John Hancock Mutual Life Insurance v. Banerji

815 N.E.2d 1091, 62 Mass. App. Ct. 906
CourtMassachusetts Appeals Court
DecidedOctober 6, 2004
DocketNo. 01-P-722
StatusPublished
Cited by4 cases

This text of 815 N.E.2d 1091 (John Hancock Mutual Life Insurance v. Banerji) is published on Counsel Stack Legal Research, covering Massachusetts Appeals Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
John Hancock Mutual Life Insurance v. Banerji, 815 N.E.2d 1091, 62 Mass. App. Ct. 906 (Mass. Ct. App. 2004).

Opinion

1. Facts. Baneiji submitted his original application for an individual disability policy in 1990. When Hancock issued the policy, it attached a copy of Baneiji’s application. One of the provisions of the policy (the FEP provision) allowed a policyholder to apply for expanded monthly benefits as his annual income increased, and in 1993 Banerji sought such expanded coverage.2 Because Hancock, as is typical of disability insurers (see 12 Couch, Insurance § 182:31 [3d ed. 1998]), sought to avoid allowing its policyholders to become [907]*907overinsured,3 the FEP application form requested information relating to the existence of other disability income insurance. Baneiji answered that he had no applicable coverage other than his Hancock policy. Hancock approved Banerji’s application for the FEP benefit and sent him an “addendum page,” or rider, to be attached to the underlying policy. Hancock did not attach to the addendum page a copy of Baneiji’s application for the FEP benefit, nor did it require Banerji to return the policy to Hancock so that Hancock could attach the application for the FEP benefits to the policy.

Baneiji suffered a stroke in 1991, which left him partially disabled, but he did not apply for disability benefits because his employer did not reduce his pay during his period of recovery. On August 19, 1994, his employer terminated his employment, citing bad attitude and frequent unexplained absences. Shortly thereafter, Baneiji filed a claim for disability benefits from Hancock. Following an investigation, Hancock paid disability benefits under the original policy ($1,500 per month), but denied FEP benefits (which would have amounted to an additional $1,550 per month). Hancock’s investigation had disclosed that, contrary to Baneiji’s answer in the FEP application, he had group disability insurance coverage provided by his employer, amounting to sixty percent of his income. It is undisputed that if that information had been disclosed to Hancock, Baneiji would not have qualified for the FEP benefits.4

2. Discussion. Massachusetts law contemplates that a copy of the insurance policy application will be attached to the insurance policy when it is issued. See G. L. c. 175, §§ 108(5)(a), 131. The purpose of those statutes is to afford the applicant “the opportunity to correct material errors in the application,” Meyer, Life & Health Insurance Law § 6:8, at 167 (1972); id. at § 6:9 (Supp. 2003); see 3 Holmes, Appleman on Insurance § 15.1 (2d ed. 1998), and to secure the insurer’s right to rely on misrepresentations to rescind the policy, 2 Couch, Insurance § 18:6 (3d ed. 1995). Failure to attach the application bars the insurer from relying on false answers in the application in a rescission action. See G. L. c. 175, § 108(5)(a); 2 Couch, supra. See also Schiller v. Metropolitan Life Ins. Co., 295 Mass. 169, 173 (1936); Pahigian v. Manufacturers’ Life Ins. Co., 349 Mass. 78, 84 (1965).

The attachment statutes on their face apply only to the original policy issuance; the requirement that the application be attached does not apply to applications for reinstatement or revival of an insurance policy. See, e.g., Opara v. Massachusetts Mut. Life Ins. Co., 441 Mass. 539, 545-546 (2004). [908]*908Compare Holden v. Metropolitan Life Ins. Co., 188 Mass. 212, 214 (1905) (referring to precursor to G. L. c. 175, § 131, statute “plainly has reference to an application upon which the original policy is issued”).

For purposes of determining the applicability of § 108(5)(a), the pivotal question in this case is thus indistinguishable from that in Opara: to paraphrase that case, did Baneiji purchase a single disability insurance policy from Hancock, or two separate and distinct policies? If he purchased one policy of insurance, which was merely supplemented by the “addendum page,” then Hancock may rely on the misrepresentation in Baneiji’s FEP application to deny his FEP claim for benefits. See Opara v. Massachusetts Mut. Life Ins. Co., 441 Mass. at 544. If, on the other hand, the FEP “addendum page” constituted the issuance of a new and distinct policy, § 108(5)(«) would bar Hancock from relying on the misrepresentation that was critical to issuance of the FEP supplemental benefit.

The FEP “addendum page” was not a new and distinct policy. Policies typically have numbers; no new policy number attached to the FEP “addendum page,” Opara, supra at 546, and no new policy was issued, only an addendum page to be attached to the underlying policy. The FEP benefit, i.e., the opportunity to raise coverage as the insured’s income grew, was a contract provision of the underlying policy, available only to an insured under such a policy, not to the general public. Unlike the application Banerji was required to fill out when applying for the underlying disability policy, which required extensive information about his lifestyle and medical history, the FEP application sought no medical information other than whether Banerji was presently disabled.5 The very paucity of the FEP application made clear that only two factors were central to issuance of the FEP benefit: first, that Banerji’s income had doubled since the issuance of the original policy and, second, that he had no available disability coverage in place or contemplated (i.e., applied for) other than his Hancock coverage. Hancock was thus not required by statute to attach the FEP benefit application to the policy in order to rely on it in rescission.

An examination of the contract as a whole shows that there was also no contractual requirement that Hancock attach the FEP application to the original policy. There are several places in the insurance contract where attachment language is used with reference to the original application, while no attachment language is used in connection with the FEP application. For example, the policy states that “[a] copy of your application is attached and is a part of this policy” (emphasis added). The original policy states that future FEP requests “will become a part of this policy.” Another example of the different treatment is the contract’s discussion of the two-year period after which misrepresentations in the application become incontestable. With respect to misrepresentations in the original application, the policy states that Hancock cannot “contest any statements in the application which is attached to this policy” (emphasis added). With respect to the FEP application, no reference to attachment is used in the two-year incontestability provision. Clearly, Hancock differentiated between the applications in its contract, presumably [909]*909because the statute only called for attachment of the original application for the underlying policy, and because attachment of the supplemental FEP application would entail a possibly cumbersome return of the underlying policy to Hancock.

Because neither the statute nor the provisions of the contract require Hancock to attach the FEP application to the original policy, its failure to do so will not prevent it from relying on Baneqi’s misrepresentation to rescind the FEP portion of the policy. Rescission, whether governed by G. L. c. 175, § 108(5)(c), or § 186, reflects long-standing common-law principles. See Barnstable County Ins. Co. v. Gale, 425 Mass. 126, 128 (1997).

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Bluebook (online)
815 N.E.2d 1091, 62 Mass. App. Ct. 906, Counsel Stack Legal Research, https://law.counselstack.com/opinion/john-hancock-mutual-life-insurance-v-banerji-massappct-2004.