Grover v. Commercial Insurance

108 F.R.D. 366, 1985 U.S. Dist. LEXIS 13646
District Court, D. Maine·Decided November 21, 1985·No. Civ. No. 84-0259 P·Published·Cited by 5 cases

Opinion

[368] OPINION AND ORDER DENYING DEFENDANT’S MOTION TO SET ASIDE DEFAULT

GENE CARTER, District Judge.

This action is before the Court on Defendant’s motion to set aside the default which was entered against it on September 19, 1984.1 The record shows that on August 17, 1984, Plaintiff filed a complaint seeking recovery of benefits under a disability insurance policy. The complaint was served on the Commissioner of Insurance and was received at Defendant’s head office in New York on September 7, 1984. It was mailed on that date to the Portland, Maine office of Underwriters Adjusting Company, where it arrived on September 14, 1984. Having determined that the claim was not of the type he dealt with, the Portland claims representative sent the complaint to Continental Life Insurance Company in Glens Falls, New York on September 17, 1984. It did not arrive at that office until September 24, 1984. An answer to the complaint was due on September 18. Someone in Glens Falls contacted counsel in Portland on the 24th, and he received a copy of the complaint in the mail on September 28, 1984. On October 1, counsel filed a motion to set aside the default.

In Phillips v. Weiner, 103 F.R.D. 177 (D.Me.1984), this Court examined the good cause standard for setting aside an entry of default under Fed.R.Civ.P. 55(c). In Phillips, the Court identified six factors to be considered in the exercise of its discretion: (1) the excuse for the delay; (2) the existence of a meritorious defense; (3) prejudice to the other party; (4) the amount of money involved; (5) the good faith of the parties; and (6) the timing of the motion to set aside the default.

Defendant’s affidavit asserts that the complaint’s long voyage was due to the mails, an error in the initial forwarding decision, and the failure of a computer follow-up system which should have tracked the matter. As the Magistrate had previously found, the excuse is weak. For the most part the delay reflects carelessness in clerical or technical practices, merely exacerbated by the slowness of the mails.

Meritorious Defense

In examining the defense under Phillips, the Court is not to weigh the facts. Rather, the Court must determine whether the defense has merit for pleading purposes. In this case, Defendant asserts that Plaintiff made various material omissions and misstatements in her application for disability insurance. Defendant wished to amend the answer to allege that the misrepresentations were fraudulently made, “thereby meeting the standard of American Home Assurance Co. v. Ingeneri, 479 A.2d 897 (Me.1984).” Report of Scheduling Conference (November 5, 1984) (per Hornby, Mag.). That amendment was foreclosed by its untimely filing, however. See Order, January 30, 1985 (per Carter, J.). The question remains, then, whether the answer in its original form set forth a meritorious defense for pleading purposes.

Defendant argues that even without amendment the complaint sets forth a claim for fraudulent misrepresentation as required by Ingeneri. Alternatively, Defendant suggests that fraud or knowing misrepresentation is not a necessary element of a defense to an action on a policy of disability insurance.

The Court has examined the affirmative defense pleaded by Defendant [369] and finds that it does not allege fraud. Under Fed.R.Civ.P. 9(b) “[i]n all averments of fraud or mistake, the circumstances constituting fraud or mistake shall be stated with particularity. Malice, intent, knowledge, or other condition of mind may be averred generally.” Although the allegations set forth in Defendant’s affirmative defense describe various misrepresentations, including Plaintiff’s failure to disclose her knowledge that she might have lupus, nowhere is there an allegation that the alleged misrepresentations were made with fraudulent intent. The Court of Appeals for the First Circuit has frequently stated that Rule 9(b) requires “specification of the time, place and content of an alleged false representation, but not the circumstances or evidence from which fraudulent intent could be inferred.” Hayduk v. Launa, 755 F.2d 441, 443-444 (1st Cir.1985) (quoting McGinty v. Beranger Volkswagen, Inc., 633 F.2d 226, 228 (1st Cir. 1980)); Wayne Investment, Inc. v. Gulf Oil Corp., 739 F.2d 11,13-14 (1st Cir.1984). Although the specifics of the fraudulent intent need not be alleged, the pleadings must give adequate notice of the claim of fraud or mistake. McGinty, 633 F.2d at 229. In McGinty, the Court found that fraud had been adequately pled because the circumstances of the misrepresentations were specified and fraudulent intent was generally pled. Since the pleading here merely alleged misrepresentation and did not allege fraudulent intent, it did not provide adequate notice to Plaintiff that she would be required to defend against a claim of fraud.

Defendant asserts that the fraud necessary to invalidate a contract is different from the fraud necessary to make out a claim for fraudulent misrepresentation and that it has adequately pled the elements of fraud to vitiate a coptract. It is plain, however, that although Defendant seeks to invalidate the insurance contract, the gravamen of its affirmative defense is fraudulent misrepresentation. Fraudulent intent is a necessary element of that claim, see, e.g., Bartner v. Carter, 405 A.2d 194 (Me. 1979), that must be pled at least generally. The Court finds, therefore, that the pleadings do not adequately set forth a meritorious defense of fraudulent misrepresentation.

Defendant suggests in the alternative that misrepresentation without fraud can form a defense to Plaintiff’s claim. In support of this contention, Defendant relies on 24-A M.R.S.A. § 2706, which purports to set forth a time limit on certain defenses to actions on health insurance contracts. Section 2706 provides in pertinent part:

Time limit on certain defenses: (a) After 3 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy____

Defendant contends that it may be inferred from this statute that there are two categories of misstatements — fraudulent and nonfraudulent — which may form the basis of a defense to claims made under a health insurance or disability contract. If such an inference is not drawn, Defendant suggests that section 2706 will have no meaning. Section 2706 is found in chapter 33 of the Maine Insurance Code, which deals generally with health insurance contracts.

The Court is unpersuaded by Defendant’s argument concerning section 2706. Section 2701 of chapter 33 defines the scope of that chapter as follows:

Nothing in this chapter shall apply to or affect:

2. Any group or blanket policy.

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Grover v. Commercial Insurance, 108 F.R.D. 366, 1985 U.S. Dist. LEXIS 13646 (D. Me. 1985).

108 F.R.D. 366 (Grover v. Commercial Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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