Oglesby v. Penn Mutual Life Insurance

889 F. Supp. 770, 1995 U.S. Dist. LEXIS 8422, 1995 WL 360749
District Court, D. Delaware·Decided May 30, 1995·No. Civ. A. 93-224 MMS·Published·Cited by 13 cases

Opinion

OPINION

MURRAY M. SCHWARTZ, Senior District Judge.

I. INTRODUCTION

This is a diversity action brought by plaintiff John T. Oglesby to collect insurance benefits under a disability policy issued in February 1987 by defendant The Penn Mutual Insurance Company (Penn Mutual). Penn Mutual has denied liability for plaintiffs claim. At summary judgment, Penn Mutual sought and was granted partial rescission of the policy based on plaintiffs concealment of medical information material to Penn Mutual’s risk of insurance. The Court held as a matter of law that when applying for the disability policy, plaintiff failed to disclose his medical history of cervical (neck) spine arthritis and its concomitant symptoms.

*772 This case now stands ready for trial. The Court has already determined that Delaware law will supply the rule of decision. Oglesby v. Penn Mutual Ins. Co., 877 F.Supp. 872, 878 (D.Del.1994). Presently at issue is whether, under the disability policy and Delaware law, Penn Mutual should be able to present to the jury its defense to coverage pursuant to the so-called “first manifest” doctrine. Under this theory, Penn Mutual would argue that the policy does not cover claims for disability arising from sickness that first made itself known prior to the issuance of the policy.

For the following reasons, the Court holds that under the terms of the disability policy at issue, Penn Mutual may not assert at trial a defense under the “first manifest” doctrine.

II. FACTUAL BACKGROUND

On November 24, 1986, plaintiff applied to Penn Mutual for the disability policy that is now the focus of this lawsuit. Docket Item (“D.I.”) 61 at 52. As part of the application process, Penn Mutual required plaintiff to complete a written application and undergo a medical exam and interview by a Penn Mutual medical examiner. Id. at 52-53. Plaintiff was then a 47 year old radiologist serving as Chief of Cardiovaeular and Interventional Radiology at the Medical Center of Delaware. Id. at 52.

The Penn Mutual application form and the Penn Mutual medical examiner both required plaintiff to detail his complete medical history. In so doing, plaintiff did not report an incident of severe neck and left arm pain which had required treatment with cervical traction, ultrasound therapy, and Valium. Id. at 51, 53, 225-27. Plaintiffs illness, which caused him symptoms for almost two months in 1981, had been diagnosed by a neurologist as degenerative cervical arthritis. Id. at 218. However, the only arthritis plaintiff disclosed to Penn Mutual was arthritis in his hip joints. Id. at 51, 53. Penn Mutual approved plaintiffs application and issued a disability policy effective February 1, 1987. D.I. 4 at V 3. The pokey specifically excluded from coverage “any impairment due to degenerative arthritis or rheumatism of the hip region.” D.I. 61 at 39. If plaintiff was to suffer total disabikty, Penn Mutual would pay a monthly insurance benefit of $5,000. Id. at 32.

In April 1990, plaintiff experienced another painful episode of his cervical arthritis, similar to his bout in 1981. Plaintiff again sought treatment from his neurologist, whom he had not consulted in the intervening nine years. D.I. 61 at 217. Plaintiffs symptoms were such that he could not perform some of his hospital duties as Chief of Cardiovascular and Interventional Radiology. Over the next few months, physical and medical therapy failed to alleviate plaintiffs symptoms. His neurologist then referred him to a neurosurgeon; plaintiff underwent surgical repair of two of his cervical vertebrae in October 1990. Id. at 236-37. Although the prognosis for full recovery was good, plaintiffs pain persisted, and he still could not perform certain of his employment responsibikties. In June 1992, after months of physical therapy, plaintiffs physicians informed him his condition would be permanent. Plaintiff immediately filed a claim with Penn Mutual, stating he could no longer perform the substantial and material duties of his regular occupation. He resigned his post as Chief of Cardiovascular and Interventional Radiology in 1992, but was able to continue duties as a general radiologist. Id. at 286. Penn Mutual refused to pay plaintiffs claim; thus, plaintiff instituted this action on the policy.

As its investigation of plaintiffs claim unfolded, Penn Mutual discovered plaintiffs concealment during the appkeation process. Pursuant to statutory mandate, the insurance pokey contained an incontestability provision directly addressing misstatements by such an insured during the appkeation process. Deviating somewhat from the statutory language, Penn Mutual had contracted to not contest such statements made by plaintiff after two years from the effective date of the pokey. Plaintiffs onset of disabikty occurred more than two years later than February 1987, the issue date of the pokey. Consequently, as to the base pokey originally issued, Penn Mutual did not contest at summary judgment plaintiffs misstatements during the appkeation process nor move for invalidation of the policy.

*773 Penn Mutual had also issued, however, for additional consideration, annual policy riders increasing the amount of insurance benefits payable to plaintiff in the event of total disability. Each of these riders incorporated by reference the same two year incontestability period as provided in the base policy; each rider’s incontestability period commenced on the rider’s effective date. With the 1990 onset of plaintiffs disability, the timetable of events allowed Penn Mutual to contest the benefit increase riders issued in 1989-1992. Accordingly, Penn Mutual moved for partial summary judgment seeking rescission of these riders. Because plaintiff had concealed information material to the risk assumed by Penn Mutual, the Court ordered the rescission of the 1989-1992 benefit increase riders. Oglesby v. Penn Mutual Ins. Co., 877 F.Supp. 872, 890 (D.Del.1994).

At the final pretrial conference in this matter, Penn Mutual made known its intention to defend its denial of coverage with a doctrine known as “first manifest.” This “first manifest” defense is derived from language contained on the first page of plaintiffs disability policy, which sets forth:

Coverage Provided by This Policy. Subject to all provisions of the policy, we insure you against disability or other loss resulting from:
sickness, which first makes itself known while this policy is in force....
Throughout this policy, we will use the word[ ] sickness ... as we just defined [it].

D.I. 61 at 30. Penn Mutual contends under this provision that because plaintiffs cervical arthritis first made itself known or “first manifested” itself in 1981, before the policy was in force, it may deny coverage as to this illness.

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Oglesby v. Penn Mutual Life Insurance, 889 F. Supp. 770, 1995 U.S. Dist. LEXIS 8422, 1995 WL 360749 (D. Del. 1995).

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