Oglesby v. Penn Mutual Life Insurance

877 F. Supp. 872, 1995 U.S. Dist. LEXIS 2340, 1994 WL 733768
CourtDistrict Court, D. Delaware
DecidedFebruary 16, 1995
DocketCiv. A. 93-224 MMS
StatusPublished
Cited by39 cases

This text of 877 F. Supp. 872 (Oglesby v. Penn Mutual Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Oglesby v. Penn Mutual Life Insurance, 877 F. Supp. 872, 1995 U.S. Dist. LEXIS 2340, 1994 WL 733768 (D. Del. 1995).

Opinion

OPINION

MURRAY M. SCHWARTZ, Senior District Judge.

INTRODUCTION

Plaintiff John T. Oglesby, II filed suit against defendant The Penn Mutual Life Insurance Company (“Penn Mutual”) in Delaware state court. Oglesby alleged breach of contract for failure to pay benefits under a disability insurance policy and breach of the duty of good faith and fair dealing. Specifically, he averred that from August 1990 to the present, he has been totally disabled within the meaning of the policy, and that Penn Mutual wrongfully denied him benefits thereunder. Oglesby is a citizen of Delaware.

Pursuant to 28 U.S.C. § 1441, defendant, a Pennsylvania corporation, removed plaintiff’s lawsuit to federal court, invoking federal diversity jurisdiction under 28 U.S.C. § 1332. Penn Mutual also filed counterclaims seeking declaratory relief, alleging it is not obligated on the policy and seeking to void or rescind certain components of the policy.

Before the Court is defendant Penn Mutual’s motion for full or partial summary judgment, based on four different grounds. Penn Mutual contends it is entitled to full summary judgment because: (1) Oglesby is not totally disabled from his regular occupation within the meaning of the policy; and (2) Oglesby failed to timely comply with the notice and proof of loss provisions required by both the policy and 18 Del.C. § 3311. In the alternative, Penn Mutual seeks partial summary judgment, arguing that, even if Oglesby is disabled under the policy, (3) he is not entitled to the benefit increases from the 1989-1992 policy amendment riders because the riders are subject to rescission under *875 equitable fraud principles, and (4) he is barred from collecting increased benefits from the 1991-1992 policy amendment riders because he was already disabled when the riders became effective.

The Court heard oral argument in this matter on October 19, 1994. Upon consideration of the parties’ arguments, both written and oral, for the reasons that follow, the Court will deny full summary judgment and grant Penn Mutual’s motion for partial summary judgment as to the rescission of the 1989-1992 benefit riders. Under these dispositions, defendant’s fourth ground for summary judgment is rendered moot.

FACTUAL BACKGROUND

Plaintiff Oglesby, a physician, applied to Penn Mutual for disability insurance in November 1986 through his longtime friend and Penn Mutual insurance agent, William Lee. Docket Item (“D.I.”) 61 at 57-58. At the time, Oglesby was 47 years old. D.I. 61 at 52. Plaintiff was then and remains a Board certified radiologist at the Medical Center of Delaware in Newark, Delaware; he is also a partner in a group practice of 19 radiologists. Id. at 96. When he applied for disability insurance he was the hospital’s Chief of Vascular and Interventional Radiology, a medical sub-specialty within the radiology discipline. Id. at 52.

Though most laymen may be familiar with the responsibilities of a general radiologist, e.g., interpretation of x-ray and other radiological film studies, the duties of an interventional and vascular radiologist are not as self-evident. The field of interventional and vascular radiology has rapidly expanded over the past decade into a discipline which overlaps many other medical specialties, such as surgery, cardiology, and gastroenterology. Id. A physician practicing interventional and vascular radiology may perform procedures as diverse as balloon angioplasty (opening clogged blood vessels), drainage of abscesses, placement of filters in the blood system supplying the lungs to prevent emboli (blood clots), and gastrostomy (feeding tube) placement. D.I. 61 at 281-82. Plaintiff claims that 80% to 100% of his duties and time were taken up by these responsibilities prior to the onset of his disability. Id. at 283; D.I. 63 at 23, 26, & 29.

At the heart of this action is whether plaintiff is now disabled from practicing such medical procedures. A recap of plaintiffs medical history, a chronology of assorted ailments, is therefore in order. During the 1970s, Oglesby experienced intermittent lower back aches, relieved by aspirin or rest. D.I. 61 at 224. In 1981, he suffered an onset of “severe bolt-like” pain in his neck, which also radiated down his left arm. Id. at 225-227. Consultation with a neurologist revealed a neck condition, cervical radiculopathy (nerve root irritation); this was diagnosed as resulting from cervical spine arthritis. Id. at 225. Oglesby’s symptoms abated after treatment with the drug Motrin; his illness lasted approximately two months. Id. at 116, 225-227. Plaintiff did not seek treatment for any recurrence of neck symptoms as of November 1986, the time he applied for the Penn Mutual policy. Id. at 217. In 1985, plaintiff underwent a total hip replacement due to a long history of arthritis in the hip joint. Id. at 51.

Plaintiff submitted his application for Penn Mutual disability insurance on November 24, 1986. Id. at 52. The application’s question number 12 asked that he describe his “Occupation and Exact Daily Duties.” Id. at 51. Plaintiff answered by declaring he was a “Physician — Radiologist—Diagnostic Radiology and Director of Interventional and Cardiovascular Radiology.” Id. The Penn Mutual application also included questions about plaintiffs medical history. Question 20(a) asked, within the past five years, had plaintiff “consulted a physician; been advised to have medical treatment or surgery; been hospitalized; requested, received or been refused insurance benefits for any injury or sickness?” Id. Plaintiff answered affirmatively, stating yes, he had undergone a total hip replacement in 1985 due to degenerative arthritis. Id.

Question 20(c) asked whether plaintiff “ever had any known indication of or been treated for: ... disease or disorders of the ... bones including spine, back, or joints?” Oglesby answered this by cross-referencing to the answer in 20(a). Id. Question 20(e), *876 however, was not limited to “within the past five years.” Oglesby did not disclose his previous cervical spine (neck) problem. Oglesby signed the bottom of the application, certifying that all statements contained therein were true, complete, and correctly recorded. Id. at 52.

On November 3, 1986, a medical examiner for Penn Mutual 1 performed a history and physical on plaintiff. She interviewed him pursuant to questions on a Penn Mutual Medical Examiner Report Form. Id. at 53. On the Report Form, question 2(h) asked, “Have you even been treated for or had any indication of arthritis, gout, or disorder of muscles, bones or joints?”. Id. Oglesby answered this in the affirmative, elaborating with details of his total hip replacement. Id.

The medical examiner also documented plaintiff as having a history of “degenerative changes in the

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Bluebook (online)
877 F. Supp. 872, 1995 U.S. Dist. LEXIS 2340, 1994 WL 733768, Counsel Stack Legal Research, https://law.counselstack.com/opinion/oglesby-v-penn-mutual-life-insurance-ded-1995.