Hejsak v. Great-West Life & Annuity Insurance

331 F. Supp. 2d 756, 2004 U.S. Dist. LEXIS 16416, 2004 WL 1850283
CourtDistrict Court, W.D. Wisconsin
DecidedAugust 17, 2004
Docket03-C-629-C
StatusPublished
Cited by1 cases

This text of 331 F. Supp. 2d 756 (Hejsak v. Great-West Life & Annuity Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Hejsak v. Great-West Life & Annuity Insurance, 331 F. Supp. 2d 756, 2004 U.S. Dist. LEXIS 16416, 2004 WL 1850283 (W.D. Wis. 2004).

Opinion

OPINION AND ORDER

CRABB, District Judge.

In this civil action for monetary relief, plaintiff Jacqueline Hejsak asserts breach of contract and bad faith claims against defendant Greab-West Life & Annuity Insurance Company for denying her benefits under a life insurance policy issued to her husband, Robert Hejsak. Jurisdiction is present. 28 U.S.C. § 1332.

Presently before the court are the parties’ cross motions for summary judgment, plaintiffs motion to supplement the affidavits of two experts and defendant’s motion for leave to reply to plaintiffs additions to the record. I conclude that because defendant has not shown that Robert Hejsak knew or should have known that he suffered from a “central nervous system disorder” or “liver disease” as defined in the policy, defendant did not have authority to rescind the policy under Wis. Stat. § 631.11(l)(b). Therefore, I will deny defendant’s motion for summary judgment and grant plaintiffs motion as to the breach of contract claim. However, plaintiff has not met her burden to show that it was unreasonable for defendant to believe that Robert Hejsak knew or should have known that he suffered from a “central nervous system disorder” affecting his spinal cord. For this reason, I will deny plaintiffs motion for summary judgment on her claim of bad faith and grant defendant’s motion on that claim. Finally, because I did not consider plaintiffs additional documents in reaching a decision in this case, I will deny as unnecessary plaintiffs motion to supplement her affidavits and defendant’s motion for leave to reply to plaintiffs additional documents.

From the parties’ proposed findings of fact and the record, I find the following facts to be material and undisputed.

UNDISPUTED FACTS

Plaintiff Jacqueline Hejsak is a citizen of Wisconsin. She is the widow of Robert J. Hejsak. Defendant Greab-West Life & Annuity Insurance Company is a citizen of the state of Colorado. It provides life insurance products to its customers.

On October 18, 1999, in response to unsolicited mail from U.S. Bank offering life insurance through defendant, Robert Hej-sak applied for a life insurance policy with defendant, requesting coverage of $150,000. Plaintiff filled out a similar application for life insurance.

In his application for life insurance with defendant, Robert Hejsak answered “No” to all of the medical questions, including the following:

As of the date you sign this application and within the last 10 years has a medi *759 cal professional diagnosed you as having or treated you for: ^
1. Any of the following diseases or disorders: (check all that apply):
□ heart disease or disorder
□ liver disease or Hepatitis (other than type A)
2. Stroke, paralysis, brain or central nervous system disorders, multiple sclerosis or epilepsy?

Defendant has internal practices and procedures that state that among the “qualifications” it requires of applicants before it issues a policy is a “No” answer to all the medical questions on the application. Defendant’s internal procedures list the medical questions on the application and also list “spinal cord” as part of the question asking whether the applicant has been diagnosed with or treated for “[sjtroke, paralysis, brain, spinal cord or central nervous system disorders, multiple sclerosis or epilepsy” (emphasis added). Sometime after Robert Hejsak signed defendant’s life insurance application, defendant revised its application to include the term “spinal cord” in the question so that the application now reads “[sjtroke, paralysis, brain, spinal cord or central nervous system disorders, multiple sclerosis or epilepsy.”

On October 27, 1999, defendant issued life insurance policy no. 87520645 to Robert Hejsak on the basis of the application that he signed on October 18. Defendant would not have issued the policy to him if he had answered “Yes” to any of the medical questions on the application. The policy states that it will “not be contested on the basis of misrepresentation after it has been in force during the Insured’s lifetime for 2 years from the Issue Date.” In addition, the “Death Benefit Provisions” section of the policy states that defendant “will pay interest on the Proceeds from the date of death to the date of settlement at a rate not less than required by law.”

Plaintiff is intimately familiar with Robert Hejsak’s medical history for the ten years preceding October 18, 1999 because she attended many of his visits to his doctor, spoke regularly with his physicians and was present when his physicians spoke to him. No medical professional ever told Robert Hejsak in the presence of plaintiff that he had been diagnosed or treated for a central nervous system disorder, a heart disease or disorder or a liver disease. In addition, Robert Hejsak never told plaintiff or anyone else in plaintiffs presence that he believed that he had been diagnosed as having been treated for a central nervous system disorder, a heart disease or disorder or a liver disease.

Robert Hejsak died on March 12, 2001 as a result of multiple gunshot wounds. On May 1, 2001, plaintiff applied to defendant for the benefits of the policy. Because Robert Hejsak died within two years of issuance of the policy, defendant investigated Robert Hejsak’s medical history by reviewing some of his medical records for the ten years prior to his death. Robert Hejsak’s medical records revealed the following information about him:

a. On January 23, 1997, he was involved in a motor vehicle accident.
b. Michael F. Gonzales, M.D. and Mar-shall E. Pederson, M.D. were two physicians who treated him at various times after the accident.
c. According to a letter by Gonzales dated July 8, 1999, Hejsak was “physically disabled by spinal damage at multiple levels,” required “ongoing and regularly scheduled medical care for multiple medical problems,” expected to require additional spinal surgery” and was “suffering from liver damage and urologic damage all of which require regular medical and surgical care.”
*760 d. As early as August 12, 1997, Peder-son discussed with him at length his spinal condition and told him that “the automobile accident certainly has caused a strain of the cervical, thoracic and lumbar spine.”
e. A handwritten note from Gonzales dated August 20, 1997 reads “DIAGNOSES 1) Thoracic Disc Herniation, 2) Cervical Disk Herniation, 3) Sacroiliac and Lumbosacral Strain.”
f. In another handwritten note to a pharmacist dated August 9, 1999, Gonzales stated that Robert Hejsak “has cervical spinal stenosis, sacroiliac displacement and has also been given the diagnosis of ‘stiff-man syndrome’ ... He is also being monitored for hepatic, renal or hematologic side effects of his condition.”
g.

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331 F. Supp. 2d 756, 2004 U.S. Dist. LEXIS 16416, 2004 WL 1850283, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hejsak-v-great-west-life-annuity-insurance-wiwd-2004.