Dec 12, 2018
Steven Ray Tiffany had life insurance through his work at Genmar Transportation. He paid for the insurance out of his wages. When he died, the beneficiary of the policy, Teri Tiffany, filed a claim. UNUM, the insurer, denied Teri’s claim because it determined that Steven had never provided evidence of insurability when he initially took out the life insurance. Teri argued that regardless of Steven’s failure to provide evidence of insurability at the time he applied for coverage, the policy was in place for three years before his death and UNUM had happily accepted premiums for the coverage that entire time. She argued that this constituted a waiver of any need to present the evidence of insurability.
Unfortunately for Teri, the U.S. District Court for the Western District of Michigan was bound by precedent of the U.S. Court of Appeals for the Sixth Circuit which had squarely rejected the same argument made in an earlier case. Teri’s claim was dismissed. But Judge Richard Alan Enslen, was troubled by the injustice of seeing UNUM receive premiums from Tiffany for three years and walk away without any obligation to pay out insurance benefits upon his death. He brackets his dismissal order with strong words for UNUM.
After noting that the insurer has wrongly withheld premiums from Tiffany, he begins the opinion by stating: "UNUM should voluntarily repay those premiums lest it trade its role in legitimate commercial insurance for the ways of the thief and confidence man" (emphasis in original). Again, at the end of the decision, Judge Enslen states:
". . . the Court is . . . concerned about one grave injustice . . . [n]amely, by both resisting the claim for benefits because the decedent was uninsurable and receiving benefits on the supplemental policy for a three-year period . . . UNUM has put itself into the position of receiving premium payments for a risk it was unwilling to insure while keeping the premiums. While this is a nice piece of business for UNUM’s stockholders, at the bottom it is a kind of commercial theft which just courts cannot countenance."
Based on the posture of the case, Judge Enslen was not in a position to order UNUM to reimburse Tiffany’s estate the premiums. But the Judge does urge UNUM in this direction and concludes by saying, "if it fails to do so, the premiums will be a small price for its reputation as a commercial insurer that actually undertakes risks on premiums it accepts."
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