Michelle Tran v. Kansas City Life Insurance Company et al
Filing
22
ORDER GRANTING DEFENDANTS MOTION FOR SUMMARY JUDGMENT 15 . The Clerk of Court shall dismiss the action. by Judge Otis D. Wright, II. MD JS-6. MD JS-6. Case Terminated. (lc). Modified on 1/5/2017 (lc).
JS-6
O
1
2
3
4
5
6
7
United States District Court
Central District of California
8
9
10
11
Plaintiff,
12
13
Case № 2:15-cv-09963-ODW (RAOx)
MICHELLE TRAN,
v.
ORDER GRANTING MOTION FOR
14
KANSAS CITY LIFE INSURANCE
15
COMPANY, a business entity form
16
unknown; DOES 1 through 20, inclusive,
17
SUMMARY JUDGMENT [15]
Defendants.
18
19
20
21
I.
INTRODUCTION
This case involves the rescission of Luong Quoc Tran’s life insurance policy for
22
failure to disclose certain details of his medical history. Plaintiff Michelle Tran, Mr.
23
Tran’s widow, is the policy’s beneficiary. Before the Court is Defendant Kansas City
24
Life Insurance Company’s motion for summary judgment. (ECF No. 15.) For the
25
following reasons, the Court GRANTS the motion in its entirety.
26
27
28
1
II.
FACTUAL BACKGROUND
2
Mr. Tran and Plaintiff were married in 2005 and soon after had a son. (Tran
3
Decl. ¶ 2, ECF No. 16.) Seeking to protect his family, Mr. Tran applied for a
4
$300,000 “Flexible Premium Adjustable Death Benefit Life Insurance Policy” with
5
Defendant on July 27, 2014, at the recommendation of Plaintiff’s parents. (Tran Decl.
6
¶ 3; Augustin Decl., Ex. A–B at 17, 36, ECF No. 15.) The application required Mr.
7
Tran to answer twenty-three questions about his health. (Augustin Ex. A at 10.) One
8
of the questions asked whether he had been “diagnosed” or “treated” for any disease
9
or disorder relating to “diabetes, sugar in the urine” in the ten years preceding the
10
application. (Id.) A second question asked whether he had been “diagnosed” or
11
“treated” for any disease or disorder relating to “blood pressure” in the ten years
12
preceding the application. (Id.) Mr. Tran answered “no” to both questions. (Id.) He
13
also answered “no” to the remaining twenty-one questions about his medical history.
14
(Id.)
15
On the same page, Mr. Tran wrote the telephone number of his doctor, Mary
16
Tran, and authorized Defendant to contact and obtain records from Dr. Tran.1 (Id.)
17
Mr. Tran was then subjected to a physical examination. (Id., Ex. E at 125–127.) The
18
results of the physical examination were unremarkable and showed Mr. Tran to be in
19
good health. (Id.) The underwriting process appears to have been completed on
20
August 8, 2014.2 (Id., Ex. B at 74.) The policy was mailed to Mr. Tran on August 22,
21
2014. (Id. at 20.) Mr. Tran acknowledged receipt of the policy on September 6, 2014.
22
(Id., Ex. C at 75.)
23
Mr. Tran died on March 9, 2015, of a heart attack at age thirty-seven. (Tran
24
Decl. ¶ 8; Augustin Suppl. Decl., Ex. A at 13, ECF No. 17.) On April 8, 2015,
25
Plaintiff sought payment under the policy. (Snoddy Decl., Ex. B. at 13–14, ECF No.
26
15.) At the same time, Plaintiff granted Defendant permission to access her husband’s
27
1
28
The parties seem to agree that Dr. Tran was not contacted before the policy was issued. (Mot. 14,
ECF No. 15; Opp’n 7, ECF No. 16.)
2
This is the date the policy was printed. (See Augustin Decl., Ex. B at 74.)
2
1
medical records for the purpose of investigating the accuracy of his application. (Id.,
2
Ex. D at 18–19.)
3
Defendant subsequently obtained medical records from Dr. Tran. (Augustin
4
Suppl. Decl., Ex. A. 13–62.) These records indicated to Defendant that, contrary to
5
the statements Mr. Tran made in his application, he had been diagnosed and treated
6
for diabetes and high blood pressure in the ten years preceding his application for life
7
insurance. (See Snoddy Decl., Ex. E at 20.) Accordingly, Defendant sent a letter to
8
Plaintiff on June 23, 2015, denying her claim on the basis of the misrepresentations in
9
Mr. Tran’s application. (Id.)
10
Plaintiff filed this case in the Superior Court of California, County of Los
11
Angeles on November 12, 2015, alleging (1) breach of contract, (2) breach of the
12
implied covenant of good faith and fair dealing, (3) declaratory relief, an (4)
13
intentional infliction of emotional distress.
14
Defendant removed the case to federal court on December 30, 2015. (ECF No. 1.)
15
Defendant filed the pending motion for summary judgment on December 12, 2016.
16
(ECF No. 15.) The motion is now fully briefed and ready for decision. (See ECF
17
Nos. 16–19.)
(Compl. ¶¶ 24–39, ECF No. 1-2.)
18
19
III.
LEGAL STANDARD
20
Summary judgment shall be entered in favor of the moving party when “the
21
pleadings, depositions, answers to interrogatories, and admissions on file, together
22
with the affidavits, if any, show that there is no genuine issue as to any material fact
23
and that the moving party is entitled to judgment as a matter of law.” Fed. R. Civ. P.
24
56(c). The moving party initially bears the burden of showing the non-existence of a
25
material factual dispute. Celotex Corp. v. Catrett, 477 U.S. 317, 321 (1986). The
26
burden then shifts to the non-moving party to “designate ‘specific facts showing that
27
there is a genuine issue for trial.’” Id. (quoting Rule 56(e)). To carry this burden, the
28
non-moving party “must do more than simply show that there is some metaphysical
3
1
doubt as to the material facts.” Matsushita Electric Industrial Co., Ltd. v. Zenith
2
Radio, 475 U.S. 574, 586 (1986). A dispute about a material fact is genuine if a
3
reasonable jury could return a verdict for the non-moving party. Anderson v. Liberty
4
Lobby, Inc., 477 U.S. 242, 248 (1986).
5
For the purposes of summary judgment, the evidence is viewed in the light most
6
favorable to the non-moving party, and all justifiable inferences are to be drawn in her
7
favor. Id., 477 U.S. at 255; see also Sischo–Nownejad v. Merced Community College
8
Dist., 934 F.2d 1104 (9th Cir.1991). Moreover, “[c]redibility determinations, the
9
weighing of the evidence, and the drawing of legitimate inferences from the facts, are
10
jury functions, not those of a judge [when] he is ruling on a motion for summary
11
judgment.” Anderson, supra, 477 U.S. at 255.
12
13
14
IV.
DISCUSSION
A. Evidentiary Considerations
15
Before reaching any of the substantive legal issues in this case, the Court must
16
first resolve several issues of admissibility. Plaintiff argues that the medical records
17
submitted in support of Defendant’s motion are not admissible because they contain
18
private personal information in violation of Federal Rule of Civil Procedure 5.2 and
19
are not properly authenticated by their custodian.
20
Evidence 2–4, ECF No. 16-1.) Plaintiff also argues that Defendant has submitted
21
documents in “bulk” without pointing to specific facts that support its motion for
22
summary judgment. (Id. at 6.)
(See Plaintiff Objections to
23
To begin, the Court notes that Defendant has taken corrective measures in light
24
of Plaintiff’s concerns about disclosure of personal information and authentication.
25
Defendant has submitted with its reply an identical set of the medical documents with
26
Mr. Tran’s private personal information redacted and a declaration from the custodian
27
28
4
1
of records at Dr. Tran’s office, Vicki Do.3 (See Augustin Suppl. Decl., Ex. A.)4 The
2
Court finds that these measures adequately address Defendant’s concerns and will
3
consider the medical records.5
4
Plaintiff’s objection to “bulk” submissions is unclear. (See Plaintiff Objections
5
to Evidence 6.) Plaintiff does not reference a single case discussing so-called “bulk”
6
submissions. (Id.) While the Court agrees with Plaintiff that the initial burden is on
7
Defendant to present evidence and facts in support of its motion for summary
8
judgment, Defendant has done so here. Defendant has highlighted misrepresentations
9
that it believes warrant rescission of the life insurance policy and has put forth a
10
statement of uncontroverted facts and conclusions of law to which Plaintiff has
11
responded. (See Mot. 8–9; Memorandum Statement of Genuine Disputes, ECF No.
12
16-2.)
13
B. Breach of Contract
14
Defendant asserts that Plaintiff’s breach of contract claim must fail because
15
there is no enforceable contract between the parties—in other words, that Mr. Tran’s
16
3
17
18
19
20
21
22
23
24
25
26
27
28
While the submission of new evidence is not typically allowed in conjunction with a reply,
evidence that is merely responsive to issues raised in an opposition may be considered. PSM
Holding Corp. v. Nat’l Farm Fin. Corp., No. CV0508891MMMFMOX, 2013 WL 12080306, at *4
(C.D. Cal. Oct. 8, 2013) (cumulating cases in support of this proposition). Here, the new evidence is
responsive to issues raised for the first time in Plaintiff’s opposition and thus the Court will consider
the evidence.
4
In a set of evidentiary objections filed after Defendant’s reply, Plaintiff argues that the corrective
measures are insufficient because Vicki Do’s declaration “cannot be clearly related to the documents
that are attached, as there is nothing about the declaration that confirms the records presented are the
actual records referred to, or that they are full and complete.” (Objection to Supplemental
Declaration 4, ECF No. 20.) Plaintiff is grasping at straws. Ms. Do’s declaration states that her
“office produced a copy of the medical records attached hereto as Exhibit A.” (Do Decl., ECF No.
14 (emphasis added).) The medical documents immediately follow the declaration and are labeled
“Exhibit A.” (Augustin Suppl. Decl., Ex. A.) Plaintiff’s argument that these records are incomplete
is also without foundation. (Objection to Supplemental Declaration 4.) Plaintiff has not explained
why she believes that the records are incomplete and a review of the records does not give rise to
any such suspicion.
5
The Court notes that the insurance application remains unredacted. (Augustin Decl. Ex. A.)
However, the Court finds that striking the application from the evidentiary record is too extreme a
measure under the circumstances. For the protection of Mr. Tran’s privacy, the Court will seal the
Augustin Declaration and its exhibits.
5
1
misrepresentations rendered any contract void ab initio. (Mot. 8); see also Cal. Ins.
2
Code § 359. Therefore, Defendant has the burden to show that it rightfully rescinded
3
Mr. Tran’s policy on the basis of his material misrepresentations. Salkin v. United
4
Servs. Auto. Ass’n, 835 F. Supp. 2d 825, 831 (C.D. Cal. 2011), aff’d sub nom. Salkin
5
v. USAA Life Ins. Co., 544 F. App'x 713 (9th Cir. 2013).
6
As a general matter, California law “permits an insurer to rescind a policy when
7
the insured has misrepresented or concealed material information in connection with
8
obtaining insurance.” (TIG Ins. Co. of Michigan v. Homestore, Inc. 137 Cal. App. 4th
9
749, 755–756 (2006); see also Trinh v. Metro. Life Ins. Co., 894 F. Supp. 1368, 1372
10
(N.D. Cal. 1995) (“Material misrepresentations on an insurance application are
11
grounds for the [life] insurance company to rescind the policy.”). Indeed, California
12
Insurance Code Section 331 could not be clearer: “concealment, whether intentional
13
or unintentional, entitles the injured party to rescind insurance.” These statements are
14
consistent with California’s long-held policy that an insurance company has “the
15
unquestioned right to select those whom it will insure and to rely upon him who
16
would be insured for such information as it desires as a basis for its determination to
17
the end that a wise discrimination may be exercised in selecting its risks.” Am. Gen.
18
Life Ins. Co. v. Green, No. 2:06-CV02048MCEKJM, 2008 WL 2096833, at *4 (E.D.
19
Cal. May 16, 2008) (quoting Robinson v. Occidental Life Ins. Co. of Cal., 131 Cal.
20
App. 2d 581, 586 (1955)).
21
Courts have generally applied a three-part test to determine whether an
22
insurance company may rescind a life insurance policy based on material
23
misrepresentations in the application. See Casey By & Through Casey v. Old Line
24
Life Ins. Co. of Am., 996 F. Supp. 939, 944 (N.D. Cal. 1998) (citing Trinh, 894 F.
25
Supp. at 1372). The three elements of the test are: (1) whether the applicant made a
26
27
28
6
1
misrepresentation; (2) whether the misrepresentation was material; and (3) whether
2
the applicant knew that he made a material misrepresentation.6 Id.
3
1. Whether Mr. Tran Made Misrepresentations and Knew of His Ailments
4
Defendant argues that the medical records indicate, “among other things,” that
5
Mr. Tran was diagnosed with diabetes on July 23, 2011, and with hypertension on
6
August 20, 2011. (Mot. 9.) Defendant also argues that the medical records indicate
7
he was prescribed medicine for these ailments on August 20, 2011. (Id.) The Court
8
agrees, finding the medical records submitted by Defendant contain evidence that Mr.
9
Tran was diagnosed and treated for diabetes and hypertension in the ten years
10
preceding his application for life insurance and that he knew of these ailments.
i.
11
Evidence of Diabetes
12
The medical records obtained from Dr. Tran span a roughly three-year period
13
from June 5, 2010 to April 23, 2014. (Augustin Suppl. Decl. Ex. A at 14–61.)
14
Proceeding chronologically, the first relevant record is from Mr. Tran’s July 23, 2011
15
visit to Dr. Tran. This record indicates a diagnosis for “DM II,” medical shorthand for
16
diabetes mellitus type 2.7 (Id. at 44.) Directly underneath this diagnosis is a note to
17
“Repeat FBS,” medical shorthand for the Fasting Blood Sugar test.8 (Id.)
18
On August 13, 2011, Mr. Tran had laboratory tests done. (Id. at 19–22.) The
19
corresponding laboratory report shows glucose levels consistent with diabetes and
20
includes a stamp on the final page indicating that someone from Dr. Tran’s office
21
called Mr. Tran regarding the results. (Id. at 20, 22.) A record from Mr. Tran’s
22
August 20, 2011 visit to Dr. Tran indicates a diagnosis of “DM II.” (Id. at 43.) This
23
24
25
26
27
28
6
The third element is not about whether the misrepresentation itself was intentional or unintentional,
it is about whether the applicant knew or “appreciated” that he had the undisclosed condition. See
generally Casey, 996 F. Supp. at 949.
7
See Medical Abbreviations, Taber's Online, http://www.tabers.com/tabers online/view/TabersDictionary/767492/0/Medical_Abbreviations (last accessed January 2, 2017); see also Gonzales v.
Comm’r of Soc. Sec. Admin., No. CV 14-0078-JPR, 2015 WL 685347, at *4 n.5 (C.D. Cal. Feb. 18,
2015) (citing Taber’s as authority for medical abbreviations).
8
See Medical Abbreviations, Taber's Online, http://www.tabers.com/tabers online/view/TabersDictionary/767492/0/Medical_Abbreviations (last accessed January 2, 2017).
7
1
record also appears to include a notation relating to a drug prescription that begins
2
with the prefix “gluco.”9 (Id.)
3
Next, a record from Mr. Tran’s April 13, 2013 visit to Dr. Tran indicates a
4
diagnosis of “DM II” and that Mr. Tran was “off meds” for “DM II.” (Id. at 42.) That
5
same day, Mr. Tran had additional laboratory tests done.
6
corresponding report shows hemoglobin a1c levels “consistent with diabetes.” (Id.)
7
This report also includes a stamp on the final page indicating that someone from Dr.
8
Tran’s office called Mr. Tran regarding the results. (Id. at 18.) A record from Mr.
9
Tran’s May 5, 2013 visit to Dr. Tran also indicates a diagnosis of “DM II.” (Id. at
10
41.) Finally, a record from Mr. Tran’s April 23, 2014 visit to Dr. Tran indicates a
11
diagnosis of “DM II” with the related notation “not take meds.” (Id. at 40.)
ii.
12
(Id. at 17.)
The
Evidence of Hypertension
13
The first medical record referencing Mr. Tran’s high blood pressure is from
14
June 5, 2010. (Id. at 38.) A record from Mr. Tran’s visit to Dr. Tran on that day has a
15
note indicating “BP.”10 (Id.) Next, a record from Mr. Tran’s August 20, 2011 visit
16
to Dr. Tran indicates a diagnosis of “HTN,” medical shorthand for hypertension.11
17
(Id. at 43.) Finally, a record from Mr. Tran’s April 13, 2013 visit to Dr. Tran, also
18
indicates a diagnosis for “HTN” and that he is “off meds” for the ailment. (Id. at 42.)
iii.
19
Conclusions
20
In summary, Dr. Tran’s records show five occasions on which she diagnosed
21
Mr. Tran with diabetes (including July 23, 2011) and at least two occasions on which
22
she diagnosed Mr. Tran with hypertension (including August 20, 2011). The records
23
also support Defendant’s argument that Mr. Tran at one time took medication for
24
these ailments (presumably if he was “off meds” for the ailments, he was at one time
25
26
27
28
9
The Court is unable to read the remainder of the word due to the poor quality of the reproduction.
The abbreviation “BP” is a medical common shorthand for blood pressure. See Medical
Abbreviations,
Taber's
Online,
http://www.tabers.com/tabers
online/view/TabersDictionary/767492/0/Medical_Abbreviations (last accessed January 2, 2017).
11
See Medical Abbreviations, Taber's Online, http://www.tabers.com/tabers online/view/TabersDictionary/767492/0/Medical_Abbreviations (last accessed January 2, 2017).
10
8
1
“on meds” for the ailments).
Therefore, the Court finds that Mr. Tran made
2
misrepresentations in conjunction with his life insurance application when he
3
indicated that he had not been diagnosed with, or treated for, a disease or disorder
4
relating to diabetes or blood pressure in the previous ten years.
5
Further, evidence supports the conclusion that Mr. Tran knew about his ailment.
6
Both ailments appear to have been diagnosed more than once and to have existed over
7
a multi-year period. Philp v. Jackson Nat’l Life Ins. Co., 107 F.3d 878 (9th Cir. 1997)
8
(finding applicant appreciated or knew of ailment where he had a “long medical
9
history” of ailment). Additionally, Mr. Tran appears to have been contacted about
10
laboratory test results that showed glucose and hemoglobin a1c levels consistent with
11
diabetes. (Augustin Suppl. Decl. Ex A at 18, 22.) Moreover, as discussed above, the
12
records suggest that Mr. Tran took medication for the two ailments. Freeman v.
13
Allstate Life Ins. Co., 253 F.3d 533, 537 (9th Cir. 2001) (finding where applicant had
14
ailment for several years and was taking medication for it, she “must have realized”
15
she had the condition).
16
The Court finds that Defendant has not put forth sufficient evidence to create a
17
genuine dispute of material fact as to these two prongs of the test. Plaintiff has
18
offered her own declaration and the declaration of David Burgess, an independent
19
insurance underwriter, as evidence that Mr. Tran did not make a misrepresentation. In
20
Plaintiff’s declaration she alleges that Mr. Tran did not have diabetes or high blood
21
pressure from 2012 until he applied for life insurance in July 2014. (Tran Decl. ¶ 4–
22
5.) First, Plaintiff, as a layperson, is not qualified to make medical assessments or
23
diagnoses.12 See Fed. R. Evid. 701(c); see also Clark v. Thomas, No. 2:09-CV-02272-
24
JAD, 2014 WL 2573738, at *7 (D. Nev. June 6, 2014) (“The Ninth Circuit recognizes
25
that lay witnesses (i.e., people who are not qualified medical-care providers) may not
26
provide any medical diagnosis because ‘medical diagnoses are beyond the competence
27
12
28
While Plaintiff may properly offer her personal observations about Mr. Tran’s symptoms,
disposition, or appearance, she does not offer those insights here; Plaintiff offers her own diagnoses.
See Fed. R. Evid. 701(a).
9
1
of lay witnesses to make.’”) Second, her declaration does not discuss the period from
2
2011 to 2012 during which Mr. Tran appears to have been diagnosed with both
3
diabetes and hypertension. (See Augustin Suppl. Decl., Ex. A at 43, 44.)
4
Plaintiff also presents the declaration of David Burgess, an independent
5
insurance underwriter, who argues that Mr. Tran may have been confused by the
6
diabetes question and that he may have answered the question truthfully because
7
diabetes is neither a disease nor a disorder, “it is a condition.” (Burgess Decl. ¶¶ 11–
8
12, ECF 16-4.) First, it does not matter whether the question was confusing or not
9
because
the
misrepresentation
need
not
be
intentional;
an
unintentional
10
misrepresentation may still be grounds for rescission. See Cal. Ins. Code § 331;
11
Barrera v. State Farm Mut. Automobile Ins. Co., 71 Cal.2d 659, 665–666, fn. 4 (1969)
12
(finding that an insurer may rescind a policy for material misrepresentation “even
13
though the insured’s misstatements were . . . the product of innocence.”). Second, the
14
Court does not agree that the question is in any way confusing. Burgess argues that
15
the question is confusing because it reads “diabetes (sugar in urine)” making it seem
16
like only a specific subset of diabetes is at issue. (Burgess Decl. ¶ 12.) The problem
17
is that the question does not read like that; the actual question reads “diabetes, sugar in
18
urine?” (See Augustin Decl., Ex. A at 10.) As actually written, with the comma and
19
without the parenthesis, there is no doubt that the question is asking whether Mr. Tran
20
had a disease or disorder relating to diabetes or sugar in his urine. (Id.) Additionally,
21
even if the question was confusing and this confusion qualified as grounds for
22
nullifying the answer, that still does not address the misrepresentation Mr. Tran made
23
about whether he suffered from a disease or disorder related to blood pressure.
24
Finally, Burgess is not qualified to make statements regarding whether diabetes is a
25
disease, disorder, or a condition. While Burgess may qualify as an expert in the
26
context of insurance underwriting, he is a layperson for the purpose of making
27
medical determinations. See Fed. R. Evid. 701(c). In conclusion, the Court finds that
28
10
1
Defendant has met its burden with regard to elements one and three of the rescission
2
test. See Casey, 996 F. Supp. at 944.
3
2. Materiality
4
“The materiality of a misrepresentation is a question of law.” Id. (quoting
5
Merced County Mut. Fir. Ins. Co. v. State, 233 Cal. App. 3d 765, 772 (1991). There
6
are two tests for materiality. Casey, 996 F. Supp. at 948. Under the first test, any
7
answer to a specific question in an application for insurance is material: “[t]hat the
8
insurer puts questions in writing and asks for written answers has itself been deemed
9
proof of materiality.” Trinh, 894 F. Supp. at 1373 (quoting Taylor v. Sentry Life Ins.
10
Co., 729 F.2d 652, 655 (9th Cir.1984)).
Under the second test ‘[m]ateriality is
11
determined by the probable and reasonable effect that truthful disclosure would have
12
had on the insurer in determining the advantages of the proposed contract.’” Id. In
13
other words, a court must ask whether the insurer’s decision to issue the relevant
14
policy would have been affected by having access to the correct information. Lunardi
15
v. Great-W. Life Assurance Co., 37 Cal. App. 4th 807, 828 (1995) (“Essentially, [a
16
court] must decide whether the insurer was misled into accepting the risk or fixing the
17
premium of insurance.”) (internal quotations omitted). Because this test is subjective,
18
a declaration from the insurer’s underwriter indicating that coverage would not have
19
been offered but for the misrepresentation is typically sufficient to satisfy the test.
20
Nieto v. Blue Shield of California Life & Health Ins. Co., 181 Cal. App. 4th 60, 77
21
(2010) (“This is a subjective test; the critical question is the effect truthful answers
22
would have had on [the actual insurer] . . . .”) (emphasis in original) (quoting Imperial
23
Casualty & Indemnity Co. v. Sogomonian, 198 Cal. App. 3d 169, 181 (1988)); see
24
also Trinh, 894 F. Supp. at 1373 (citing declarations as sufficient).
25
Defendant has easily satisfied the first test for materiality. Defendant asked
26
specific questions about Mr. Tran’s medical history on the application for life
27
insurance. (See Augustin Decl. Ex. A.) This is by itself sufficient to establish
28
materiality.
11
1
However, Defendant also prevails under the second test. Defendant submits the
2
declaration of its chief underwriter Michael Augustin indicating that had Mr. Tran
3
completed the application “truthfully and accurately” he “would not have been able to
4
provide evidence of insurability to Kansas City Life satisfactory to offer coverage as
5
issued.” (Augustin Decl. ¶ 19.) While this statement is certainly not as clear as it
6
could be, the Court takes it to mean that Defendant would not have offered Mr. Tran
7
the policy it did with knowledge of his true medical history. The Court finds it
8
reasonable that an insurer would consider previous diagnoses for diabetes and
9
hypertension material in deciding whether to offer a life insurance policy. Because
10
this test is “subjective” and the insurer that issued the policy to Mr. Tran would not
11
have done so with the correct information, the Court finds that Defendant has
12
established materiality under the second test.13 In conclusion, Defendant has met its
13
burden to show materiality regardless of which of the two tests is applied.
14
C. Defenses to Rescission
15
1. Waiver
16
Plaintiff argues that Defendant waived the right to rescind Mr. Tran’s policy
17
when it failed to adequately investigate the accuracy of his application before issuing
18
the policy. (Opp’n 3–5.) However, in California “an insurer has no independent duty
19
to investigate facts in an insurance application.” Philp, 107 F.3d 878 (citing S.F.
20
Lathing Co. v. Pennsylvania Mut. Life Ins. Co., 300 P.2d 715, 719 (Cal. Ct. App.
21
1956)). Put even more succinctly, “an insurer may rescind an insurance contract for
22
material misrepresentations even if the insurer issued the policy without investigating
23
the applicant’s medical history.” Id. (quoting Cohen v. Pennsylvania Mut. Life Ins.
24
13
25
26
27
28
Plaintiff’s expert David Burgess speculates that Defendant would have issued Mr. Tran the same
policy at the same price even if he had disclosed his true medical history. (Burgess Decl. ¶ 25.)
However, the Court need not resort to speculation where Defendant’s chief underwriter has
expressly indicated under penalty of perjury that Mr. Tran would not have qualified for the policy if
he had disclosed his true medical history. (Augustin Decl. ¶ 19.) As the test is subjective, and is
focused solely on the impact the misrepresentation would have had on the particular insurer in
question, the Court finds the declaration of Defendant’s underwriter is completely dispositive on this
issue. Nieto, 181 Cal. App. 4th at 77.
12
1
Co., 312 P.2d 241, 245 (Cal.1957) and Old Line Life Ins. Co. v. Superior Court, 229
2
Cal. App. 3d 1600, 1606 (Ct. App. 1991)).
3
Waiver of the right to rescind for misrepresentation is only appropriate in the
4
rare instance that the insurer is actually aware of a misrepresentation in the application
5
and chooses to enter into the contract anyway. DiPasqua v. Cal. W. States Life Ins.
6
Co. 106 Cal. App. 2d 281, 284–285 (1951). It is undisputed that Defendant did not
7
have actual knowledge of Mr. Tran’s true medical history before issuing the policy.
8
Therefore, Defendant did not waive the right to rescind based on an initial failure to
9
obtain Mr. Tran’s medical records.14
10
2. Post-claim Underwriting
11
Plaintiff also argues that Defendant cannot rescind the policy based on
12
information, in this case medical records, it acquired after the policy became effective.
13
However, as Defendant points out, post-claim underwriting is not a defense to
14
rescission in the life insurance context. (Mot. 11.) Life insurers in California, unlike
15
health insurers, may engage in post-claim underwriting during the policy’s contestable
16
period.
17
prohibition on post-claim underwriting); Salkin, 544 F. App’x at 715 (agreeing with
18
district court that life insurers are exempt from prohibition on post-claim
19
underwriting).
Salkin, 835 F. Supp. 2d at 834 (finding life insurers are exempt from
20
Courts have repeatedly allowed so-called post-claims underwriting in the event
21
that a policy holder dies within their life insurance policy’s contestable period.
22
Freeman, 253 F.3d at 537 (affirming a district court decision in favor of insurer that
23
rescinded life insurance based on a misrepresentation in the application that was
24
discovered during contestable-period investigation); Salkin, 835 F. Supp. 2d at 835
25
26
27
28
14
Even if there was a requirement to investigate the veracity of an applicant’s answers in an
application for insurance, Defendant conducted a reasonable investigation by subjecting Mr. Tran to
a physical examination. (See Augustin Decl. Ex. E at 125–127.) Because the physical examination
revealed no diseases or disorders of consequence, it is hardly surprising that Defendant would have
ended its investigation before requesting health records from Dr. Tran.
13
1
(granting summary judgment in favor of insurer that rescinded life insurance based on
2
a misrepresentation in the application that was discovered during contestable-period
3
investigation). Indeed, at least one court has gone so far as to term such investigations
4
“standard” procedure. Yang v. Peoples Benefit Ins. Co., No. CIV F 06-458 AWIDLB,
5
2007 WL 1555749, at *2 (E.D. Cal. May 25, 2007) (referring to contestable period
6
investigation that involved obtaining medical records for the purpose of evaluating
7
potential misrepresentations in a life insurance application as “standard.”) Here, it is
8
undisputed that the records were obtained with Plaintiff’s permission during the
9
policy’s two-year contestable period.
Thus, Plaintiff’s post-claims underwriting
10
defense fails. As there is no issue of material fact and Defendant has proven as a
11
matter of law that it properly rescinded Mr. Tran’s life insurance policy, the Court
12
GRANTS its motion for summary judgment as to the breach of contract claim.
13
D. Remaining Claims
14
Plaintiff’s claims based on the breach of the implied covenant of fair dealing,
15
declaratory relief, and intentional infliction of emotion distress all fail because her
16
breach of contract claim fails. As Defendant points out, where there is no breach of
17
contract there can be no breach of the implied covenant of good faith and fair dealing.
18
See San Diego Housing Comm’n v. Indus. Indem. Co., 68 Cal. App. 4th 526, 544
19
(1998) (“Where a breach of contract cannot be shown, there is no basis for finding a
20
breach of the covenant.”). Likewise, because the Court finds that the contract was
21
properly rescinded, it cannot declare that a valid contract presently exists between the
22
parties. As such, the claim for declaratory relief fails. Finally, the emotional distress
23
claim fails because Defendant’s actions were not “extreme and outrageous” in
24
rescinding Mr. Tran’s life insurance policy. See Nichols v. Nw. Mut. Life Ins. Co., 487
25
F. App’x 339, 342 (9th Cir. 2012) (citing Christensen v. Superior Ct., 54 Cal.3d 868,
26
903 (1991)); see also Hailey v. California Physicians’ Serv., 158 Cal. App. 4th 452,
27
476 (2007) (“a plan does not subject itself to liability for intentional infliction of
28
emotional distress by attempting in good faith to assert its perceived legal right to
14
1
rescind a [insurance] contract, even if it is likely the subscriber will suffer emotional
2
distress.”) To summarize, the Court GRANTS Defendant summary judgment on the
3
breach of implied covenant of good faith and fair dealing claim, the declaratory relief
4
claim, and the intentional infliction of emotional distress claim.15
5
V.
For the above reasons, the Court GRANTS Defendant’s motion for summary
6
7
CONCLUSION
judgment in its entirety. The Clerk of Court shall dismiss the action.
8
9
IT IS SO ORDERED.
January 5, 2017
10
11
____________________________________
OTIS D. WRIGHT, II
UNITED STATES DISTRICT JUDGE
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
15
The Court also notes that Plaintiff failed to make any mention her declaratory relief or intentional
infliction of emotional distress claims in her opposition to summary judgment.
15
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?