Robertson v. Cincinnati Life Insurance Company, 3:16-cv-04242

Background

In Jan 2013 Jon Robertson applied for life insurance from Cincinnati Life; he denied chest pain and tobacco use on the application. A policy issued Jan 30, 2013. Robertson died Jan 13, 2015 of esophageal cancer.
Plaintiff Heather Robertson (personal representative) sued after Cincinnati Life denied the death claim and voided the policy in April 2015, alleging breach of contract, violation of WV UTPA, common-law bad faith, and reasonable-expectations doctrines.
Cincinnati Life contends post‑claim medical records show Robertson experienced chest pain and was a former smoker, and that those were material misrepresentations that justify rescission.
Plaintiff contests the accuracy and materiality of medical-record entries and offers affidavits and testimony that Robertson was not a smoker and that some records incorrectly recorded chest pain.
The court denied summary judgment to both parties on breach of contract (disputed material facts as to chest pain and smoking) and on the UTPA unreasonable-investigation claim, granted plaintiff summary judgment that Cincinnati Life violated WV regulation §114‑14‑8 (no written standards for claim investigations), granted defendant summary judgment on the standalone reasonable‑expectations claim, and denied defendant summary judgment on punitive damages.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether insurer may avoid policy for misrepresentations (breach of contract)	Robertson argues no legally sufficient evidence that he had chest pain or was a smoker; any entries relate to minor/immaterial ailments.	Cincinnati Life says medical records show chest pain and prior smoking; misrepresentations were material and insurer would not have issued policy.	Denied summary judgment to both: facts on chest pain and smoking are genuinely disputed and for a jury.
Whether insurer violated WV UTPA §33‑11‑4(9)(d) by refusing claim without reasonable investigation	Robertson says investigation was cursory (didn't interview affidavit witnesses, relied uncritically on records).	Cincinnati Life says it obtained and weighed medical records and contrary evidence before rescission.	Denied summary judgment to both: reasonableness of investigation is a jury question; court noted evidence could support either outcome.
Whether insurer violated WV regulation §114‑14‑8 (written standards for prompt investigation)	Robertson contends insurer has no written investigation standards; procedural notes do not address investigation.	Cincinnati Life argues its "claim procedural notes" satisfy the regulation.	Granted for plaintiff: court concluded no reasonable juror could find the notes meet the regulation's requirement to adopt written standards for prompt investigations.
Whether reasonable‑expectations doctrine provides independent claim	Robertson asserts reasonable‑expectations relief.	Cincinnati Life argues doctrine is interpretive, not a standalone cause of action.	Granted for defendant: court held doctrine is a rule of contract construction, not a separate claim, and granted insurer summary judgment on that count.

Key Cases Cited

Anderson v. Liberty Lobby, 477 U.S. 242 (summary‑judgment standards)
Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574 (summary‑judgment credibility/inference guidance)
JKC Holding Co. v. Washington Sports Ventures, 264 F.3d 459 (4th Cir. 2001) (reasonable inference limits at summary judgment)
Powell v. Time Ins. Co., 382 S.E.2d 342 (W. Va. 1989) (materiality standard for misrepresentations in insurance applications)
Massachusetts Mut. Life Ins. Co. v. Thompson, 460 S.E.2d 719 (W. Va. 1995) (insured may rebut insurer's avoidance defense by showing minor, immaterial ailments)
Dodrill v. Nationwide Mut. Ins. Co., 491 S.E.2d 1 (W. Va. 1996) (definition of "general business practice" under UTPA)
Hayseed, Inc. v. State Farm Fire & Cas., 352 S.E.2d 73 (W. Va. 1986) (punitive damages in insurance context require intentional tort/actual malice)