A district judge in Georgia barred certain opinions of an life insurance industry expert because no authority, underwriting or otherwise, was cited in support of such opinions.
This case is about whether Pacific Life was entitled to rescind two life insurance policies and deny claims for benefits under them when it learned during the contestable claim period that Jimmie Long (“Mr. Long”) made material misrepresentations about his history of, and treatment for, abusing alcohol. Plaintiff Ronald Blalock (“Plaintiff”) owned, and was the beneficiary under, both policies. The policies were issued in January 2022, approximately four months before Long died in a car accident. Seven days after Long’s death, his insurance producer submitted claims for the benefits provided for in the policies. In accordance with the policies’ terms, Pacific Life conducted a contestable claim investigation—a routine action taken when an insured dies within two years of a policy’s issuance—to determine if the benefits were payable.
Long’s medical records and Pacific Life’s investigation revealed that Long made material misrepresentations in his applications for insurance coverage. Pacific Life accordingly decided to rescind the policies and deny Plaintiff’s claims. Apparently dissatisfied with Pacific Life’s decisions, Plaintiff commenced this lawsuit. Plaintiff asserted claims for breach of contract and bad faith failure to pay benefits against Pacific Life.
Plaintiff identified Vera Dolan as an expert witness to support his
claims. Plaintiff asked Dolan to investigate two issues. He asked her to investigate Pacific Life’s contestable claim review of the two policies to determine if the review was fair, reasonable, and consistent with the standard of care. He also asked Dolan “to investigate the denial of claim payment to Long’s policies beneficiary, Ronald Blalock.”
Insurance Expert Witness
Vera Dolan has been involved in the life insurance industry as an underwriter for over 41 years, since 1982. She is one of the leading mortality experts in the life insurance industry. She writes underwriting manuals and policy and procedure manuals for life and health insurance companies.
Discussion by the Court
Dolan, addressed the question of whether the medical records warranted Pacific Life’s finding of material “alcohol abuse” and concluded that “Long’s underwriting profile was not consistent with the profile of an alcohol abuser as defined by Pacific Life’s underwriting guidance.”
Dolan opined that “Pacific Life is falsely stating that reviewing ten years of medical records at time of claim is fair and justified, when only five years of the most contemporaneous medical records were reviewed at time of issue without any finding of alcohol abuse.” Pacific Life argued that Dolan’s opinion was based on “speculation” and “unreliable principles and methods.”
The Court held that Dolan cited no authority, underwriting or otherwise, supporting this opinion. Dolan did not dispute that it was appropriate to ask Long about his medical history for the ten years preceding his application for insurance. Nor did she dispute that Pacific Life could appropriately rely on the truthfulness of the information Long provided when it issued the Policies.
When Long died within the contestable period, the only means available to confirm the accuracy of that information was to request records from the providers who saw Long during that ten-year period.
Held
The Court excluded Dolan’s opinion regarding the consideration of ten years’ worth of medical records. Her other opinions were limited pursuant to the parties’ consent.
Key Takeaway:
Vera Dolan argued that Pacific Life’s practice of reviewing ten years of medical records at the time of claim, despite only reviewing five years at the time of policy issuance, was not fair or justified. She added that Long’s underwriting profile was not consistent with the profile of an alcohol abuser as defined by Pacific Life’s underwriting guidance. The Court, however, rejected her opinion regarding the consideration of ten years’ worth of medical records.
Case Details:
| Case Caption: | Blalock V. Pacific Life Insurance Company |
| Docket Number: | 5:23cv14 |
| Court: | United States District Court, Georgia Middle |
| Order Date: | July 09, 2024 |
Leave a Reply