JOHN G. HEYBURN, II, District Judge.
Plaintiff brings this action seeking recovery for life insurance benefits under a policy for which her son, Dennis M. Yates ("Yates"), applied on July 22, 2008. As fate would have it, Yates passed away before the life insurance company, Bankers Life & Casualty Insurance Co. ("Bankers" or "the insurance company"), determined whether it would fully accept the application and insure Yates. Nearly two months after Yates' death, and three and half months after the initial application for coverage, Bankers denied the application and deemed Yates uninsurable. Believing that the denial was not a mere coincidence, Plaintiff claims that it was made in bad faith and, therefore, that Bankers owes the full policy amount. Bankers now moves for summary judgment on the ground that it acted in good faith in denying coverage as a matter of law. This case presents a number of interesting and challenging issues that the Court will address in turn.
With only a few important exceptions, the facts of this case are largely undisputed.
On July 30, 2008, Hazelton electronically transmitted the application to Bankers' corporate headquarters to be processed.
Upon receipt, Bankers assigned Yates' file to Sally Dattulo, a full-time underwriter. During the application review, two other Bankers' employees, Janine Foy and Sharon Neavins, also "handled" the file. Bankers requested and received medical records from Yates' primary physician, Dr. Tran.
It appears that this, in essence, concluded Bankers' review of Yates' application. Bankers offers no evidence that it attempted to obtain the results of the 2002 colonoscopy
Bankers claims that on November 4, 2008, it sent a letter of denial to the local agent
Critical to this case is the fact that Yates died as a result of a heart attack on September 11, 2008. Plaintiff states that she notified the local office within a few days of Yates' death to file a claim for benefits. Bankers contends that the decision makers, i.e. the underwriters, were not aware of Yates' death until the November 11, 2008 email from Corbin, which came after the underwriters denied coverage. Whether the underwriters knew or did not know of Yates' death appears to be a critical issue in this case and likely one that must be decided by a jury.
Because she had not heard anything from Bankers, Plaintiff filed a complaint with the Kentucky Department of Insurance on December 12, 2008. That department sent a letter to Bankers inquiring about the status of the claim. Bankers responded by saying that coverage was denied on November 4, 2008 because it had not received all of the medical records requested. It also attached a note from the file stating, "The application for coverage was rejected because colonoscopy results were not received prior to the death of the applicant." The department of insurance forwarded this letter to Plaintiff, which she claims was the first notification of the denial of coverage she received.
Count One of the Complaint is for breach of contract. Essentially, Plaintiff argues that the conditional receipt Bankers gave Yates created a contract of insurance and Bankers breached that contract when it refused to pay $150,000.00 in benefits upon Yates' death. The primary issue, then, is whether Bankers had a contractual obligation to provide life insurance benefits. The Kentucky Court of Appeals directly addressed this issue in Investors Syndicate Life Ins. & Annuity Co. v. Slayton, 429 S.W.2d 368 (Ky.Ct.App.1968), and held,
Id. at 370 (citations omitted); see also Estate of Riddle v. Southern Farm Bureau Life Ins. Co., 421 F.3d 400 (6th Cir. 2005). Likewise, in our case, Bankers retroactively decided that Yates was uninsurable as of his application date.
The Court first considers whether the question of Bankers' good faith is one of law for the Court or one of fact for a jury. Based on Slayton, Bankers argues that it is a matter of law for the Court to decide. In Slayton, the Larue Circuit Court held a jury trial and the jury found that the defendant life insurance company did not exercise good faith in finding the plaintiff uninsurable. On appeal, the Kentucky Court of Appeals held, "In our opinion the record shows good faith beyond reasonable dispute. . . . In our opinion the [insurance company] was entitled to a directed verdict." Slayton, 429 S.W.2d at 370. Nothing about this language suggests that it is improper to submit the issue to a jury as a general rule. Rather, Slayton represents a typical determination that there was insufficient evidence for a reasonable jury to find in favor of the plaintiff; in other words, the insurance company in that case was entitled to summary judgment because there was no material factual dispute.
Moreover, the Court finds that the Sixth Circuit considered this issue in Riddle and determined that the question of good faith is a proper jury question. There, the district court submitted the issue of good faith to a jury and the jury found in favor of the insured. The Sixth Circuit affirmed that verdict, stating, "So long as the plaintiffs produced sufficient evidence to convince a reasonable jury that the defendant rejected Riddle's application in bad faith, the fact that Southern Farm might have found Riddle uninsurable had they acted in good faith is not relevant under Kentucky law." Riddle, 421 F.3d at 407 (emphasis added). The Circuit went on to say that, with regard to whether the evidence established good faith, "[c]hoosing between two reasonable inferences is the function of the jury," id. at 408, and "the district court did not err in denying the defendant's motion for judgment as a matter of law and submitting the issue to the jury," id. at 409. Finally, the Circuit held that "both contract formation and [the insurance company's] alleged bad faith refusal to pay a valid claim were issues for jury determination." Id. at 410. This Court is bound to follow the Sixth Circuit's interpretation of Kentucky law and, therefore, finds that Bankers' good faith is a proper jury question.
The only remaining issue is whether sufficient evidence exists for a reasonable juror to find bad faith. The Court is guided in this analysis by both Slayton and Riddle.
In Slayton, the Kentucky Court of Appeals found that it was "beyond reasonable dispute" that the insurance company acted in good faith. Slayton, 429 S.W.2d at 370. There, the insured made numerous false statements on his application: (1) he indicated that he had never been denied insurance coverage by a another company when in fact he had been denied by a different
In Riddle, the Sixth Circuit affirmed a jury verdict finding that the insurance company acted in bad faith in denying coverage. There, it was undisputed that the insured suffered from numerous serious medical conditions. The Circuit even noted that it may have been permissible to find him uninsurable in good faith. However, the actions of the insurance company in reviewing his claim permitted an inference of bad faith. Upon learning of his death, the insurance company removed the case from the assigned underwriter and subsequently had three supervisors review the file. Each supervisor noted additional concerns, some of which they recognized were extremely vague, and the underwriting manager admitted that he scrutinized the application more than the average one and even went through it with a "fine tooth comb." The Circuit found this was sufficient evidence to allow a jury to find bad faith.
Riddle, 421 F.3d at 408-09.
Certainly, our case shares more similarity with Riddle than Slayton. Here, Bankers does not even contend that Yates was, in fact, uninsurable. Rather, they simply contend that they did not have sufficient information to determine if he was insurable. While that may be true and may be a good faith denial of coverage, it may equally be reasoned that Bankers was simply looking for a reason to deny coverage, meaning that they acted in bad faith.
Numerous potentially suspicious circumstances surround Bankers' review of Yates' application. These circumstances create a reasonable possibility that Bankers acted in bad faith.
First, though Bankers noted an interest in medical records from Yates' most recent colonoscopy on August 30, 2008, it did not actually request those records until October
Next, Bankers admits that Yates' file, like the file in Riddle, was reviewed by no less than three underwriters. This could lead to a conclusion that Bankers was conducting an exceedingly thorough investigation to find a reason to deny coverage, just as it did in Riddle. Third, Bankers offered an obscure and misleading reason for denial: its failure to receive requested medical records. While it is true that Bankers did not receive the requested medical records, i.e. a recent colonoscopy, Bankers may have known that no such records were actually available. Thus, the more rational reason for denying coverage is insufficient medical testing to determine insurability, not a refusal to submit required medical records. Although this is perhaps a distinction without a significant difference, by making it Bankers increases the suspicion surrounding its review of Yates' application.
Fourth, Bankers offers no evidence that it would generally deny a policy simply because an applicant failed to obtain a diagnostic test unrelated to the insurance application. Bankers is in the business of issuing policies, not denying them. When an application is denied, Bankers expends valuable resources determining insurability and gets nothing in return. Thus, it is reasonable to believe that it would take all reasonable steps to determine whether Yates was or was not actually insurable, rather than simply denying coverage because of a lack of testing. That alone raises significant suspicion about the legitimacy of Bankers' denial.
Significant suspicion also surrounds the company's handling of the denial. Bankers claims to have denied the policy on November 4 by sending a letter to the local agent. Yet, it cannot produce a copy of that letter. Moreover, the local agency continued to inform Plaintiff that her son's claim was being processed and Bankers never informed her of the denial of his application. While this may be explained by a serious communication flaw between Bankers' main office and its local agencies, these facts could also raise questions as to Bankers' good faith.
Finally, Bankers claims that its underwriting agents did not know of Yates' death until after denying coverage.
In the end, it is entirely possible that Bankers acted in good faith and simply determined that it could not insure Yates because he failed to obtain a colonoscopy. However, the suspicious actions described above make it equally possible that Bankers discovered Yates' death prior to making a coverage determination and began looking for reasons to deny coverage in bad faith. As the Sixth Circuit explained in Riddle, determining the correct inference from these two permissible ones is a decision properly reserved for the jury. Riddle, 421 F.3d at 408.
Next, the Court considers Count Three of the Complaint, which alleges violations of the Kentucky Consumer Protection Act ("KCPA").
Plaintiff's final claim, Count Four of the Complaint, is for violations of the Kentucky Unfair Claims Settlement Practices Act ("UCSP"), which provides a remedy for an insured whose claim is denied in bad faith. Bankers argues that the UCSP only provides a remedy for a denial of a claim, not a denial of a policy itself. The Sixth Circuit addressed this issue in Riddle.
Riddle, 421 F.3d at 410. Given this guidance from the Sixth Circuit, it appears that Plaintiff may proceed on her UCSP claim.
Being otherwise sufficiently advised,
IT IS HEREBY ORDERED that Defendant's Motion for Summary Judgment is SUSTAINED IN PART and DENIED IN PART. Counts Two and Three of the Complaint are DISMISSED WITH PREJUDICE. Plaintiffs' claims for breach of contract (Count One) and bad faith denial of insurance benefits (Count Four) remain.
This is not a final and appealable order.