Hock v. New York Life Insurance Co.

876 P.2d 1242, 18 Brief Times Rptr. 1102, 1994 Colo. LEXIS 515, 1994 WL 270040
CourtSupreme Court of Colorado
DecidedJune 20, 1994
Docket93SC3
StatusPublished
Cited by452 cases

This text of 876 P.2d 1242 (Hock v. New York Life Insurance Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hock v. New York Life Insurance Co., 876 P.2d 1242, 18 Brief Times Rptr. 1102, 1994 Colo. LEXIS 515, 1994 WL 270040 (Colo. 1994).

Opinion

Justice VOLLACK

delivered the Opinion of the Court.

We granted certiorari to review the court of appeals decision in Abdelsamed v. New York Life Insurance Co., 857 P.2d 421 (Colo.App.1992), which concluded that the trial court abused its discretion in several of its evidentiary rulings and remanded the case for retrial on the breach of contract claim and bad faith breach of insurance • contract claim, as well as on New York Life Insurance Company’s counterclaim for rescission. We hold that the trial court did not abuse its discretion. We therefore reverse the court of appeals and remand with directions to reinstate the trial court’s judgment.

I.

A. History of Illness

The petitioner, Ahmed Abdelsamed (Ab-delsamed), a self-employed engineering consultant, purchased disability insurance coverage on March 27, 1986, through the Institute of Electrical and Electronic Engineers which had a group disability policy with New York Life Insurance Company (NYL). 1 The application form, which Abdelsamed completed *1246 and submitted on December 12, 1985, required him to provide detailed information regarding Ms income and the existence of other outstanding insurance policies. Abdel-samed listed his gross annual income for 1985 as $392,000 and stated that he had no other disability insurance. However, in the preceding four months, he had applied for disability insurance from three other companies, and at the time of his application to NYL, he was insured by two of them under policies which would provide him with monthly disability benefits totalling $10,000. 2

Abdelsamed claims that on December 19, 1985, several days after Abdelsamed mailed his application form to NYL, he confirmed in writing a telephone conversation he had had with an employee of NYL. In his letter, Abdelsamed expressed that he wanted to amend his application form to include two other disability policies: Mutual Benefit Life, Class 4-A, $4,000 to Age 65; and Monarch, Class 4-A, $6,000 Life. According to Abdel-samed’s letter, NYL’s employee had told Ab-delsamed that his failure to include the other two policies on the application did not matter as long as the total coverage did not exceed sixty percent of his income.

On March 30, 1986, three days after the policy was issued, Abdelsamed, who was in Egypt working on an engineering contract with ACETO Engineers-Contractors, a private Egyptian company, was hospitalized in Cairo with a “major affective disorder, depressed type.” 3 He remained in the psychiatric hospital until August 31, 1986. From September 1986 to January 30, 1987, Abdel-samed was hospitalized for a second time and received psychiatric treatment at a different hospital in Cairo. Upon release, he began his return journey to the United States via Germany. He traveled to Munich, Germany, where he was again admitted to a psychiatric hospital after apparently suffering a psychotic episode during which he allegedly lost his important documents, including his passport, medical records, financial records, and confirmation of his compensation from ACETO.

Abdelsamed returned to the United States. 4 On March 19, 1987, less than one week after his arrival, El Paso County District Court Judge Donald E. Campbell committed Abdelsamed to the state hospital in Pueblo, Colorado, based on his determination that Abdelsamed was mentally ill, and a danger to himself and others.

After Abdelsamed was released from the state hospital seventeen days later, he lived in a community shelter for the homeless. Abdelsamed was subsequently deemed eligible for Social Security Disability benefits based upon his psychiatric disability. Since then, Abdelsamed has continued to receive psychiatric care and has not worked.

B. Disability Benefits Claim-

In April 1986, while undergoing his first psychiatric hospitalization in Egypt, Abdel-samed filed a claim for disability benefits with NYL. Since Abdelsamed’s claim was filed within two years after the policy had become effective, NYL invoked the provision allowing it to undertake a contestability in *1247 vestigation and verify the statements made on the application rather than begin payments on the thirty-first day after Abdel-samed- had been hospitalized.

NYL hired investigators in Egypt to verify Abdelsamed’s hospitalization and to verify his reported gross income of $392,000 in 1985. NYL requested from Abdelsamed his daily hospital records from the Egyptian hospitals and for authorization to obtain records from the Internal Revenue Service and Small Business Administration to verify his earnings.

NYL’s investigators confirmed that Abdel-samed was hospitalized during the specified dates in two psychiatric hospitals in Cairo. Abdelsamed’s treating doctors at both hospitals supplied NYL with discharge summaries detailing Abdelsamed’s medical diagnosis and prognosis.

NYL informed Abdelsamed that the summary information was insufficient and that NYL would not consider his claim unless he provided NYL with daily hospital records from each hospital. Both hospitals failed to produce the detailed records. 5

Abdelsamed subsequently provided NYL with a copy of the district court’s order committing him involuntarily to the Colorado State Hospital, and also informed NYL that he had been under continuous psychiatric treatment since his return to the United States. NYL’s investigator in Colorado Springs confirmed that Abdelsamed was under a psychiatrist’s care, that the federal government had approved his receipt of Social Security Disability benefits, and that he had lived at a homeless shelter. Abdelsamed also provided NYL with official Internal Revenue Service summaries of his 1984 and 1985 tax returns, as well as several one-page hospital discharge summaries.

NYL contended that the documentation was insufficient, and in August 1987, NYL closed Abdelsamed’s file pending the receipt of the requested information. Abdelsamed provided no further information, and NYL neither denied nor approved Abdelsamed’s claim.

In November 1987, Abdelsamed filed suit in El Paso County District Court against NYL for failing to pay his disability benefits. He sought compensatory and punitive damages for breach of contract, bad faith breach of an insurance contract, and outrageous conduct. NYL counterclaimed for rescission of the contract, claiming that Abdelsamed had misrepresented material facts within his application, namely, his gross income for 1985 and the existence of other disability insurance coverage.

At trial, an analyst with the State of Colorado, Division of Insurance, testified as a non-expert witness that after reviewing Ab-delsamed’s 1985 tax return she believed his income for that year was $385,840.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Peo v. Thompson
Colorado Court of Appeals, 2025
Stonig v. Midyette
Colorado Court of Appeals, 2025
V&H v. Beardsley
Colorado Court of Appeals, 2025
Matter of Marilyn G Hoye Trust
Colorado Court of Appeals, 2025
Havana v. JERB
Colorado Court of Appeals, 2025
Estate of Grosse-Rhode
Colorado Court of Appeals, 2025
Ironshore v. Pool
Colorado Court of Appeals, 2025
Cuerna Verde v. Adams
Colorado Court of Appeals, 2025
Peterson v. Aurora
Colorado Court of Appeals, 2025
Matter of Clark Brothers
Colorado Court of Appeals, 2024
Estate of Jays
Colorado Court of Appeals, 2024
Bluebird v. Johnson
Colorado Court of Appeals, 2021
Fritzler v. Mitchell (In re Estate of Fritzler)
413 P.3d 163 (Colorado Court of Appeals, 2017)
Gold Hill Development Co., L.P. v. TSG Ski & Golf, LLC
2015 COA 177 (Colorado Court of Appeals, 2015)
Walker v. Ford Motor Company
2015 COA 124 (Colorado Court of Appeals, 2015)
Vititoe v. Rocky Mountain Pavement Maint., Inc.
412 P.3d 767 (Colorado Court of Appeals, 2015)
Meister v. Stout
2015 COA 60 (Colorado Court of Appeals, 2015)
Fisher v. State Farm Mut. Auto. Ins. Co.
419 P.3d 985 (Colorado Court of Appeals, 2015)
People ex rel. J.G.
2014 COA 182 (Colorado Court of Appeals, 2014)
Leaf v. Beihoffer
2014 COA 117 (Colorado Court of Appeals, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
876 P.2d 1242, 18 Brief Times Rptr. 1102, 1994 Colo. LEXIS 515, 1994 WL 270040, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hock-v-new-york-life-insurance-co-colo-1994.