Provident Life & Accident Insurance v. Goel

274 F.3d 984, 51 Fed. R. Serv. 3d 1090, 2001 U.S. App. LEXIS 25926, 2001 WL 1540391
CourtCourt of Appeals for the Fifth Circuit
DecidedDecember 4, 2001
Docket99-60443
StatusPublished
Cited by154 cases

This text of 274 F.3d 984 (Provident Life & Accident Insurance v. Goel) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Provident Life & Accident Insurance v. Goel, 274 F.3d 984, 51 Fed. R. Serv. 3d 1090, 2001 U.S. App. LEXIS 25926, 2001 WL 1540391 (5th Cir. 2001).

Opinion

DENNIS, Circuit Judge:

After suffering an injury to his hand that prevented him from performing surgery, Dr. Dinesh K. Goel sought disability benefits under a policy issued by Provident Life and Accident Insurance Company (“Provident”). Although it paid on the claim, Provident reserved its rights and ultimately brought this declaratory judgment action to rescind the policy, contending that Dr. Goel did not satisfy a condition precedent to coverage by failing to cancel a disability policy he held with another insurer. The district court granted summary judgment to Provident and de *988 nied Dr. Goel’s subsequent motion for relief from judgment. Our consideration of the record, the briefs, and the arguments presented by both parties convinces us that summary judgment was appropriate. We further find that the district court did not abuse its discretion in denying Dr. Goel’s Rule 60(b) motion for relief from judgment. Accordingly, we affirm.

I. FACTS AND PROCEDURAL HISTORY

This action concerns the validity of a disability insurance policy issued by Provident to Dr. Dinesh K. Goel. The circumstances surrounding the issuance of the policy date back to 1992. At that time, Dr. Goel practiced as a surgical specialist in Jackson, Mississippi, where he continues to reside. Although Dr. Goel maintained $11,000 a month in disability coverage with The Paul Revere Life Insurance Company, , his financial obligations and rapidly rising income caused him to seek additional coverage. To that end, Dr. Goel contacted Anil Sharma, a personal friend and Provident agent, to discuss increasing his coverage to approximately $25,000 a month. Through Mr. Sharma, Dr. Goel submitted three applications for disability coverage with Provident.

On his first application, dated November II, 1992, Dr. Goel stated that he did not have disability coverage. Provident later issued a policy that provided the $15,000 monthly benefit requested in the application. But after realizing that he did not disclose his Paul Revere coverage on the Provident application, Dr. Goel allowed this policy to lapse through non-payment of the first premium.

On June 21,1993, Dr. Goel submitted his second application to Provident. In a letter dated September 27, 1993, a Provident Field Underwriter informed Mr. Sharma that “[i]n order for Mr. Goel to qualify for the $25,000 of benefit you requested, his income level would need to be upwards of $1,000,000.00 annually, to be considered as an exception to the Maximum Issue Rule.” 1 Based on his $400,000 income in 1992, Provident advised Dr. Goel that it would issue him $15,000 a month in coverage if he agreed to cancel his Paul Revere policy. 2 Because Dr. Goel was unwilling to cancel his Paul Revere coverage, he allowed the second application to expire.

In 1993, Dr. Goel’s income increased to over $719,000. This significant increase brought about Dr. Goel’s third and final application to Provident on February 28, 1994. On his application, Dr. Goel disclosed his $11,000 policy with Paul Revere but answered “N/A” to the following question:

4.(0 If any coverage is to be replaced by the coverage applied for, the following coverage(s) will be permanently can-celled within 30 days of the issue date or effective date, whichever is later, of the insurance coverage issued pursuant to this application.
Co. Name_Amount $_

In a “Personal History Interview” conducted in connection with his application, Dr. Goel again disclosed his Paul Revere policy and further indicated that he would not terminate his existing coverage. But Provident also maintained its position concerning the Paul Revere coverage: it would provide $15,000 a month in coverage only if Dr. Goel agreed to cancel his Paul Revere policy. Provident therefore prepared an Amendment to Dr. Goel’s application that changed his answer to Question 4(f) from “N/A” to “Paul Revere.”

On June 28, 1994, Provident approved and printed, along with the Amendment, a *989 disability policy for Dr. Goel that provided a monthly benefit of $15,000. Instructions accompanying the Amendment and the. policy directed the agent to obtain Dr. Goel’s signature on the Amendment before releasing the policy to him. 3 The Amendment, relating to cancellation of the Paul Revere coverage, stated:

In consideration of the issuance of the policy to which this amendment is attached, it is understood and agreed that my signed application dated February 28,1994 is amended as follows:
THE ANSWER TO QUESTION 4F IS CHANGED TO READ: “PAUL REVERE”

Neither Dr. Goel nor the agent, Mr. Shar-ma, recalls the Amendment or when it was signed. 4 But Provident did receive the signed Amendment, and a copy remains in its underwriting file. 5 Moreover, Dr. Goel retained the policy as issued and paid the monthly premiums.

On October 26,1996, Dr. Goel suffered a disabling injury to his hand that prevented him from performing surgery. He later sought benefits under the Provident policy. During its investigation of his claim, Provident discovered that Dr. Goel had not caneelled his Paul Revere coverage. Provident therefore elected to pay benefits under a reservation of rights.

On April 16, 1997, Provident filed a Complaint for Declaratory Judgment and Other Relief seeking to rescind and cancel the disability policy and recover all benefits paid to Dr. Goel. In its Complaint, Provident alleged that it issued the policy to Dr. Goel “on the condition or promise of Goel that he would cancel his Paul Revere coverage.” According to Provident, Dr. Goel’s failure to cancel the Paul Revere policy rendered the Provident policy “voidable.” Dr. Goel answered the Complaint and filed a Counterclaim demanding damages from Provident for bad faith breach of contract. Dr. Goel also invoked the incontestability provision of the Provident policy 6 and raised affirmative defenses of waiver, estoppel, and fraud. Provident denied Dr. Goel’s allegations in its Answer to the Counterclaim.

On February 20, 1998, Dr. Goel filed a Motion for Partial Summary Judgment on his contract claim; Provident responded three days later with a Motion for Summary Judgment on its complaint. On September 28, 1998, after hearing oral argu *990 ment on the parties’ motions, the district court granted Provident’s motion and denied Dr. Goel’s motion. In reaching its decision, the court relied on the Amendment to Question 4(f) of Dr. Goel’s application and found that Dr. Goel breached a condition precedent to coverage by failing to cancel his Paul Revere policy. The district court reasoned that the policy— presented along with the Amendment to the application — constituted a counter-offer by Provident that Dr. Goel accepted by signing the Amendment, retaining the policy, and paying the required premiums.

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274 F.3d 984, 51 Fed. R. Serv. 3d 1090, 2001 U.S. App. LEXIS 25926, 2001 WL 1540391, Counsel Stack Legal Research, https://law.counselstack.com/opinion/provident-life-accident-insurance-v-goel-ca5-2001.