Hejinian v. General American Life Insurance

25 Mass. L. Rptr. 408
CourtMassachusetts Superior Court
DecidedJanuary 13, 2009
DocketNo. 053851BLS1
StatusPublished

This text of 25 Mass. L. Rptr. 408 (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, 25 Mass. L. Rptr. 408 (Mass. Ct. App. 2009).

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.

On July 13, 2007, this Court allowed Hejinian’s motion for partial summaiy judgment as to coverage under the Policy, and vacated the stay as to Hejinian’s claim for unfair settlement practices in violation of G.L.c. 93A and 176D. Memorandum of Decision and Order on Plaintiffs Motion for Partial Summaiy Judgment and Defendants’ Motion for Summaiy Judgment at 19 (“the First Summary Judgment Decision”) [22 Mass. L. Rptr. 684]. The parties have since conducted additional discovery as to that claim and each now cross-moves for summaiy judgment. After hearing, Hejinian’s motion for summaiy judgment is ALLOWED and General American’s motion for summaiy judgment is DENIED.

DISCUSSION

In deciding this second motion for summaiy judgment, this Court assumes familiarity with the First [409]*409Summary Judgment Decision. In that First Summary Judgment Decision, this Court found as a matter of law that Hejinian was entitled to coverage under his wife’s life insurance Policy. Here, this Court must determine whether, as a matter of law, General American engaged in an unfair claim settlement practice in violation of G.L.c. 176D, §3(9) (and, as a consequence, in violation of G.L.c. 93A, §2) by failing to effectuate a “prompt, fair and equitable” settlement of a life insurance claim “in which liability has become reasonably clear.” G.L.c. 176D, §3(9)(f). Since there is no dispute that the only offer of settlement that General American ever made to Hejinian was to offer him the return of his paid premiums with interest — the paltiy sum of only $335.84, General American would indeed have engaged in an unfair claim settlement practice if liability had become reasonably clear.

“Whether the defendant’s liability in this case became ‘reasonably clear’ calls for an objective standard of inquiiy into the facts and the applicable law.” Demeo v. State Farm Mut. Auto Ins. Co., 38 Mass.App.Ct. 955, 956 (1995). “That objective test calls upon the fact finder to determine whether a reasonable person, with knowledge of the relevant facts and law, would probably have concluded, for good reason, that the insurer was liable to the plaintiff.” Id. at 956-57. See also Bobick v. U.S Fidelity & Guar. Ins. Co., 57 Mass. App. 1, 7 n.6 (2003).

There is no material dispute as to the relevant facts in this case:

1. On the Medical Declarations Form of her Application for Life Insurance (“the Application”), which she signed on February 14, 2003, Ellertson answered “no” to the question as to 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, or any disorder of the thyroid or lymph glands or other endocrine disorders. She answered “yes” as to whether in the last ten years she had been treated for or diagnosed as having “cancer, tumor, cyst or disorder of the skin,” but wrote that she had a “benign mole removed.”

2. There is no evidence that these answers were false. More specifically, there is no evidence that, at the time she signed this Application, Ellertson had been treated for or diagnosed as having cancer, or knew that she had cancer.

3. After receiving her Application and before issuing her life insurance Policy, General American caused Ellertson to undergo a paramedical examination. It did not require her to undergo a medical examination, which must be conducted by a licensed physician. See Robinson v. Prudential Ins. Co. of America, 56 Mass.App.Ct. 244, 245 (2002) (a “medical examination” is “an examination by a physician”).

4. By June 3, 2003, Ellertson had been diagnosed with breast cancer, and this diagnosis was confirmed in a second opinion on June 6, 2003.

5. When General American approved the Application on June 11, 2003, it did not know of Ellertson’s cancer diagnosis. If it had known, it would not have issued her the Policy.

6. When the Policy was delivered to Ellertson on June 23, 2003, it was accompanied by a Notice and Policy/Certificate Delivery Receipt (“Receipt”). The Receipt states in pertinent part:

In order to continue to provide you with quality insurance products at competitive premium rates, it is necessary that our underwriters have complete and accurate information on the lives of individuals applying for insurance. Therefore, it is only fair to you and to all of our policyholders that questions on the application are answered completely to the best of your knowledge. Please review carefully the answers recorded to the questions in the copy of the application that is attached to this policy. Contact us immediately, in writing or by calling the Home Office..., if any answers are not complete and true to the best of your knowledge and belief.

Below this information in the Receipt is what is referred to as a “Certification” which declares in pertinent part:

I acknowledge that I have received Policy Number 3,838,523 on this date and accept it as issued. The coverage provided by this policy was explained to me. I understand the insurance protection provided.
I certify that Part I and Part II (medical or non-medical) of the application were attached to this policy when it was delivered to me. I have reviewed these parts of the application and the answers provided were accurately recorded. The answers are complete, correct and true to the best of my knowledge and belief. I further certify that the information contained in these parts of the application remains true and correct to the best of my knowledge and belief as of this date. There has been no change in my health since the date of the application and/or examination for insurance.

Ellertson signed and returned this Receipt on June 23, 2003, along with a check for payment of the first premium.

7. Ellertson tragically died of cancer on March 21, 2004.

If this life insurance claim were governed by G.L.c. 175, §124, no reasonable person, applying these relevant facts, could reasonably have concluded that General American should decline coverage on this Policy. Section 124, enacted in 1892, provides:

In any claim arising under a policy issued in the commonwealth by any life company, without previ[410]

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Cite This Page — Counsel Stack

Bluebook (online)
25 Mass. L. Rptr. 408, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hejinian-v-general-american-life-insurance-masssuperct-2009.