Court Sides with Long-Term Care Insurer Over Claim Denial and Potential Fraud

A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v. Mass. Mut. Life Ins. Co., No. 22-cv-2933, 2024 WL 2106452 (D. Colo. Apr. 26, 2024).

Though MassMutual initially approved Mr. Meyer’s claim in April 2018 after a psychologist determined that he had a severe cognitive impairment, MassMutual uncovered evidence in March 2020 during the benefits recertification process that suggested he was not severely cognitively impaired. MassMutual surveilled Mr. Meyer and recorded Mr. Meyer driving, shopping, carrying groceries, and walking unassisted. MassMutual ultimately terminated Mr. Meyer’s benefits in October 2020. Mr. Meyer then sued MassMutual for breach of contract and bad faith. MassMutual filed a counterclaim for fraud and, as part of the requested remedy, sought to invalidate Mr. Meyer’s policy for fraud in the claim process.

In the opinion, the judge granted MassMutual’s motion for summary judgment on Mr. Meyer’s breach of contract and bad faith claims. The judge relied on a variety of evidence in the record to draw these conclusions. For example, the judge noted that MassMutual was not liable for terminating Mr. Meyer’s benefits because it produced objective video surveillance evidence that showed Mr. Meyer was not severely cognitively impaired given that he could drive and shop independently.

The judge also denied Mr. Meyer’s motion for summary judgment on MassMutual’s counterclaim for fraud. Mr. Meyer specifically asked the judge to hold that MassMutual cannot void his policy even if the jury finds that he committed fraud. Notably, the judge declined to decide the issue until after the jury determines whether Mr. Meyer committed fraud. The opinion is thus significant because it suggests the District of Colorado might ultimately join the jurisdictions that permit insurers to void long-term care insurance policies for fraud after the contestability period expires.

The material contained in this communication is informational, general in nature and does not constitute legal advice. The material contained in this communication should not be relied upon or used without consulting a lawyer to consider your specific circumstances. This communication was published on the date specified and may not include any changes in the topics, laws, rules or regulations covered. Receipt of this communication does not establish an attorney-client relationship. In some jurisdictions, this communication may be considered attorney advertising.

About the Author: Maureen A. O'Kane

Associate Maureen O’Kane advocates for clients seeking solutions in insurance litigation matters. Previously, as a summer associate at Faegre Drinker, Maureen collaborated with attorneys on constitutional, contract and employment litigation matters. She also served as a judicial intern to the Hon. Mark A. Kearney of the Eastern District of Pennsylvania. Visit Maureen’s full bio on the Faegre Drinker website.

About the Author: Nolan Tully

Nolan Tully advocates for insurance and financial services clients facing challenges in various aspects of their businesses. Nolan assists life, long-term care and disability insurers as well as annuity issuers with product development, regulatory compliance, and dispute resolution and litigation. Visit Nolan's bio on the Faegre Drinker website.

Leave a Reply

Your email address will not be published. Required fields are marked *

©2024 Faegre Drinker Biddle & Reath LLP. All Rights Reserved. Attorney Advertising.
Privacy Policy