Weinstein v. Mutual Benefit Life in Rehabilitation

713 A.2d 569, 313 N.J. Super. 609, 1998 N.J. Super. LEXIS 332
New Jersey Superior Court Appellate Division·Decided July 10, 1998·Published·Cited by 1 cases

Opinion

The opinion of the court was delivered by

EICHEN, J.A.D.

The primary issue presented on this appeal is whether certain misrepresentations made by plaintiff Richard Weinstein concerning his income and medical history in an application for a disability income insurance policy entitled defendant Mutual Benefit Life in Rehabilitation (Mutual Benefit)3 to rescind the policy. The motion judge concluded that the misrepresentations did not bar plaintiffs recovery under the policy because Mutual Benefit was not adversely affected by the false statements and that reformation of the policy was a more equitable remedy. Accordingly, the judge [612] denied Mutual Benefit’s motion for summary judgment on its counterclaim for rescission and its motion for reconsideration and entered final judgment in favor of plaintiff against Mutual Benefit in the stipulated sum of $81,508, representing plaintiffs policy benefits, inclusive of costs and prejudgment interest. Mutual Benefit appeals and we reverse.

In May 1991, plaintiff applied for a disability income insurance policy (the policy) from Mutual Benefit. On July 1, 1991, the policy was issued. It contained an incontestability clause which stated, in pertinent part:

After this policy has been in force for two years, we will not reduce or deny a claim for benefits on the basis of the statements in the application, except fraudulent misstatements.

In June 1992, while the policy was still in its contestability period, plaintiff submitted a claim to Mutual Benefit contending that he had become disabled due to a severe lower back condition. During the course of investigating the claim, Mutual Benefit learned that plaintiff had been diagnosed and treated for problems with his right knee in May 1989. The record reveals that plaintiff had “a right medial meniscectomy” in 1981 which he failed to include in response to questions on the application. The record also discloses that plaintiff continued to have problems with his knee and that he and his treating physician discussed and contemplated various surgical procedures to correct the condition. Plaintiff had not disclosed this medical history in his policy application.

In addition, Mutual Benefit discovered that plaintiff had been untruthful in stating his income for the year 1990. Specifically, plaintiff had indicated in the application that his earned income was $185,000, whereas his accountant verified that plaintiff had earned only $118,000 that year. On January 13, 1993, Mutual Benefit declined plaintiffs claim for benefits based upon the “material misrepresentations” contained in plaintiffs application.4

[613] In support of its motion for summary judgment, Mutual Benefit submitted a certification from George S. Chumas, the director of underwriting, indicating that if plaintiffs actual medical history had been disclosed, it “would have affected [Mutual Benefit’s] assessment of the disability insurance risk presented by Mr. Weinstein,” and plaintiffs policy would not have been issued as written. He stated that “a different and less favorable policy, one which would have included an exclusion of coverage rider for the right knee,” would have been offered. Mr. Chumas also stated that because plaintiffs actual earned income was substantially less than indicated on the application, his monthly benefits also would have been substantially less.5 He further indicated that “[b]ased upon [plaintiffs] nondisclosed medical history and misrepresentation of his 1990 earned income, [Mutual Benefit] was not provided with the necessary information to accurately and appropriately underwrite Mr. Weinstein’s disability policy.”

During argument on the summary judgment and reconsideration motions, the motion judge determined that rescission is required only where the “false statements] materially affect[] either the acceptance of the risk or the hazard assumed by the insurer,” quoting N.J.S.A. 17B:24-3d and citing Massachusetts Mut. Life Ins. Co. v. Manzo, 122 N.J. 104, 584 A.2d 190 (1991) and Ledley v. William Penn Life Ins. Co., 138 N.J. 627, 651 A.2d 92 (1995). Because Mutual Benefit had conceded that it would have issued some form of policy to plaintiff even if he had disclosed all of the relevant information, the judge concluded that the false statements had not “materially affected the hazard assumed” by Mutual Benefit. The judge reasoned that Mutual Benefit was not “adversely affected” by the earnings misrepresentation or the withheld medical information concerning plaintiffs knee because it simply would have excluded coverage for plaintiffs knee (which was not the subject of the disability claim) and paid a reduced benefit based on plaintiffs lower income. The judge also noted [614] that the premium charged to plaintiff was already one-third higher than the “standard” premium because of plaintiff’s high blood pressure. Accordingly, the judge concluded that the misrepresentations were not “material” justifying denial of coverage under the policy.

The Legislature defined the term “materiality” in the disjunctive, providing that a false statement would bar recovery if it affects “either the acceptance of the risk or the hazard assumed by the insurer.” N.J.S.A. 17B:24-3d (emphasis added). In Manzo, our Supreme Court concluded that no causal connection between an insured’s false statements and the ultimate cause of death is required to bar recovery. In so concluding, the Court stated that “[a]n insurer is entitled to relief when it relies on incorrect information provided by an insured in an insurance application if the information was material either to the insurer’s decision to insure or to the terms of the contract.” Massachusetts Mut. Life Ins. Co. v. Manzo, supra, 122 N.J. at 118, 584 A.2d 190 (emphasis added).

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Weinstein v. Mutual Benefit Life in Rehabilitation, 713 A.2d 569, 313 N.J. Super. 609, 1998 N.J. Super. LEXIS 332 (N.J. Ct. App. 1998).

713 A.2d 569 (Weinstein v. Mutual Benefit Life in Rehabilitation) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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