Jones v. Jackson National Life Insurance

819 F. Supp. 1372, 1993 U.S. Dist. LEXIS 4737, 1993 WL 137321
CourtDistrict Court, W.D. Michigan
DecidedMarch 19, 1993
Docket1:92-cv-00135
StatusPublished
Cited by11 cases

This text of 819 F. Supp. 1372 (Jones v. Jackson National Life Insurance) is published on Counsel Stack Legal Research, covering District Court, W.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jones v. Jackson National Life Insurance, 819 F. Supp. 1372, 1993 U.S. Dist. LEXIS 4737, 1993 WL 137321 (W.D. Mich. 1993).

Opinion

OPINION OF THE COURT

McKEAGUE, District Judge.

This case presents fundamentally a breach of contract action to recover benefits under a policy of life insurance. Defendant Jackson National Life Insurance Company has denied liability, asserting the contract of insurance is void because the insured’s health changed prior to delivery of the policy and because the application for insurance contained material misrepresentations. Further, defendant has filed a third-party complaint against its agent, Terry L. Lothamer, alleging that he is liable, under various contract and tort theories, for the amount of any benefits it may be compelled to pay. This court has jurisdiction by virtue of the parties’ diversity of citizenship. It has been determined that Michigan law governs adjudication of the claims contained in both complaints. Now before the Court are the parties’ cross-motions for summary judgment.

I. SUMMARY OF FACTS

Dennis M. Jones died on March 15, 1991, at the age of 45. He is survived by his wife, Ellen C. Jones, plaintiff herein, and three children. He had worked as an insurance *1374 agent and was most recently employed by Insurance and Risk Management, Inc., of Muncie, Indiana, as a producer of commercial lines insurance. During the summer of 1990, he had consulted with his friend and coworker, insurance agent Terry L. Lothamer, about purchasing additional life insurance. Lothamer served as an independent agent of Jackson National Life Insurance Co. (“Jackson National”), authorized to solicit applications for insurance and deliver policies. Upon Lothamer’s suggestion, Jones applied for a $500,000 standard policy with Jackson National. Jones completed the application on July 25 and 26,1990. The application was mailed to Jackson National on July 26 or 27.

In relevant part, the application revealed that Jones had a hiatal hernia and was taking the prescription medication Zantac. In response to the question whether he had had any diagnostic tests during the past five years, Jones disclosed only that he had had a urine test in April 1990. In fact, he had also undergone an upper gastrointestinal tract x-ray examination on April 16, 1990. The upper g.i. x-ray revealed the existence of the hiatal hernia and stricture, or narrowing, of the esophagus. The results of the upper g.i. exam had been communicated to Jones by telephone the next day.

On July 27, 1990, one day after completing the application, Jones kept an appointment with his family doctor, Joseph Pippenger, M.D., for treatment of continuing heartburn and swallowing problems, the symptoms which had precipitated the upper g.i. exam. Dr. Pippenger appears to have believed these symptoms and the stricture of the esophagus were related to the hiatal hernia, but recommended that Jones undergo further diagnostic testing. Pursuant to this recommendation, Jones received notice on August 14, 1990, that an esophagoscopy, or endoscopy of the esophagus, had been scheduled for September 13,1990. Jones did not apprise Jackson National of this development.

On September 7, 1990, Jackson National notified Lothamer that Jones’ application had been approved. This notice was followed on September 11,1990, by notice that the policy would be put in force upon receipt of the first annual premium payment of $1,030. Lothamer had, in fact, mailed Jones’ check in that amount to Jackson National the day before. On September 11, 1990, Jackson National mailed the policy from its office in Carmel, Indiana, to Lothamer, who received it the morning of September 13, 1990.

Jones underwent the endoscopy examination in the afternoon of September 13, 1990, at the office of Dr. Lee G. Jordan, M.D., Methodist Hospital in Indianapolis. Dr. Jordan reached the preliminary conclusion that the stricture of the esophagus was caused by a cancerous tumor. He communicated this diagnosis to Jones and arranged for a CT (computerized tomography) scan examination later that afternoon before Jones returned home. The CT scan results would enable a conclusive diagnosis.

Later that evening, after returning home, Jones began experiencing sever chest pains. He was admitted to Ball Memorial Hospital in Muncie on September 13, 1990, and transferred to Methodist Hospital on September 14, where he was found to have tumors in his stomach and esophagus. Portions of Jones’ esophagus, stomach, intestine, and spleen were surgically removed on September 14 and 15, 1990. Jones was released from Methodist Hospital and returned home on October 5,1990. In the meantime, Lothamer had delivered the Jackson National life insurance policy to him in the hospital on September 20, 1990.

Ultimately, the treatment of Jones’ cancer was unsuccessful. He died on March 15, 1991. His wife filed a claim for life insurance benefits on March 25,1991. Jackson National investigated the claim and denied it by letter dated May 23, 1991. The sole reason for the denial: that Jones had, in the September 14, 1990 cancer diagnosis, experienced a change in health prior to delivery of the policy to him, of which he did not inform Jackson National in writing. This action followed.

II. CLAIMS PRESENTED

Plaintiff alleges in count I of the complaint that Jackson. National’s refusal to pay benefits under the policy constitutes a breach of contract. She claims entitlement to the sum *1375 of $500,000 in benefits, plus statutory interest since the date of Jones’ death. In count IV, plaintiff alleges Jackson National’s refusal to pay benefits on a timely basis is a violation of the Uniform Trade Practices Act, M.C.L. § 500.2006, because the claim is not reasonably disputed. Based on this violation, plaintiff claims penalty interest. 1

Jackson National, in turn, asserts third-party claims against Lothamer. Counts II, III and TV of the third-party complaint contain claims alleging that Lothamer is liable for any loss Jackson National is made to bear because of his negligence, breach of fiduciary duty and silent fraud. 2 That is, Jackson National alleges its loss, if any, will have been caused by its agent’s, Lothamer’s, failure to disclose Jones’ changed health prior to delivery of the policy; for if Jackson National had known of Jones’ cancer diagnosis on September 13, 1990, it would have withheld delivery of the policy.

III. SUMMARY JUDGMENT STANDARD

All three parties have filed cross-motions for summary judgment in support of and in defense of the claims presented. The motions ask the Court to evaluate the factual support for the claims presented. The Court must look beyond the pleadings and assess the proof to determine whether there is a genuine need for trial. Matsushita Electric Ind. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). The standard for determining whether summary judgment is appropriate is “whether the evidence presents a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law.” Anderson v. Liberty Lobby, Inc.,

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Bluebook (online)
819 F. Supp. 1372, 1993 U.S. Dist. LEXIS 4737, 1993 WL 137321, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-jackson-national-life-insurance-miwd-1993.