Marie Deonier & Associates v. Paul Revere Life Insurance

2000 MT 238, 9 P.3d 622, 301 Mont. 347, 2000 Mont. LEXIS 242
CourtMontana Supreme Court
DecidedAugust 31, 2000
Docket99-115
StatusPublished
Cited by26 cases

This text of 2000 MT 238 (Marie Deonier & Associates v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marie Deonier & Associates v. Paul Revere Life Insurance, 2000 MT 238, 9 P.3d 622, 301 Mont. 347, 2000 Mont. LEXIS 242 (Mo. 2000).

Opinion

JUSTICE TRIEWEILER

delivered the opinion of the Court.

¶ 1 The original Plaintiff, Kathryn Vestal, brought this action in the District Court for the Thirteenth Judicial District in Yellowstone County to recover disability insurance benefits and other damages from Defendants, The Paul Revere Life Insurance Company and Marie Deonier & Associates, Vestal’s insurance agent, as a result of Paul Revere’s denial of Vestal’s disability claim. Deonier asserted cross-claims against Paul Revere for indemnity and breach of fiduciary duties. Vestal subsequently settled with Paul Revere and dismissed her claims against Paul Revere and Deonier. The parties were then realigned-Deonier as the Plaintiff and Paul Revere as the Defendant. The District Court dismissed Deonier’s claim for breach of fi *349 duciary duty by summary judgment. Following a nonjury trial on Deonier’s claim for indemnity, the District Court entered judgment against Paul Revere. Deonier appeals the District Court’s summary judgment and Paul Revere cross-appeals the District Court’s judgment in favor of Deonier. We reverse the judgment of the District Court in part and affirm in part.

¶2 The following issues are presented on appeal by Deonier:

¶3 1. Did the District Court err when it dismissed Deonier’s claim for breach of fiduciary duty by summary judgment?

¶4 2. Did the District Court err when it refused to decide the legality of Paul Revere’s disability policy?

¶5 The following issue is presented on cross-appeal by Paul Revere:

¶6 3. Did the District Court err when it required Paul Revere to indemnify Deonier?

FACTUAL BACKGROUND

¶7 The Plaintiff, Marie Deonier, was a licensed disability and life insurance agent. In 1986, Paul Revere appointed Deonier as one of its independent agents and expressly authorized Deonier to solicit applications, deliver policies, collect premiums, and service Paul Revere’s clients. Deonier did not have an exclusive relationship with any disability insurance carrier, nor was Paul Revere the primary company for which Deonier sold insurance policies.

¶8 The original Plaintiff, Kathryn Vestal, enrolled in the University of Montana School of Law in 1988. On May 24, 1989, Vestal sought medical help from the University of Montana Student Health Services for insomnia that she was experiencing. Vestal was prescribed low dose antidepressants over the next several months.

¶9 In 1990, Vestal accepted employment as a staff attorney in the Billings Office of Hearings and Appeals of the Social Security Administration. Vestal met with Deonier in June 1991 to discuss Vestal’s desire to purchase a disability insurance policy. Because of Vestal’s special needs as a federal employee, Deonier recommended a Paul Revere policy. Deonier completed the insurance application based on information provided by Vestal. The insurance application expressly disclosed the fact that Vestal had suffered insomnia for a period of time during law school.

¶10 On June 27,1991, Paul Revere issued Vestal a disability insurance policy which did not exclude any preexisting conditions. Vestal’s policy contained the following provisions pertinent to this case:

9.2 INCONTESTABLE
*350 a. After your policy has been in force for two years, excluding any time You are Disabled, We cannot contest the statements in the application.
b. No claim for Disability beginning after two years from the Date of Issue will be reduced or denied because a disease or physical condition that existed before the Date of Issue unless it is excluded by name or specific description.
3.2 PRE-EXISTING CONDITION LIMITATIONS
We will not pay benefits for a Pre-Existing Condition if it was not disclosed on Your application. You are responsible for verifying the accuracy of each and every statement on Your application. Also, We will not pay benefits for any loss We have excluded by name or specific description.
DEFINITIONS
“Sickness” means sickness or disease which first manifests itself after the Date of Issue and while Your Policy is in force.
“Pre-existing Condition” means a Sickness or physical condition for which, prior to the Date of Issue:
a. Symptoms existed that would cause an ordinarily prudent person to seek diagnosis, care, or treatment; or
b. Medical advice or treatment was recommended by or received from a Physician.

¶11 In 1975, the Fifth Circuit Court of Appeals decided Massachusetts Casualty Insurance Company v. Forman (5th Cir. 1975), 516 F.2d 425. In Massachusetts Casualty Insurance Company, the insurance company asserted a legal defense to the incontestable clause in its policy based on its definition of “sickness” which excluded disabilities that manifested themselves prior to the issue date of the policy. This legal position is presently known as the “Forman defense.”

¶12 In 1981, a Montana Federal District Court decided the case of Doettl v. Colonial Life & Accident Insurance Company (D. Mont. 1981), 505 F. Supp. 127. The Doettl case discussed an insured’s reliance on an incontestible clause, citing Massachusetts Casualty Insurance Company, 516 F.2d 425, and stating that “[t]he almost universal rule is that incontestible clauses do not abrogate defenses going to coverage.” Doettl, 505 F. Supp. at 128.

¶13 In 1987, counsel for Paul Revere presented a paper to the Association of Life Insurance Counsel entitled: “The Forman Defense in Disability Insurance.” The paper outlined Paul Revere’s position as follows:

*351 The Forman defense permits a company to deny beyond the two-year contestable period, a disability claim for a disease which had clearly manifested itself prior to the policy date, on the ground that it is not a covered sickness under the policy. It is available in approximately 40 states and can be asserted in the remaining states with the right set of facts or by filing for declaratory relief and continuing to pay the claim. However, in many of these states, there is no clear authority pro or con and the company will be making new and hopefully favorable law. Accordingly, it is imperative that corporate counsel review carefully each claim where the Forman defense would be involved and select only those which have “clean” facts for the company and amply demonstrate the insured’s duplicity.

Id. at 779.

¶14 Based on the Montana Federal District Court’s decision in Doettl, 505 F. Supp.

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Bluebook (online)
2000 MT 238, 9 P.3d 622, 301 Mont. 347, 2000 Mont. LEXIS 242, Counsel Stack Legal Research, https://law.counselstack.com/opinion/marie-deonier-associates-v-paul-revere-life-insurance-mont-2000.