medication for any disease or disorder of the lungs and/or respiratory system, that in the five years previous to the questionnaire he had not been advised to have surgery, treatment, or medical tests that he hadn’t previously disclosed, and that he hadn’t had any other illness, disease, or injury not disclosed in his previous answers. (See Def.’s Mot. For Summ. J. Ex 5.) Mr. Garcia did indicate that he had high blood pressure, yet failed to indicate any other disease or heart disorder. The paramedical examination also indicated that Mr. Garcia had suffered from the flu, from which he had enjoyed a full recovery. (See Def.’s Mot. For Summ. J. Ex 5.) Mr. Garcia was assisted with the paramedical questionnaire by Devan Powell, and both Garcia and Powell signed the attestation clause, indicating that “to the best of my knowledge and belief the statements and answers on this Application for Insurance are true and complete.” (Id.) According to FNWL policy, the application was reviewed and evaluated and eventually approved at an increased premium rate. 2 (See Def.’s Mot. For Summ. J. Ex. 3, 8.)

*1231 Mr. Garda passed away on January 31, 2005, due to cardiopulmonary arrest or possibly as a consequence of cardiomyopathy.” (See Def.’s Mot. For Summ. J. Ex. 11.) Shortly thereafter, Plaintiff filed a claim for benefits under the policy. Because the policy had been in effect for less than two years, it had not yet become incontestable under Nevada law, and FNWL began a claim investigation. During the investigation, FNWL interviewed Plaintiff, requested further information from agent Dawahare, and obtained Mr. Garcia’s medical records.

Mr. Garcia’s medical records predating his Life Application revealed a history of treatment for cardiomyopathy from June 1997, through December 1999, treatment for chronic obstructive pulmonary disease from June 1997, through June 2003, and treatment for congestive heart failure from November 1989, through June 2003. (See Def.’s Mot. For Summ. J. Ex. 13-24.)

As part of FNWL’s investigation of Garcia’s policy, and due to the discrepancy between Mr. Garcia’s Life Application and medical records, FNWL interviewed agent Dawahare about Mr. Garcia’s Application interview and questionnaire. Agent Dawahare represented to FNWL, under penalty of perjury, that Mr. Garcia disclosed nothing about his medical history of heart and lung complications during the completion of the Life Application.

As a result of the claim investigation, including Mr. Garcia’s medical history, and his apparent failure to inform FNWL regarding his extensive medical history in the Life Application, as well as agent Dawahare’s testimony regarding the Life Application procedure, FNWL concluded that Mr. Garcia’s policy was null and void because it would not have issued the policy had it known Garcia’s true medical history, and because FNWL found that Garcia’s Life Application and Paramedical History Questionnaire contained material misrepresentations regarding Garcia’s history of cardiomyopathy and pulmonary problems. (See Def.’s Mot. For Summ. J. Ex. 30, 31.)

Following FNWL’s denial of Plaintiffs application under Mr. Garcia’s policy, Plaintiff filed the instant lawsuit on or about October 18, 2005. Plaintiffs Complaint contains claims for relief against FNWL, for (1) breach of contract; (2) equitable relief; (3) bad faith; and (4) violation of the Unfair Trade Practices Act. The Complaint also seeks attorney’s fees and punitive damages. 3

Upon Plaintiff filing suit, FNWL sought the testimony of both agent Dawahare and paramedical examiner Devan Powell in order to sustain its denial of coverage on Plaintiffs benefits claim.

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Related

Siefers v. Pacificare Life Assurance Co.
729 F. Supp. 2d 1229 (D. Nevada, 2010)

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Bluebook (online)
608 F. Supp. 2d 1228, 2008 U.S. Dist. LEXIS 108448, 2008 WL 5863695, Counsel Stack Legal Research, https://law.counselstack.com/opinion/garcia-v-dawahare-nvd-2008.