Court holds that decedent did not intentionally misrepresent a prior medical condition in his application for life insurance benefits

John Casamassina left the communications company that he worked for in December of 1996 and became self-employed. To replace the life insurance provided by his company, his wife contacted United States Life Insurance Company (US Life) in May or June 1997 to obtain more information about a life insurance policy.

On August 5, 1997, Mr. Casamassina visited with Dr. Poet, an ear, nose, and throat specialist, because of sinus congestion and headaches. Along with these symptoms, Mr. Casamassina was experiencing nasal discharge, sore throat, dizziness, lightheadedness, nausea, headache, vomiting, and blurred vision. Mr. Casamassina was diagnosed with vertigo, given a nose spray, and told that he would be “ok.”

Six days later, on August 11, 1997, Mr. Casamassina saw Dr. Rattinger for his annual physical examination. This was Mr. Casamassina’s first visit with Dr. Rattinger, and discussed his congestion and headaches with the physician. Dr. Rattinger’s impression was that the headaches were caused by stress, and prescribed a muscle relaxant and recommended an MRI.

When Mr. Casamassina arrived for the prescribed MRI, he refused it because of claustrophobia. He then attempted to reschedule the MRI with Dr. Rattinger’s office, who told him it was unnecessary to do so since Mr. Casamassina’s symptoms had completely resolved. When Mr. Casamassina returned to Dr. Rattinger’s office on September 19, 1997, he told the doctor he felt fine, Dr. Rattinger reported no complaints on that day, and felt it was unnecessary to reschedule the MRI.

Later that same day, the Casamassinas met with a representative of US Life at their home for a basic medical examination as part of Mr. Casamassina’s application for a $500,000 life insurance policy with US Life. Mr. Casamassina responded to the questions posed by the health questionnaire as best as he could, reporting that he had previously been treated for headaches.

On November 6, 1997, US Life issued Mr. Casamassina’s policy. The following day, Mr. Casamassina met with Dr. Rattinger and mentioned that he was dizzy and nauseated in the morning. Dr. Rattinger recommended that if the symptoms continued, Mr. Casamassina should have a head MRI. Mr. Casamassina’s symptoms did continue, and a November 19, 1997, head MRI revealed a brain tumor. After an operation to remove the tumor on December 4, 1997, Mr. Casamassina passed away.

Mrs. Casamassina filed a claim under the policy issued by US Life, who then denied the claim. Mrs. Casamassina then filed suit.

The question in this suit was whether Mr. Casamassina had intentionally made misrepresentations that caused US Life to issue the policy under circumstances it ordinarily would not have. US Life claimed that Mr. Casamassina had intentionally omitted information about his headaches, nausea, vomiting, and changes in vision in answering the questionnaire during the basic medical examination at his home.

The court disagreed with this argument, believing that based on the available medical records and the language of the policy, Mr. Casamassina had not misrepresented anything based on his best knowledge and belief. Prior to the medical exam on November 7, 1997, Mr. Casamassina had no reason to believe that a more serious problem was the underlying cause of the symptoms that had resolved by the time he was completing the application for life insurance, and therefore he had not lied or failed to answer completely any of the questions asked by US Life during the basic medical examination.

The court ruled, therefore, that Mrs. Casamassina could present her evidence to the jury to decide whether it should have been reasonable for Mr. Casamassina to answer the questions asked during the basic medical examinations differently, such that US Life might have been forewarned of a more serious medical condition.

See Casamassina v. U.S. Life Ins. Co., 958 So. 2d 1093 (Fla. 4th DCA 2007).

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