Murtha v. Golden Rule Ins. Co., Civil Action No. 3:98-CV-975 (JCH) (D. Conn. 3/5/2001)

• Decision Date: 05 March 2001
• Docket Number: Civil Action No. 3:98-CV-975 (JCH).
• Parties: MARY MURTHA, Substitute Plaintiff, v. GOLDEN RULE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — District of Connecticut

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MARY MURTHA, Substitute Plaintiff, v. GOLDEN RULE INSURANCE COMPANY, Defendant.

Civil Action No. 3:98-CV-975 (JCH).

United States District Court, D. Connecticut.

March 5, 2001.

RULING ON MOTION FOR SUMMARY JUDGMENT [DKT. NO. 30]

JANET C. HALL, District Judge.

The substitute plaintiff, Mary Murtha ("plaintiff"), brings this civil action on behalf of the deceased, Jeffrey Moreau ("Moreau"), against the defendant Golden Rule Insurance Company ("Golden") for breach of contract and a violation of the Connecticut Unfair Trade Practices Act ("CUTPA") based on a violation of the Connecticut Unfair Insurance Practices Act ("CUIPA"), for failure to cover Moreau's medical bills under a medical insurance policy issued to Moreau by Golden. Amended Complaint (Dkt. No. 11).¹ Golden has raised eight special defenses to each of the plaintiff's claims and four counterclaims. Second Amended Answer, Special Defenses & Counterclaim (Dkt. No. 24).

Now before the court is Golden's Motion for Summary Judgment [Dkt. No. 30] on the plaintiff's two claims. For the reasons that follow, the motion is granted.

I. FACTS

The following facts are undisputed. In March 1977, Moreau was admitted to Saint Francis Hospital where he underwent surgery for the removal of a brain tumor. Plaintiff's Brief in Opposition (Dkt. No. 39) at 2. Almost twenty years later, on July 16, 1996, Moreau visited Dr. Stephen Leach of the Windham Medical Group, P.C. for purposes of a general physical examination. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 1; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶ 1. On February 12, 1997, Moreau sought medical advice relating to headaches he had been experiencing, and he underwent a neurological examination and CAT scan at Saint Francis Hospital. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 2; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶¶ 1-2.

Also on February 12, 1997, Moreau, with the plaintiff's assistance, completed and submitted an application for a medical insurance policy with Golden ("application"). Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 3; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶ 1. Moreau indicated that he had not received any medical advice or treatment in the past six months, in response to Question 19 on the application, failing to disclose the treatment he received earlier that same day. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 4; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶¶ 1, 4; see also Defendant's Memo. of Law (Dkt. No. 32), Ex. 1.

In response to Question 21(c) on the application, Moreau indicated that he had not experienced any indications, signs, symptoms, diagnoses or treatment of headaches in the last ten years, failing to disclose the headaches he was experiencing. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 6; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶¶ 1, 4; see also Defendant's Memo. of Law (Dkt. No. 32), Ex. 1. Moreau failed to list any doctors or other health care professionals that Moreau has consulted with or been treated by in the last five years, failing to disclose the treatment he received that same day. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 8; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶¶ 1, 4; see also Defendant's Memo. of Law (Dkt. No. 32), Ex. 1.

Based on this application, Golden issued a medical insurance policy to Moreau with effective dates of coverage for injuries of February 13, 1997, and for illnesses of February 27, 1997. Defendant's 9(c)1 Statement (Dkt. No. 31) at ¶ 9; see also Defendant's Memo. of Law (Dkt. No. 32), Ex. 1. Section 16 of the policy states, in part:

Material Misstatements or Omissions: This policy may be voided by us, or claims may be denied, by reason of misstatements by you in any application for this policy or in any additional information which you provide in support of the application. This action may be taken by us in the first two years of a person's coverage. Beyond two years after the effective date of coverage, this policy may be voided only by reason of fraudulent misstatement as determined by a court of competent jurisdiction.

Defendant's Memo. of Law (Dkt. No. 32), Ex. 1. The application also contained a "Statement of Understanding" above Moreau's signature line, which states:

I have personally completed this application. I represent that the answers and statements on this application are true, complete, and correctly recorded to the best of my knowledge. I UNDERSTAND AND AGREE that this application and the payment of the initial premium do not give me immediate coverage. Coverage for illness begins on the 15th day after a person becomes insured for injury. Incorrect or incomplete information on this application may result in lose of coverage or claim denial. The information provided in this application, and any supplements or amendments to it, will be made a part of any policy/certificate which may be issued. The producer is only authorized to submit the application and initial premium, and mu not change or waive any right or requirement. I have received a conditional receipt.

Id. Moreau signed and dated the application beneath this statement on February 12, 1997. Id.

The CT scan taken on February 12 showed no evidence of a recurrent tumor, but Moreau continued to seek medical treatment for his headaches in March and April 1997. Plaintiff's Brief in Opposition (Dkt. No. 39) at 4. Moreau was diagnosed with a brain tumor in May 1997 and underwent surgery to remove the tumor on July 15, 1997. Id.

Moreau submitted claims for this treatment, which Golden denied on the basis of the policy's Pre-Existing Condition clause. Id. at 5; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶ 6; see also Defendant's Memo. of Law (Dkt. No. 32), Ex. 1; Plaintiff's Brief in Opposition (Dkt. No. 39), Ex. 10. Golden accepted premiums in the aggregate amount of $1,824.28 from Moreau for the policy. Plaintiff's Brief in Opposition (Dkt. No. 39), Ex. 10; Plaintiff's 9(c)2 Statement (Dkt. No. 38) at ¶ 8.

On October 1, 1997, Golden asked Dr. Norman W. Oestrike, a neurologist, to review Moreau's medical records to determine whether Moreau had a pre-existing condition according to the terms of the policy. Defendant's Memo. in Support (Dkt. No. 32), Ex. 9 at ¶ 3. By letter of December 10, 1998, Golden informed Moreau that it was voiding his policy for material misstatements in response to Questions 19, 21(c), and 25-27 on the application. Plaintiff's Brief in Opposition (Dkt. No. 39), Ex. 10.

II. STANDARD OF REVIEW

In a motion for summary judgment, the burden is on the moving party to establish that there are no genuine issues of material fact in dispute and that it is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c); Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256 (1986); White v. ABCO Engineering Corp., 221 F.3d 293, 300 (2d Cir. 2000). A court must grant summary judgment "`if the pleadings, depositions, answers to interrogatories, and admissions on file, together with affidavits, if any, show that there is no genuine issue as to any material fact. . . . '" Weinstock v. Columbia Univ., 224 F.3d 33, 41 (2d Cir. 2000) (quoting Fed.R.Civ.P. 56(c)). "An issue of fact is `genuine' if `the evidence is such that a reasonable jury could return a verdict for the nonmoving party.'" Konikoff v. Prudential Ins. Co. of Am., 234 F.3d 92, 97 (2d Cir. 2000) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). "An issue of fact is `material' for these purposes if it `might affect the outcome of the suit under the governing law.'" Id. (quoting Liberty Lobby, 477 U.S. at 248).

"[I]f after discovery, the nonmoving party has failed to make a sufficient showing on an essential element of [its] case with respect to which [it] has the burden of proof," summary judgment is appropriate. Hellstrom v. U.S. Dep't of Veterans Affairs, 201 F.3d 94, 97 (2d Cir. 2000) (internal quotation marks omitted) (quoting Berger v. United States, 87 F.3d 60, 65 (2d Cir. 1996)). "The non-moving party may not rely on conclusory allegations or unsubstantiated speculation. Instead, `the non-movant must produce specific facts indicating' that a genuine factual issue exists. `If the evidence [presented by the non-moving party] is merely colorable, or is not significantly probative, summary judgment may be granted.' To defeat a motion, `there must be evidence on which the jury could reasonably find for the [non-movant].'" Scotto v. Almenas, 143 F.3d 105, 114 (2d Cir. 1998) (citations omitted).

"In deciding the motion, the trial court must first resolve all ambiguities and draw all inferences in favor of the non-moving party, and then determine whether a rational jury could find for that party." Graham v. Long Island R.R., 230 F.3d 34, 38 (2d Cir. 2000). "If reasonable minds could differ as to the import of the evidence, . . . and [i]f . . . there is any evidence in the record from any source from which a reasonable inference in the [nonmoving party's] favor may be drawn, the moving party simply cannot obtain a summary judgment." R.B. Ventures, Ltd. v. Shane, 112 F.3d 54, 59 (2d Cir. 1997) (internal quotation marks omitted) (quoting Brady v. Town of Colchester, 863 F.2d 205, 211 (2d Cir. 1988)).

"At the same time, the non-moving party must offer such proof as would allow a reasonable juror to return a verdict in his favor. . . ." Graham, 230 F.3d at 38. A plaintiff may not create a genuine issue of material fact by presenting unsupported statements or "sweeping allegations." Shumway v. United Parcel Serv., Inc., 118 F.3d 60, 65 (2d Cir. 1997). The non-moving party "cannot defeat the motion by relying on the allegations in his pleading, or on conclusory statements, or on mere assertions that affidavits supporting the motion are not credible. The motion `will not be defeated merely . . . on the basis of conjecture or surmise.'" Gottlieb v. County of Orange, 84 F.3d 511, 518 (2d Cir. 1996) (citations omitted); see also ...