Hejinian v. General American Life Insurance

22 Mass. L. Rptr. 684
CourtMassachusetts Superior Court
DecidedJuly 16, 2007
DocketNo. 053851BLS2
StatusPublished
Cited by1 cases

This text of 22 Mass. L. Rptr. 684 (Hejinian v. General American Life Insurance) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hejinian v. General American Life Insurance, 22 Mass. L. Rptr. 684 (Mass. Ct. App. 2007).

Opinion

Gants, Ralph D., J.

The plaintiff Pauli Hejinian (“Hejinian”) was married to Charlotte Ellertson (“Ellertson”), who died of cancer on March 21, 2004. At the time of her death, Ellertson had a $1,000,000 life insurance policy with the defendant General American Life Insurance Company (“General American”), with Hejinian as her beneficiary (“the Policy”). On July 13, 2004, Hejinian filed a claim for death benefits under Ellertson’s Policy with General American. On November 9, 2004, General American denied Hejinian’s claim on the ground that Ellertson had failed to disclose that she had been diagnosed with cancer at the time the Policy was delivered. Hejinian then brought this action against General American, alleging that it breached the insurance contract, as well as the covenant of good faith and fair dealing, and committed an unfair settlement practice in violation of G.L.c. 93A and 176D by refusing to pay the death benefit on the Policy. Hejinian also brought this action against insurance agent Peter Rodis (“Rodis”) and Rodis’s employer, New England Life Insurance Company d/b/a Strategic Financial Partners (“New England Life”), for professional negligence for their alleged failure to submit Ellertson’s application to General American in a timely manner.

The Court severed and stayed Hejinian’s claim for unfair settlement practices in violation of G.L.c. 93A and 176D pending the resolution of the claims concerning coverage (i.e. the claims for breach of contract and breach of the covenant of good faith and fair dealing). Now before the Court are Hejinian’s motion for partial summary judgment as to coverage under the Policy and General American’s cross motions for summary judgment as to the coverage claims, as well as Rodis’s and New England Life’s separate motions for summary judgment as to the claims brought against them.1 After hearing, for the reasons detailed below, Hejinian’s motion for summary judgment as to coverage is ALLOWED, and General American’s motion for summary judgment is DENIED. In light of the [685]*685allowance of Hejinian’s motion for summary judgment as to coverage, Hejinian’s claims against New England Life and Rodis are DISMISSED AS MOOT, since those claims survive only if this Court were to find no coverage under the Policy.2

BACKGROUND

The material facts are not in dispute. On February 14, 2003, the 36-year-old Ellertson completed and signed an Application for Life Insurance (“the Application”) for a ten-year, $1,000,000 life insurance policy with General American, which she submitted to her insurance agent, Rodis.3 At the time Ellertson completed the Application, she had not been diagnosed with any serious medical condition. The Application identified Ellertson’s husband, Hejinian, as the beneficiary.4 The Application consisted of a form that called for general information (“General Application Form”), and a Medical Declarations form (“Medical Declarations Form”). Two versions of the Medical Declarations Form were completed: one by Ellertson herself and one by a paramedical examiner.

On the Medical Declarations Form, Ellertson was asked to respond to various questions concerning her health. Among other things, Ellertson was asked to declare whether in the last ten years she had been treated for or diagnosed as having any disease or disorder of the reproductive organs or breasts; any disorder of the thyroid or lymph glands or other endocrine disorders; or “cancer, tumor, cyst or disorder of the skin.” Medical Declarations Form at 1. She answered “no” to all but the question concerning “cancer, tumor, cyst or disorder of the skin,” and wrote that she had a “benign mole removed.” Ellertson was also asked to identify the doctor able to provide the most complete and up-to-date information concerning her health. Id. She checked the box indicating “none.”

Various Declarations were printed towards the end of the General Application Form, including:

“I agree that [t]he statements and answers in this application and any amendments to it, in any supplements, or made to the medical examiner are true and complete to the best of my knowledge and belief . . .”; General Application Form at 4.
“I agree that [i]f a premium payment is not given, then insurance will take effect when a policy is approved by the Company for issue as applied for, the first full premium is paid and the health and insurability of any person proposed for insurance have not changed since the date of this app [sic].” Id. and
“The Applicant and agent certify that the Applicant has read, or had read to him or her the completed application and that he or she realizes that any false statement or misrepresentation therein may result in loss of coverage under the policy.” Id.

Ellertson signed the General Application Form below the Declarations. She did not pay a premium at the time she submitted the Application.

At the end of the Medical Declarations Form, Ellert-son signed the Form below the printed statement, “I agree that the statements and answers in this Medical Declarations [sic] are true and complete to the best of my knowledge and belief.” Medical Declarations Form at 2.

In conjunction with the Application, General American engaged American Para Professional Systems (“APPS”) to conduct a paramedical examination of Ellertson.5 APPS sent a physician unlicensed in the Commonwealth of Massachusetts to conduct the examination.6 The examination took place on February 4, 2003. The examination consisted of Ellertson’s response to questions concerning her medical history contained on the Medical Declarations Form and the collection of blood and urine samples. General American did not require Ellertson to submit to a medical examination.7 See Baime Aff. ¶¶8-9 (“By supplying APPS with a Medical Declarations form . . . [General American] defined the content of that... examination. This form indicates that. . . Prescott’s examination of . . . Ellertson was a paramedical examination rather than a medical examination.”).

There is no evidence that, as of February 14, 2003, when Ellertson signed the General Application and Medical Declaration Forms, having already completed her paramedical examination, she knew or had reason to know that any of the medical information in her Application was false.8 However, on March 25, 2003, she visited Dr. Alan Drabkin at Mount Auburn Hospital because of a cyst on her breast that the doctor assessed as a swollen lymph gland. He asked her to return in two weeks to determine if she needed a biopsy. She returned the next day, though, to see Dr. Drabkin, now complaining of increased pain in that area and a sense that the lump had changed in size. Dr. Drabkin’s examination caused him to question his prior assessment, since there was now less of a discrete mass on her breast, and he recommended that she see a surgical colleague, Dr. Marvin Corlette, for an urgent consultation.

Dr. Corlette saw her that day and, after examination, doubted that the lump on Ellertson’s breast was cancerous. He told her to take aspirin and soak the location, and to return if she noticed any change in the lump. Dr. Corlette saw her again on May 6 or 7, 2003, and used a needle to remove tissue from the location of the lump on her breast.

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Related

Hejinian v. General American Life Insurance
25 Mass. L. Rptr. 408 (Massachusetts Superior Court, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
22 Mass. L. Rptr. 684, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hejinian-v-general-american-life-insurance-masssuperct-2007.