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Massachusetts Mutual Life Insurance Co. v. Beeharilal

United States District Court, M.D. Louisiana

March 24, 2015

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY,
v.
PERMANAND BEEHARILAL

ORDER

RICHARD L. BOURGEOIS, Jr., Magistrate Judge.

Before the court is a Motion to Compel filed by Defendant and Counterclaim Plaintiff Permanand Beeharilal ("Beeharilal") on January 17, 2015. (R. Doc. 20). Plaintiff and Counterclaim Defendant Massachusetts Mutual Life Insurance Company ("MassMutual") has filed an Opposition. (R. Doc. 25). Beeharilal has filed a Reply. (R. Doc. 39).

I. Background

This dispute concerns whether Beeharilal made a material misrepresentation in his application for disability income insurance provided by MassMutual by not disclosing certain medical issues regarding his left knee. On August 24, 2012, Beeharilal submitted his application, which asked the following questions and to which he provided the following answers:

Question 53
Have you ever received treatment or been diagnosed as having or had any of the following? (If "Yes", check condition(s) and give details below.)[1]
Answer to Question 53
Yes. Allergy.
Question 54
Have you ever had any disorder of the following? (If "Yes", check condition(s) and give details below.)[2]
Answer to Question 54
No.
Question 55
Other than above, within the past 5 years have you had any illness, information, injury or surgery, physical examination, medical consultation, counseling, electrocardiogram, x-ray or laboratory study, or been a patient in a hospital or other medical facility? If "Yes", specify.
Answer to Question 55
No.

(R. Doc. 20-2 at 7, 10). Beeharilal did not represent on the application that in January of 2007, he "had slipped on stairs and injured the meniscus in his left knee, " which led to "outpatient arthroscopic surgery on June 23, 2007." (R. Doc. 20-1 at 2-3, 6).

MassMutual issued Beeharilal a disability income insurance policy numbered 8751328 ("Policy"). The Policy provides a monthly benefit of $11, 000 up to the age of 67, including cost of living increases and other enhancements.

On July 9, 2013, Beeharilal submitted a written claim for benefits in light of an "anterior discectomy decompression with insertion of an artificial disc at C6-7" on June 21, 2013. (R. Doc. 20-1 at 3). This was followed by "two surgeries in 2014 for a herniated disc at L5-S1." (R. Doc. 20-1 at 3). While investigating the claim, MassMutual's claims adjusters discovered Beeharilal's left knee meniscus tear and anthroscopy and consulted the disability insurance chief underwriter, who determined that "[i]f the insured's true circumstances had been known at time of application, [the] policy would not have been issued as it was." (R. Doc. 20-2 at 15). Based on this determination, MassMutual denied Beeharilal's claim on January 28, 2014. (R. Doc. 20-2 at 11-13). In the denial letter, MassMutual asserts that Beeharilal's left knee meniscus tear and arthroscopy should have been disclosed in response to Question 53 (by checking "yes" and "Physical Impairment) and Question 54 (by checking "Bones" and "Joints." (R. Doc. 20-2 at 12-13). MassMutual concluded that the Policy was void and returned Beeharilal's premium payments plus interest. (R. Doc. 20-2 at 13).

On February 7, 2014, MassMutual filed its Complaint initiating this action. (R. Doc. 1). MassMutual seeks rescission of the Policy or a declaration pursuant to 28 U.S.C. ยง 2201 "that the Policy never came into effect because, at the time it was issued, Beeharilal's health was not represented in the Application." (R. Doc. 1 at 4).

On March 18, 2014, Beeharilal filed an Answer and Counterclaim. (R. Doc. 6). Through his counterclaim, Beeharilal seeks a judgment ordering, among other things, MassMutual to pay disability benefits and other enhancements under the Policy and to pay bad faith damages pursuant to Louisiana Revised Statute 22:1821(A). (R. Doc. 6 at 9-10). In his Answer, Beeharilal states that his knee injury was not responsive to Questions 53 and 54 of the application, which respectively concerned "conditions" and "disorders." (R. Doc. 6 at 5). Beeharilal argues in the instant motion that Question 55 of the Application - which asked whether "within the past 5 years" he had any "injury or surgery" - is the relevant question concerning his left knee meniscus tear and arthroscopy. (R. Doc. 20-1 at 3-4).[3]

On June 25, 2014, Beeharilal propounded the Requests for Production at issue on MassMutual. (R. Doc. 20-4 at 9-16).[4] Requests for Production Nos. 15, 16, 17, and 18, seek copies of MassMutual's underwriting and claims guidelines, including identification ...


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