Lima v. Equitable Financial Life Insurance Company

CourtDistrict Court, D. South Dakota
DecidedJune 11, 2025
Docket4:24-cv-04087
StatusUnknown

This text of Lima v. Equitable Financial Life Insurance Company (Lima v. Equitable Financial Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. South Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lima v. Equitable Financial Life Insurance Company, (D.S.D. 2025).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF SOUTH DAKOTA SOUTHERN DIVISION

BRANDY LIMA, AND MARJORIE HOFER, 4:24-CV-04087-RAL INDIVIDUALLY AND ON BEHALF OF DONALD HOFER; Plaintiffs, OPINION AND ORDER GRANTING IN PART MOTION FOR SUMMARY JUDGMENT vs. EQUITABLE FINANCIAL LIFE INSURANCE COMPANY, Defendant.

This is an insurance dispute over whether Defendant Equitable Financial Life Insurance Company (Equitable) properly terminated a policy insuring the life of Donald Hofer. Donald, his wife Majorie Hofer, and the Hofers’ daughter Brandy Lima (collectively “the Plaintiffs”), allege that Equitable failed to provide the required notice that the policy had lapsed. They assert claims for breach of contract, insurance bad faith, and unjust enrichment. They also seek a declaratory judgment ordering Equitable to remit the death benefit they claim is owed under the policy. Equitable moves for summary judgment on the Plaintiffs’ claims and its counterclaim seeking a declaratory judgment that it did not breach the policy. This Court grants Equitable’s motion on the Plaintiffs’ claims for bad faith, unjust enrichment, and declaratory judgment, but denies the motion on the breach of contract claim and Equitable’s counterclaim. I. Facts

Donald obtained a flexible premium variable life insurance policy (the Policy) from Equitable in 1989. Doc. 23 § 6; Doc. 30 § 6. Unlike a traditional whole life insurance policy, Donald’s Policy did not require fixed premium payments to remain in force. Doc. 15-1 at 1; Doc. 23 § 12; Doc. 30 J 12; Fleisher v. Phoenix Life Ins., 18 F. Supp. 3d 456, 460 (S.D.N.Y. 2014) (“Traditional whole life insurance policies require payment of a fixed monthly premium.”). Instead, the policy owner could choose and adjust the frequency and the amount of premium payments. Doc. 15-1 at 1; Doc. 23 § 12; Doc. 30 12. Under the Policy, Equitable would deduct certain expense charges from Donald’s premium payments and then place the remainder in his selected investment accounts. Doc. 15-1 at 1-2, 13; Doc. 23 ff 14-15; Doc. 30 ff 14-15. To remain in force, the Policy needed to have enough value to cover the monthly deductions for the cost of insurance and other fees. Doc. 15-1 at 12-13; Doc. 23 Jf 9-11, 15; Doc. 30 J 9-11, 15. If the Policy had insufficient funds to cover these monthly deductions, Equitable would mail the policy owner a written notice and give them a 61-day grace period to make the necessary payment: Grace Period. The duration of insurance coverage depends upon the Net Cash Surrender Value[!] being sufficient to cover the total monthly deductions described on Page 9. If the Net Cash Surrender Value at the beginning of any policy month is less than such deductions for that month, we will send a written notice to you and any assignee on our records at last known addresses stating that a grace period of 61 days has begun, starting with the beginning of that policy month. The notice will also state the amount of the premium payment sufficient to cover monthly deductions for 3 months. Doe. 15-1 at 12; Doc. 23 9; Doc. 30 9 9. If the necessary sum was not paid during the grace period, the Policy would end: If we do not receive such amount at our Administrative Office before the end of the grace period, we will then (1) withdraw and

1The Net Cash Surrender Value is the policy account value minus any applicable surrender charge, policy loan, or loan interest. Doc. 15-1 at 17; Doc. 23 ¢ 10; Doc. 30 10.

retain the entire amount in your Policy Account, including any applicable surrender charge; and (2) send a written notice to you and any assignee on our records at last known addresses stating that this policy has ended without value. Doc. 15-1 at 12; Doc. 23 7 9; Doc. 30 { 9. Donald was diagnosed with dementia and began living in a nursing home around 2013, 24 years after the Policy first issued. Doc. 31 9 4. As Donald’s condition worsened, Marjorie began managing payment of the Policy’s premiums.” Id. 5. The Policy lapsed 16 times while Marjorie was handling the premium payments because its value fell below the amount necessary to cover the monthly deductions.? Doc. 27 J 9; Doc. 31 § 6. For each of these lapses, Equitable mailed a notice to the last known address of the Policy’s owner and someone made the required payment to prevent the Policy from terminating. Doc. 27 4 9. Lima became aware of these lapses, saw some of Equitable’s notices, and gave her mother money to make the payments to avoid cancellation. Doc. 31 7-8. Marjorie struggled to maintain the Policy, so Lima took over making payments in 2021. Doe. 23 4 20; Doc. 30 J 20; Doc. 31 9. Lima set up an automatic withdrawal of $575 per month from her checking account to sustain the Policy. Doc. 23 § 21; Doc. 30 § 21; Doc. 31 4] 11-14. During a phone call in January 2021, Lima asked an Equitable representative whether her monthly $575 payment would “cover everything”; the representative replied that the cost of insurance was $527.12 a month, so the $575 payment “should be just fine.” Doc. 31 4 13; Doc. 31-2. Lima

*Marjorie has a durable power of attorney for Donald and is bringing Donald’s claims in this case in a representative capacity. Doc. 12 at 1. 3An affidavit from Equitable says that the Policy lapsed 16 times between November 2011 and December 2020. Doc. 27 J 9. Lima agrees that the Policy lapsed “several” times but does not recall exactly how many. Doc. 31 { 6.

became the owner of the Policy in March 2021, and made herself the primary beneficiary of the Policy in November 2021. Doc. 23 ff 20, 22; Doc. 30 {ff 20, 22; Doc. 27 { 10. Equitable began mailing annual reports to Lima at her address in Marion, South Dakota, once she became the Policy’s owner. Doc. 23 J 23; Doc. 30 § 30. Equitable mailed Lima an annual report in August 2022 showing that the monthly deductions exceeded $590 and projecting that, if Lima continued paying $575 a month, the policy account value and cash surrender value would be only $583.54 by August 22, 2023 4 Doc. 23 FF 24-25; Doc. 30 ff 24-25. The August 2022 annual report noted that the policy account and cash surrender value could fluctuate depending on Lima’s investments and warned that the Policy “may be in danger of terminating without value in the next 12 months unless additional premium is paid.” Doc. 15-2 at 4; Doc. 23 {| 26-27; Doc. 30 ff 26-27. The monthly $575 payment by ACH from Lima’s account to. Equitable continued after August 2022. Doc. 23 28; Doc. 30 { 28. Equitable also sent Lima confirmation notices each month from August 2022 through July 2023 for the $575 monthly premium she paid. Doc. 23 { 29; Doc. 30 § 29; Doc. 27-3. These notices showed that the Policy’s account value was declining. Doc. 23 29; Doc. 30 { 29; Doc. 27-3. The confirmation notice Equitable mailed to Lima on July 20, 2023, showed that the Policy’s account value was $561.93. Doc. 23 30; Doc. 30 § 30; Doc. 27-3 at 34. The Policy lapsed on July 23, 2023, because its value dropped below that necessary to cover that month’s deduction.’ Doc. 23 § 32; Doc. 30 { 32.

4 Lima agrees that the August 2022 annual report includes this information, Doc. 30 24-25, but argues that the annual reports and notices Equitable sent would be unhelpful to those lacking a sophisticated understanding of Equitable’s forms, Doc. 33 at 7. 5 Lima agrees that she did not make any payments between July 23, 2023, and September 23, 2023, because Equitable did not make any automatic withdrawals from her account during the grace period. Doc. 33 at 5 n.2; see also Doc. 30 36. The record is unclear whether an ACH for $575 occurred in July 2023.

The parties disagree about what happened next. Equitable claims that its automated computer system generated a notice of policy lapse and that its third-party vendor, Broadridge Financial Solutions, Inc. (Broadridge), mailed this notice to Lima at her address in Marion, South Dakota, on July 25, 2023. Doc.

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Lima v. Equitable Financial Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lima-v-equitable-financial-life-insurance-company-sdd-2025.