447 Mass. 875 | Mass. | 2006
We are asked in this case to consider the scope of G. L. c. 175, § 108 (5) (a),
In 2000, a judge in the Superior Court, sitting without a jury, found for the insured, Julian Banerji, on the claim for rescission of John Hancock Mutual Life Insurance Company of FEP
In a rescript opinion, the Appeals Court reversed the judgment with regard to rescission, awarding Hancock rescission of the FEP benefit. The Appeals Court thus found it unnecessary to decide Banerji’s ancillary claims. John Hancock Mut. Life Ins. Co. v. Banerji, 62 Mass. App. Ct. 906, 909 (2004). Relying principally on Opara, supra, the Appeals Court held that neither the attachment statute, G. L. c. 175, § 108 (5) (a), nor the wording of Baneiji’s individual disability insurance policy required attachment of the application for the FEP benefit because that benefit was a supplement to Banerji’s individual disability policy and not a “new and distinct policy.” Id. at 908. We granted Baneiji’s application for further appellate review.
We affirm the judgment of the Superior Court on Hancock’s rescission claim, although on different grounds from those relied
1. Background. We summarize the relevant factual findings from the judge’s detailed and thoughtful memorandum of decision. This case concerns two applications submitted by Banerji to Hancock for disability insurance benefits. The first was an application for an individual disability insurance policy, which guaranteed the insured an income stream based on his existing income, together with a predetermined annual cost-of-living adjustment in the event that the insured became disabled and was unable to continue working at full salary.
In August, 1990, Banerji, through Hancock agent Jack Turgel, applied to Hancock for an individual disability insurance policy.
In September, 1990, while his application was pending, Banerji accepted a new position as a senior research scientist at Procept, Inc. (Procept). As a result of this change in employment, his salary rose from $25,000 to $47,000. He promptly notified Hancock of the change in employment and of his new salary. Hancock did not inquire whether Procept provided Baneiji with disability insurance; Procept did in fact provide group disability insurance, but Baneiji was unaware of this.
On October 2, 1990, Hancock issued an individual disability insurance policy to Baneiji. It provided for a monthly benefit of $1,500, with annual cost-of-living adjustments, in the event that Baneiji became disabled and was unable to work. The policy, to which Banerji’s application was attached, stated, among other things, that “[a] copy of your application is attached and is a part of this policy.”
In October, 1991, Banerji suffered a stroke. After a brief period of hospitalization, he returned to work at Procept full time and at full salary. Banerji did not apply for disability benefits at that time. In November, 1993, while still employed at Procept (albeit in a new position designed to accommodate
In December, 1993, Hancock approved Banerji’s FEP application, and Banerji’s monthly premiums increased accordingly. Turgel then sent Baneqi a letter containing the FEP endorsement, together with instructions that the endorsement should be attached to Banerji’s 1990 individual disability policy. The letter did not refer to Baneqi’s FEP application, nor was a copy of the FEP application attached to or enclosed with the endorsement.
In August, 1994, Banerji left his employment at Procept.
2. Application of the attachment statute. Construing the cognate attachment statute applicable to life insurance policies that preceded G. L. c. 175, § 131, in 1905, this court held that the “language of the statute plainly has reference to an application upon which an original policy is issued, and not to any contract of revival.” Holden v. Metropolitan Life Ins. Co., 188 Mass. 212, 214 (1905) (Holden). See Reidy v. John Hancock Mut. Life Ins. Co., 245 Mass. 373, 376 (1923) (concluding that application for reinstatement of lapsed insurance policy not subject to attachment statute). Relying in substantial measure on those two cases, Hancock argues the attachment statute at issue
Hancock’s position and the decision of the Appeals Court, however, run contrary to our holding in Opara, supra. In that case, the insured had allowed a $1 million whole life policy of insurance to lapse due to nonpayment of the premium. Subsequently, and after several medical procedures in which doctors had determined that he had a cancerous growth in his small bowel, the insured applied for reinstatement of the policy. On his reinstatement application, the insured misrepresented his physical condition. See id. at 542. The insurer approved the reinstatement application (as well as a subsequent application to change the policy from whole life to term life coverage), and sent the insured a reinstated policy to which his original application, but not his reinstatement application, was attached. Id. at 543. After the insured died, his beneficiaries sought payment under the reinstated policy, which the insurer refused based on the statements in the reinstatement application. Id. at 544. We held that, because of the insured’s misstatements in his reinstatement application, the original policy was never reinstated. We held further that in such circumstances, the attachment statute did not prevent the insurer from refusing to pay benefits under the policy to the beneficiaries. Id. at 546-547. See Holden v. Metropolitan Life Ins. Co., supra at 214 (attachment statute does not apply to “any contract of revival”).
Here, unlike in Opara and Holden, the insured did not apply for reinstatement of an existing (albeit lapsed) policy; instead, he applied for a new, separate, and distinct layer of disability protection, in the form of new benefits not provided under his
The situation here is different. To obtain his additional FEP benefits, Banerji was required to submit a new application,
Where there was a new application for new benefits not provided in the original insurance contract and for new consideration, and where that new application contained representations material to Hancock’s underwriting decision, the FEP application was an “application for a policy” as that term is used in G. L. c. 175, § 108 (5) (a). See 2 G. Couch, Insurance § 18:8 (3d ed. 1995 & Supp. 2005) (“A statutory requirement that the application be attached to the policy does not require attachment of a supplemental application which contains no new matter of material import. Where, however, substantial amendment of the application takes place, the amended application or other documents containing the amendments must be attached to the policy”). See also G. L. c. 175, § 108 (1) (defining “policy of accident and sickness insurance” as including “any policy or contract” [emphasis supplied]). Hancock may rely on Banerji’s statements in his application for FEP benefits if, and only if, Hancock attached the FEP application to the issued FEP endorsement.
Hancock’s argument that the FEP benefit should be analyzed under the reinstatement exception in G. L. c. 175, § 108 (5) (a), is unavailing.
3. Remaining claims. We may summarily dispose of Baneiji’s remaining claims. First, we agree with the judge that the evidence at trial demonstrated that Hancock acted in good faith and reasonably in investigating and disputing Banerji’s claim for FEP benefits. Baneiji’s claims under G. L. c. 93A, and G. L. c. 176D, therefore fail for want of evidence. See Buster v. George W. Moore, Inc., 438 Mass. 635, 642-644 (2003) (judge’s findings supported by evidence will be upheld on appeal unless there is clear error).
Second, we agree with the judge that Baneiji is not entitled
Banerji also seeks damages in both tort and contract for infliction of emotional distress, pointing to testimony concerning the stress and emotional problems that Banerji and his wife suffered when Hancock refused to pay the FEP benefits. Hancock argues that these issues are not adequately preserved. But we need not resolve that question as we conclude that Banerji is not entitled to such damages on either basis. The judge denied the tort claim, concluding that the insurer had not engaged in any conduct that was “extreme and outrageous.” Haddad v. Gonzalez, 410 Mass. 855, 871 (1991). We agree. His careful findings are not challenged by Banerji, and his conclusion is fully consistent with these findings.
As to the contract claim for emotional distress, damages for mental suffering are generally not recoverable in an action for breach of contract. See, e.g., McClean v. University Club, 327 Mass. 68, 76 (1951); St. Charles v. Kender, 38 Mass. App. Ct. 155, 159-161 (1995). See also Restatement (Second) of Contracts § 353 (1981). Damages for emotional distress may be recovered if they result from physical harm, DiGiovanni v. Latimer, 390 Mass. 265, 271 (1983), or are the result of intentional or reckless conduct of an extreme and outrageous nature, Agis v. Howard Johnson Co., 371 Mass. 140, 144-145 (1976). The judge concluded that the insurers acted fairly (if incorrectly) in denying payment of the FEP benefit, and there is nothing inherent in the coverage provided by an insurance policy for FEP benefits that would put an insurer on notice that emotional distress would be a foreseeable result of its good faith decision to deny a claim. Cf. Sullivan v. O’Connor, 363 Mass. 579, 587 (1973) (foreseeable distress damages recoverable in action for breach of contract in respect to cosmetic operation on plaintiff’s nose). The judge was correct to deny emotional distress damages.
Finally, Banerji seeks recovery of his attorney’s fees and costs. In Wilkinson v. Liberty Mut. Ins. Co., ante 663 (2006), we recently affirmed that we adhere to the traditional rule that each party to litigation in an insurance coverage dispute is responsible for his own attorney’s fees and costs. See Waldman
4. Conclusion. The judgment of the Superior Court is affirmed. The case is remanded to the Superior Court for a calculation of damages for the FEP benefits past due, together with prejudgment and postjudgment interest, and for such other and further relief as may be required, consistent with this opinion.
So ordered.
General Laws c. 175, § 108 (5) (a), provides, in relevant part, that an “insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof.”
General Laws c. 175, § 108 (1), states: “The term ‘policy of accident and sickness insurance’ as used herein includes any policy or contract covering the kind or kinds of insurance described in subdivisions (a) and (d) of the sixth paragraph of section forty-seven.” General Laws c. 175, § 47, Sixth (a), in turn, refers to insurance for “any person against bodily injury or death by accident . . . .” Disability insurance generally is viewed as a type of accident insurance. See 1 G. Couch, Insurance § 1:47 (3d ed. 1995 & Supp. 2005) (“ ‘Accident insurance’ generally means a contract whereby one for . . . consideration agrees either to indemnify another against personal injury resulting from accident, or, in case death results, to pay a fixed sum as compensation therefor. The intention is ordinarily that the contract shall apply to all cases of disability which are the natural and ordinary results of external injury . . .”). Hancock does not dispute that the statutory attachment requirement, G. L. c. 175, § 108 (5) (a), applies to the original individual disability insurance policy issued to the defendant, or that disability insurance (as a broad category of insurance) is covered by the definition of “policy” under G. L. c. 175, § 47, Sixth (a).
Hancock issued the original individual disability insurance policy to Julian Banerji. At the time of trial, Provident had acquired Hancock’s entire individual disability insurance line, including the individual disability policy and the FEP benefit issued to Baneiji.
Following discovery but before the trial, Baneiji filed a motion in limine to exclude the FEP policy on the ground that G. L. c. 175, § 108 (5) (a), precluded Hancock from relying on Banerji’s statements in his FEP application. Baneiji raised his § 108 (5) (a) objection continuously throughout the trial.
Specifically, the judge declared the FEP endorsement valid and enforceable. He ruled against Hancock and in favor of Baneiji on the rescission issue, holding that Hancock’s contract with Baneiji required that a copy of Banerji’s FEP application be attached to the FEP endorsement when the endorsement was issued. The judgment awarded contract damages to Baneiji in the amount of $157,214.43 for past due FEP benefits, with interest and postjudgment interest; directed Hancock to pay future monthly additional FEP benefits to Banerji as they came due; and dismissed with prejudice, all appeal rights reserved, Banerji’s cross claim for breach of the duty of good faith and fair dealing pursuant to G. L. c. 93A and G. L. c. 176D, his cross-claim for negligent and intentional infliction of emotional distress, and his request for reasonable attorney’s fees and costs.
The application form for these benefits is titled “Application for Individual DISABILITY Insurance to the John Hancock Mutual Life Insurance Company — Part A.”
The application form for these benefits is titled “John Hancock Mutual Life Insurance Company Application for Additional Benefits — Individual Disability and Health Insurance.”
“Unemployment insurance and disability insurance essentially protect against the same risk: inability of an individual to earn the salary or wages to which he or she was accustomed in the immediate past. While unemployment insurance protects against loss of income/employment due to a wide variety of causes, disability protects only against such losses that are attributable to poor
On appeal, Hancock does not contest that Banerji was unaware of Precept’s group disability coverage, either when Banerji submitted his FEP application or at any other time during his employment at Procept. There was evidence that Banerji’s contract offer letter from Procept expressly mentioned “group life, health and dental insurance” as part of the compensation package, but did not mention group disability insurance coverage.
When Baneiji received the policy, he also received a preprinted “Copy of Application” endorsement, which stated: “Examine this copy carefully. If you find any error or omission, notify us at our Home Office immediately. Please explain fully the error or omission and give us your policy number.”
The FEP application did not require any additional medical underwriting information. For example, Banerji was not required to submit to a medical examination in order to be deemed eligible for the FEP benefit.
At trial, Turgel stated that he had no reason to believe that the FEP application had not been attached to or enclosed with the FEP endorsement. The judge did not find Turgel’s testimony to be credible on this point, and Hancock does not contest that finding on appeal.
There is a dispute whether Banerji resigned or whether his employment was terminated. In the claim Baneiji submitted to Hancock in October, 1994, for disability benefits, Banerji stated that the gradual onset of his stroke-related disability had led to his inability to continue working for Procept. As neither Procept nor Hancock contests Baneiji’s eligibility for disability benefits following his separation from Procept, we see no reason to assume that Baneiji’s job performance caused the termination of his employment. See John Hancock Mut. Life Ins. Co. v. Banerji, 62 Mass. App. Ct. 906, 907 (2004).
We are not persuaded by Hancock’s attempt to characterize this submission as a “request” rather than an “application.” As noted earlier, note 8, supra, the Hancock form was titled an “application” for additional benefits.
Contrary to the Appeals Court’s analysis, Holden v. Metropolitan Life Ins. Co., 188 Mass. 212, 214 (1905), does not stand for the broad proposition that the attachment statute applies only to applications for an “original” policy. Rather, the Holden court addressed the narrower question whether the attachment statute applied to an application for revival of a policy.
General Laws c. 175, § 108 (5) (a), as concerning applications for reinstatement or renewal, states: “If any such policy delivered or issued for delivery to any person in the commonwealth shall be reinstated or renewed, and the insured or the beneficiary or assignee of such policy shall make written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall within fifteen days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request, a copy of such application. If such copy shall not be so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based
The cognate attachment statute applicable to life insurance policies, G. L. c. 175, § 131, does not contain similar statutory protections for insurers with respect to the reinstatement or reversal of a life insurance policy.
Baneiji argues that Hancock’s failure to investigate the veracity of his statements in his FEP application until after he submitted a claim for FEP benefits amounts to unfair “post-claim underwriting.” “Post-claim underwriting” is the alleged practice of an insurer’s failure to engage in adequate underwriting until after a claim is submitted, and subsequently denying the claim on the basis that the insured is not entitled to the policy. See Banks v.
Baneiji’s individual disability insurance policy states, under the heading “Presumptive Disabilities,” that “[y]ou will be presumed to be disabled if injury or sickness causes total and permanent loss of any of the following:
. . . Your use of one hand and one foot.” In his notice of appeal, Banerji appealed from the judge’s determination that he is not “presumptively disabled” but makes no argument to that effect. See Haufler v. Zatos, 446 Mass. 489, 499-500 n.25 (2006) (argument not raised on appeal is waived); Mass. R. A. P. 16 (a) (4), as amended, 367 Mass. 921 (1975) (“The appellate court need not pass upon questions or issues not argued in the brief”). Even if the issue is not waived, the judge’s finding has support in the record and is not “clearly erroneous.” Mass. R. Civ. P. 52 (c), as appearing in 423 Mass. 1408 (1996). See Secretary of Envt’l Affairs v. Massachusetts Port Auth., 366 Mass. 755, 774 (1975) (in nonjury cases findings of fact are not set aside unless clearly erroneous).