This is the case of Falcon v. The Northwestern Mutual Life Insurance Company, in the U.S. District Court Western District of Pennsylvania.
This case pertains to a missing disability insurance policy. The insured says he never received a copy of the original-fully executed copy of the policy when he purchased it in 1990.
Fast forward 25 years and the insured now has a disability claim, but cannot produce a copy of the original policy documents, and neither could the insurer. The insurer was only able to produce a “substitute” or “replica” of the policy, but could not render an original.
The insured was able to produce application forms, which the court weighed in ruling on the insurer’s motion for summary judgment.
The insured said he had a lifetime disability policy, but the insurer said the insured was only entitled to two years of payments following his disability.
Shortly thereafter, the insured filed a lawsuit against the insurer for breach of contract, bad faith, and violation of the Unfair Trade Practices and Consumer Protection Law (UTPCPL), for which the insurer filed the instant motion for summary judgment on all counts.
The court was not persuaded by the insurer’s position and held that while the “substitute” or “replica” policies could be supportive of the insurer’s position that it had already paid all that was due under the terms of the policy, the court felt that wasn’t enough, and that the insurer must still prove that these policies accurately reflect what was memorialized in the actual policy.
The court’s ruling will allow a trier of fact to resolve the dispute as to whether the insured’s testimony regarding the lifetime coverage he thought he received vs. the insurer’s testimony that the “substitute/replica” policies were the same as the original policy.
With regard to the insured’s bad faith claim, likewise, the court denied the insurer’s summary judgment motion on bad faith reiterating that the insured was under no requirement to prove or produce evidence of the insurers self-dealing or ill-will under Rancosky v. Washington National Insurance, 170 A.3d 364 (Pa. 2017).
The carrier had argued that it had a reasonable basis to deny coverage, but the court did not agree, stating “while this may ultimately be proven, the Court cannot determine on a motion for summary judgment whether [the insurer] had a reasonable basis for its denial. Moreover, as the insured observes, the insurer’s behavior during the claim process constitutes evidence in support of his claim that it acted in bad faith.”
As to the insured’s claim that the carrier committed violations of the Unfair Trade Practices and Consumer Protection Law, the insurer lost on this point as well.
In the end, the insured was able to successfully frame his argument as one of deceptive conduct in issuing the policy, and not merely a refusal to pay.