North American Co for Life & Health Ins v. Pouncey

CourtDistrict Court, D. Connecticut
DecidedSeptember 3, 2024
Docket3:23-cv-00137
StatusUnknown

This text of North American Co for Life & Health Ins v. Pouncey (North American Co for Life & Health Ins v. Pouncey) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
North American Co for Life & Health Ins v. Pouncey, (D. Conn. 2024).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

North American Company for Life and Health Insurance, Civil No. 3:23-cv-00137 (SVN) Plaintiff,

v. September 3, 2024 Roberto Pouncey,

Defendant.

REPORT AND RECOMMENDATION ON PLAINTIFF’S MOTION FOR DEFAULT JUDGMENT [ECF No. 23] I. INTRODUCTION This is an insurance case in which the plaintiff, North American Company for Life and Health Insurance (“North American”), seeks a declaratory judgment declaring that a term life policy obtained by the defendant, Roberto Pouncey, is void ab initio on account of material misrepresentations in his application. (Compl., ECF No. 1, at 6.) Mr. Pouncey failed to appear, and North American moved for a default judgment. (Mot. for Default J., ECF No. 23.) The presiding District Judge, the Honorable Sarala V. Nagala, referred the motion to me, Magistrate Judge Thomas O. Farrish. (Order of Referral, ECF No. 24.) I received two additional briefs (Resp. to Show Cause Order, ECF No. 30; Suppl. Br., ECF No. 36), and I heard oral argument. (Tr. of Hrg. on Mot. for Default J., ECF No. 35.) The motion is therefore ripe for decision. Having carefully considered the matter, I recommend that Judge Nagala DENY the motion. North American’s policy contains an “incontestability clause,” a common life insurance policy provision that limits the time in which the company may contest the validity of the contract on account of misrepresentations in the application process. (Policy, ECF No. 1-2, § 3.3, p. 7.) The contestability period is two years (id.), and North American’s own pleadings plainly demonstrate that its action is untimely. (See discussion, Section III.C infra.) North American says that its own contractual clause should be disregarded because incontestability is an affirmative defense that Mr. Pouncey waived when he failed to appear.

(Suppl. Br., ECF No. 36, at 5.) It is well established, however, that courts may consider unpled affirmative defenses when adjudicating motions for default judgment, if those defenses are “set forth in the papers plaintiff himself submitted.” Walters v. Indus. & Commercial Bank of China, Ltd., 651 F.3d 280, 293 (2d Cir. 2011) (citation omitted). That is the case here, because the facts establishing incontestability are clearly set forth in the insurance policy and service-of-process documents that North American itself submitted. (See discussion, Section III.C infra.) North American argues that even if its current claims are barred by the incontestability clause, it should be given leave to amend its complaint to cure the defect. (Suppl. Br., ECF No. 36, at 1-4.) The operative complaint alleges only that Mr. Pouncey made simple, non-fraudulent misrepresentations in his insurance application. (Compl., ECF No. 1, ¶ 27.) North American

contends that it can, consistent with Rule 11, amend its complaint to upgrade these allegations to fraud, and it further contends that such an allegation would fix things because “Connecticut law does not preclude a fraud exception to incontestability.” (Suppl. Br., ECF No. 36, at 1.) But it cites no Connecticut case in which an insurer avoided the operation of its own incontestability clause in this way, and indeed the available authorities are to the contrary. (See discussion, Section III.C infra.) And even if Connecticut state courts were split or otherwise undecided on the issue of a fraud exception to incontestability, it would arguably be inappropriate for a federal court to decide the issue in a declaratory judgment. (See id.) Put differently, if North American amended its complaint to add fraud allegations, the amendment would either be futile, or it would raise jurisdictional issues. I therefore recommend that the denial of North American’s motion be without leave to replead. II. BACKGROUND The following facts are taken from North American’s complaint, and are deemed admitted

for purposes of a default judgment motion. (See discussion, Section III.C.1 infra.) North American is an Iowa company that sells life insurance and other financial products. (Compl., ECF No. 1, ¶ 2.) “On or about” February 5, 2021, it received a life insurance application from Roberto Pouncey. (Id. ¶ 8.) In his application, Mr. Pouncey represented, among other things, that he had not used cocaine within the previous ten years. (Id. ¶ 11; see also Application, Ex. A to Compl., ECF No. 1-1, at 3.) He also represented that he had not “been diagnosed or treated by a medical professional for . . . [a]lcohol abuse.” (Application, ECF No. 1-1, at 4; see also Compl., ECF No. 1, ¶ 14.) He affixed his electronic signature to the application (Application, ECF No. 1-1, at 11), and in so doing he declared that his “[s]tatements and answers in this application . . . are complete and true to [his] best knowledge and belief.” (Id. at 9.)

North American issued a life insurance policy in reliance on these representations. (Compl., ECF No. 1, ¶ 15.) The policy was a simple ten-year term policy that began on February 5, 2021 and expired on February 5, 2031. (Policy, Ex. B to Compl., ECF No. 1-2, at 4.) The death benefit was $100,000.00 (id.), and the beneficiary was Mr. Pouncey’s former spouse. (Id. at 5; see also Application, ECF No. 1-1, at 6.) Importantly for this case, the policy contained an incontestability clause. (Policy, ECF No. 1-2, at 7.) The clause read in relevant part: INCONTESTABILITY – The Company cannot contest this Policy after it has been in effect during the lifetime of the Insured for two years from the Policy Date or, if reinstated, for two years from the date of reinstatement, except for: (a) Non-payment of Premium; or (b) Fraud, where permitted by applicable law in the state where this Policy is delivered or issued for delivery.

(Id.) The clause also required Mr. Pouncey to cooperate with any timely contestability investigation that North American might pursue. (See id.) (“As long as this Policy remains contestable, the Insured, Owner, Beneficiary, or next-of-kin will cooperate with the Company in any contestable investigation conducted by the Company, including, but not limited to, supplying the Company with necessary authorizations for medical and other information.”). After it issued the policy, North American conducted a contestability investigation. Neither its complaint nor any of its subsequent submissions say exactly when the investigation began, but by January 5, 2023 – twenty-three months into the life of the Policy – it had concluded that Mr. Pouncey’s cocaine and alcohol representations were false. (See Compl., ECF No. 1, ¶ 23.) During the investigation North American obtained records from the APT Foundation, “a non- profit treatment and recovery program for individuals who suffer with substance use disorders or mental illness.” (Id. ¶ 18.) Those records revealed that Mr. Pouncey had used cocaine on February 29, 2019, well within the ten-year period encompassed by the application question. (Id. ¶ 19.) The records also revealed that he had received diagnoses of substance use disorder and alcohol use disorder, and had undergone in-patient treatment. (Id. ¶ 21.) North American says that if Mr. Pouncey had “truthfully represented his cocaine use and diagnoses and treatments for alcohol abuse, the Policy would not have been approved.” (Id. ¶ 22.)

It therefore sent him a letter on January 5, 2023, explaining that “it would like to rescind the Policy on the basis of a material misrepresentation,” and seeking “his mutual agreement to do so.” (Id. ¶ 23.) Mr. Pouncey did not respond. (Id. ¶ 24.) North American then filed a complaint in this Court on February 2, 2023, seeking to void or rescind the policy by way of a declaratory judgment. (Id.) After a brief introductory statement, the complaint alleged that diversity jurisdiction exists under 28 U.S.C. § 1332

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North American Co for Life & Health Ins v. Pouncey, Counsel Stack Legal Research, https://law.counselstack.com/opinion/north-american-co-for-life-health-ins-v-pouncey-ctd-2024.