Luisa M. Fernandez v. Bankers National Life Insurance Company

906 F.2d 559, 1990 WL 90284
CourtCourt of Appeals for the Eleventh Circuit
DecidedSeptember 25, 1990
Docket89-5485
StatusPublished
Cited by114 cases

This text of 906 F.2d 559 (Luisa M. Fernandez v. Bankers National Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Luisa M. Fernandez v. Bankers National Life Insurance Company, 906 F.2d 559, 1990 WL 90284 (11th Cir. 1990).

Opinion

FAY, Circuit Judge:

This case concerns a beneficiary’s claim to the proceeds of a life insurance policy, when the insured decedent died of a terminal illness unknown at the time of insurance application. Finding that the insured decedent’s omission of previous medical history constituted a material misrepresentation, the district court granted summary judgment for defendant-appellee Bankers National Life Insurance Company (Bankers) prior to denying as moot plaintiff-appellant Luisa M. Fernandez’s motion to compel discovery of allegedly pertinent documents. Plaintiff-appellant appeals the district court’s granting summary judgment for Bankers as well as granting summary judgment before ruling on the motion to compel discovery. Because we have determined that the district court should have ruled on the motion to compel discovery before ruling on the summary judgment motion and that genuine issues of material fact exist, we reverse and remand for proceedings consistent with this opinion.

I. FACTUAL AND PROCEDURAL BACKGROUND

The insured decedent, Daniel C. Fernandez, was employed by Charles Weiss, M.D. & Associates, P.A. in Miami Beach, Florida. Dr. Weiss, chairman of orthopedics and rehabilitation at Mount Sinai Hospital, provided a non-contributory pension and life insurance plan for his employees. Upon *561 becoming eligible for participation in the plan, Daniel Fernandez, a single male, obtained a $250,000.00 life insurance policy from Bankers. He designated his sister, plaintiff-appellant Luisa M. Fernandez, as his beneficiary.

Daniel Fernandez applied for a life insurance policy with Bankers on September 19, 1985. In response to application questions regarding his health, Fernandez responded that he had not been treated for any illnesses, diseases or injuries during the past ten years and that, within the past five years, he had submitted to annual physical examinations, the results of which were normal. The pension plan and office administrator, who saw Daniel Fernandez at least biweekly, testified that he had “no reason to believe” that Fernandez was telling “anything other than the truth” on his application for life insurance. 1 After reviewing Fernandez’s application, Bankers issued the life insurance policy effective December 24, 1985. On January 5, 1986, Fernandez submitted an amendment to the information that he had supplied Bankers and listed two elective surgeries.

Daniel Fernandez died on September 19, 1986, of respiratory distress, seizure disorder, and toxoplasmosis of the brain. The parties do not dispute that these complications resulted from Acquired Immune Deficiency Syndrome (AIDS). Under the life insurance plan with Bankers, the insured’s benefit is one hundred percent nonforfeitable if termination of employment is the result of death. 2

Following the claim on the policy on behalf of the beneficiary by Dr. Weiss as plan trustee, Bankers extensively examined the medical history of Daniel Fernandez, since his death was within the two-year contestable period from the date of policy issuance. In denying the claim, Bankers’ policy administrator detailed Daniel Fernandez’s reasons for seeing various doctors from October, 1975 to August, 1985. 3 There is no mention of AIDS in this compiled medical history. The last doctor who saw Daniel Fernandez before he applied for the life insurance policy with Bankers treated him on August 12, 1985, for herpes zoster, or shingles, and noted that Fernandez was “[djoing fine.” 4 Bankers explained that knowledge of Fernandez’s discovered medical history would have caused them to request additional information, including a blood test. Finding “material misrepresentations of medical history,” Bankers claimed that they were prevented from requesting medical testing under routine underwriting procedures. 5

This action, originally filed by plaintiff-appellant in state court, was removed by Bankers to federal court based on diversity jurisdiction. 6 Bankers moved for summary judgment and filed the affidavits of Charles J. Kindermann, Bankers’ manager and director of underwriting when the Fernandez claim was denied, and Jan Perrine, Bankers’ claims supervisor. Kindermann’s affidavit states that Fernandez’s medical records revealed that he “had been treated in the past for herpes, had numerous blood tests and was last seen by a doctor in August, 1985, for herpes approximately one month prior to his application.” 7 Kin- *562 dermann claims that the omission of this information “materially affected the acceptance of the risk” by Bankers and that disclosure would have caused Bankers to require additional information, based upon which Bankers would have either declined to issue the policy or would have issued the policy under different terms. 8 Perrine’s affidavit states that the claim “was specifically denied and the policy premium returned to the trustee since the condition which ultimately caused DANIEL FERNANDEZ’ demise existed prior to the application date, was known to DANIEL FERNANDEZ, but was not revealed on the life insurance application notwithstanding the fact that said information was requested.” 9

The district court denied Bankers’ summary judgment motion and extended discovery. The case subsequently was reassigned to another district judge. During extended discovery, the depositions of Kin-dermann and Perrine were taken.

Kindermann testified that he made the decision to deny the Fernandez claim and that he consulted Perrine and underwriting manuals in making his decision. 10 He also reviewed Daniel Fernandez’s medical history, the same medical history reviewed by Perrine, and found no specific mention of AIDS. 11 Kindermann attested that the primary reason for denying the claim was herpes zoster and that AIDS was not a factor. 12 He stated that no questions were asked concerning AIDS on the Bankers’ application in September, 1985. 13 Subsequently, questions concerning AIDS or AIDS-related conditions have been added to the Bankers’ life insurance application. Kindermann conceded that at least one other AIDS case had been reviewed during the two-year contestable period resulting in the claim being honored. 14 He acknowledged that neither prior episodes of gonorrhea, from which Fernandez apparently had recovered, nor venereal diseases generally were involved in his evaluation of the claim. 15 He stated that if “there was no medical history and the Herpes Zoster had not been there and he died of AIDS and the information on the application would have been honest, the claim would have been paid.” 16

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Bluebook (online)
906 F.2d 559, 1990 WL 90284, Counsel Stack Legal Research, https://law.counselstack.com/opinion/luisa-m-fernandez-v-bankers-national-life-insurance-company-ca11-1990.