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Rhone v. Cigna Health Management, Inc.

United States District Court, E.D. Louisiana

July 22, 2015

STEWART RHONE
v.
CIGNA HEALTH MANAGEMENT, INC., ET AL., SECTION

ORDER AND REASONS

IVAN L.R. LEMELLE, District Judge.

I. NATURE OF MOTION AND RELIEF SOUGHT

Before the Court is Defendants', Freedom Life Insurance Company of America ("Freedom Life") and USHealth Advisors, LLC ("USHealth"), Motion for Summary Judgment (Rec. Doc. 25), which seeks dismissal under Fed.R.Civ.P. 56 of Plaintiff's, Stewart Rhone (individually and as administrator of the estate of Rosalinda Rhone a/k/a Rosa Rhone), claims in this matter. Plaintiff opposes the motion, arguing issues of fact prevent summary judgment. (Rec. Doc. 35). For reasons that follow, IT IS ORDERED THAT Defendants' Motion is GRANTED.

II. FACTS AND PROCEDURAL HISTORY

The undisputed material facts are as follows. Mrs. Rosa Rhone died in December 2012 at North Oaks Hospital due to complications from lupus disease. (Rec. Doc. 25-2 at 3; 35-1 at 2). She and her husband, the named plaintiff in this matter, had submitted an application for an Individual Specified Disease policy with Defendant Freedom Life on November 1, 2012. (Rec. 25-2 at 2; 35-1 at 1). On November 5, 2012, a Freedom Life representative contacted the Rhones in order to have them repeat and verify the medical history information contained in the application. (Rec. Doc. 25-2 at 2; 35-1 at 1).

As part of both the application and subsequent telephone confirmation, neither of the Rhones made any mention of lupus or issues pertaining thereto. The record reflects that the coverage application included a series of medical history questions, which read, in pertinent part:

Has any applicant been diagnosed with, treated or taken medications for, consulted with, had symptoms of, or been advised to seek treatment for any disease or disorder of the:
...
(j) Muscles, Joints, or Connective Tissues including but not limited to Rheumatism, Arthritis, Rheumatoid Arthritis, Gout, Fibromyalgia, Temporomandibular Joint disorder, (TMJ), Carpal Tunnel Syndrome, Lupus or Lyme disease?
...
(m) Skin including but not limited to Psoriasis or Eczema.

(Rec. Doc. 25-4 at 3)(emphasis added). Notations on the application indicate a negative response to both questions. Id. As well, notations on the Customer Service Call Script created by the Freedom Life representative at the time of the follow-up call indicate negative responses to the same questions when posed during that conversation. (Rec. Doc. 25-6 at 3-4).

A section of the Freedom Life application pertaining to Applicant Acknowledgments states:

Acknowledge that any fraudulent statement or material misrepresentation on the Application and/or amendments may result in ...

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