Raifman v. Berkshire Life Insurance

81 F. Supp. 2d 412, 2000 U.S. Dist. LEXIS 426, 2000 WL 49061
CourtDistrict Court, E.D. New York
DecidedJanuary 19, 2000
DocketCV 98-5797(ADS)
StatusPublished

This text of 81 F. Supp. 2d 412 (Raifman v. Berkshire Life Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Raifman v. Berkshire Life Insurance, 81 F. Supp. 2d 412, 2000 U.S. Dist. LEXIS 426, 2000 WL 49061 (E.D.N.Y. 2000).

Opinion

MEMORANDUM OF DECISION AND ORDER

SPATT, District Judge.

On September 16, 1998, the plaintiff, Mark A. Raifman, M.D. (the “plaintiff’ or “Raifman”) commenced this lawsuit against the defendant Berkshire Life Insurance Co. (the “defendant” or “Berkshire”), alleging that Berkshire should be compelled to make disability insurance payments under four separate disability and overhead expense insurance policies. The complaint indicates that the plaintiff suffers from severe degenerative disc disease, spinal arthritis, spinal stenosis and an acute disc herniation in his lower spine. After being served with the complaint, Berkshire filed several counterclaims seek *413 ing to rescind Raifman’s disability and overhead expense insurance policies.

Presently before the Court are two separately filed motions for summary judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure (“Fed.R.Civ.P.”). Berkshire maintains that it is entitled to a judicial recission of the disability income and overhead expense insurance policies it issued to the plaintiff because the plaintiff accepted an offer from Monarch Life Insurance Company (“Monarch”) to continue in force a disability insurance policy which he had expressly agreed to discontinue. In addition, the defendant argues that the plaintiff is not entitled to payment of any disability benefits allegedly due after the commencement of his lawsuit. Finally, the defendant submits that the plaintiff has failed to establish an entitlement to punitive damages and attorneys’ fees.

The plaintiffs motion for summary judgment requests dismissal of the counterclaims that seek to rescind his disability income and overhead expense insurance policies. The plaintiff contends that Berkshire cannot rescind these policies because (i) it has waived any right to rescind by continuing to accept premiums for these policies for over more than one year after learning the purported grounds upon which it now seeks to rescind, and (ii) each policy contains an incontestability clause barring the defendant from contesting the policy based on the statements made in the insurance application after the policy has been in effect for two years.

I. BACKGROUND

The following facts are from the respective Local Civil Rule 56.1 (“Rule 56.1”) statements and are not at issue unless otherwise stated. In 1985, the plaintiff applied for and obtained a policy of disability income insurance from the Monarch Life Insurance Company providing a monthly indemnity that the defendant alleges was in the sum of $13,800. On January 29, 1992, the plaintiff submitted to Berkshire an application for disability income and overhead expense disability insurance polices (the “Application”) requesting policy benefits of $13,870 monthly indemnity for disability income and $11,-870 monthly indemnity for overhead expenses.

Question 12 of the Application stated:

Disability Income Insurance

(Describe all coverage in force including individual, franchise association, group or government plans).

In response to question number 12 of the application, the plaintiff represented as follows:

Company Monthly Benefit Year of Issue Benefit Period Other Benefits To Be Terminated

Monarch-DI Monarch $13,800 1985 Lifetime FPO Yes, upon issue of identical Berkshire policy.

(UNUM -OE $11,800 1985-7 24 Months FPO Yes, same as above.

New England —BO $200,000 lump payment 1991 Yes, same as above.

Monarch-DI $400,000 lump payment 1986 Yes, same as above.

FPO means future purchase option. In response to question 13 of the Application entitled “Details and Special Requests,” the plaintiff stated that “[Issuance of Berkshire Policies in the amounts requested with benefits so designated will cause Dr. Raifman to drop corresponding coverage with Monarch and UNUM.” In addition, in response to questions 21(d) and 22(b) of the Application, the plaintiff answered “YES” to inquiries concerning his intent to terminate the existing policies.

The plaintiff signed the Applications below a statement which read in relevant part:

*414 I(we) represent that the answers in this Part 1 are true and compete to the best of my (our) knowledge and belief; and that together with the statements of the Proposed Insured in Part 2, they shall form the basis and be part of the contract of insurance, if issued.... Only the President, a Vice-President, the Secretary or an Assistant Secretary [of Berkshire] may make, modify or discharge contracts or waive any of the Company’s requirements, and then only in writing.

On March 2, 1993 Berkshire issued Disability Income Policy No. NC H0314219 (“Policy A”) to the plaintiff which provided for $13,870 in monthly benefits plus a future purchase option. On the same date, Berkshire issued Disability Income Policy No. NC H0319151 (“Policy B”) which provided an additional $100 in monthly indemnity benefits; Overhead Expense Disability Policy No. OE H0314220 (“Policy C”) which provided $11,870 in monthly benefits plus a future purchase option; and Overhead Expense Disability Policy No. OE H0319152 (“Policy D”) which provided for an additional $100 in monthly indemnity benefits. The plaintiff has always timely paid the premiums for Policies A, B, C and D.

The first page of Policies A and B state that the policy is “non-cancellable and guaranteed renewable to age 65 with conditional continuation of limited benefits after age 65.” Similarly, the first page of Policies C and D state that the policy is “non-cancellable and guaranteed renewable to age 65 with right of continuation to age 75.” Page seven of Policies A and B state that “[t]his policy will be incontestable as to the statements, except fraudulent statements, contained in the application after it has been in force for a period of two years during your lifetime.” Page seven of Policies C and D state that “[t]his policy will be incontestable as to the statements contained in the application after it has been in force for a period of two years during your lifetime.”

As represented in the Application, in 1992 the plaintiff ceased making premium payments on the Monarch Policy. On April 30, 1993, the plaintiff received a letter from Monarch that apparently offered to continue or reinstate his policy. In June 1993, the plaintiff accepted Monarch’s offer contained in the April letter and continued its Disability Income Policy No. 1827034 by making a one time premium payment to Monarch in the sum of $1,888.33. The defendant contends that by making this payment, the plaintiff continued the Monarch Policy.

The plaintiff further claims that by making this payment, he reinstated the Monarch Policy. The plaintiff claims that on or before June 8, 1998, the defendant was aware of the alleged grounds upon which it now seeks to rescind the Policies. Berkshire admits that the plaintiff was billed for and paid premiums on all four policies after it learned that the plaintiff had reinstated his Monarch coverage. However, Berkshire contends that this billing was the result of a clerical error.

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Bluebook (online)
81 F. Supp. 2d 412, 2000 U.S. Dist. LEXIS 426, 2000 WL 49061, Counsel Stack Legal Research, https://law.counselstack.com/opinion/raifman-v-berkshire-life-insurance-nyed-2000.