Equitable Faces Return of Life Policy Reinstatement Claim

News August 28, 2024 at 01:18 PM
Share & Print

What You Need To Know

  • Malcolm Wiener was the founder of The Millburn Corp., a financial planning firm.
  • He has lectured at Yale University on archaeology in the area around the Aegean Sea.
  • The three policies involved in the litigation provided $16 million in death benefits and lapsed in 2013.
A statue showing the goddess of justice holding up scales. (Image: Adobe Stock)

A federal appeals court has revived a long-running legal battle over three universal life insurance policies from AXA Equitable Life Insurance Co. that lapsed in 2013.

Malcolm Wiener — an 89-year-old lawyer, Aegean historian and founder of the Millburn Corp., a financial planning firm — bought the policies, which originally provided $16 million in death benefits, from AXA Equitable in 1987.

Wiener has argued that he received inadequate lapse notices, bad advice from an advisor about how to keep the policies in force, and unfair treatment from AXA Equitable when he applied to have the policies reinstated.

A three-judge panel at the 2nd U.S. Circuit Court of Appeals ruled last week that a federal district court in New York was right to award summary judgment to AXA Equitable over the policy terminations. But the panel found that Wiener had presented "a genuine issue of material fact as to the actual reasons" underlying the reinstatement denials and whether those reasons were arbitrary.

The panel vacated the district court's summary judgment over the reinstatement claims and sent Wiener's reinstatement claims back to the district court for further proceedings.

AXA Equitable was part of AXA, a French financial services company, when Wiener bought the universal life policies and when AXA Equitable terminated the policies. Since then, AXA Equitable has separated from AXA and become part of Equitable Holdings, a stand-alone financial services company based in New York.

Equitable declined to comment on pending litigation.

AXA did not respond to a request for comment.

Wiener's attorneys did not respond to a request for comment.

Malcolm Wiener

Malcolm Wiener was born in Qingdao, China, in 1935. He received a Naval Reserve Officers' Training Corps scholarship to study at Harvard, where he earned a bachelor's degree in economics.

He later served as an officer in the U.S. Navy. He then earned a law degree from Harvard.

In addition to starting the Millburn Corp., he started the Millburn Ridgefield Corp., an asset manager.

He has studied the archaeology of Greek societies and other societies in the regions around the Aegean Sea, and he lectured on that topic at Yale.

He also has funded the start of the Malcolm Wiener Center for Social Policy at Harvard's Harvard Kennedy School.

The Policies

The policies involved in the litigation were flexible-premium adjustable life policies, according to exhibits included with an amended version of Wiener's complaint.

The issue age for each policy was 51. The policy beneficiary was Wiener's wife.

The owner was a defined benefit plan trust.

The initial semiannual premium payment was $96,782.50 for a policy with $7.2 million in death benefits issued in February 1987, $96,782.50 for a policy with $7.2 million in death benefits issued in April 1987 and $21,776 for a policy with $1.6 million in death benefits issued in April 1987.

AXA Equitable warns on the policy information summary sheets that "the premium payments shown above may not be sufficient to continue the policy and life insurance coverage in force to the final policy date." The final policy date is the policy anniversary nearest the insured person's 95th birthday.

The Policy Terminations

Wiener has alleged that his advisor changed the address of record for his policies without his consent, that he failed to receive premium reminder notices at the correct address, and that he received notices about the policy terminations late. He said he was willing and able to provide the cash needed to keep the policies in force.

He also alleges that his advisor failed to give him good advice about how to keep the policies in force before he received the termination notices, and that, after he received the termination notice, he was told to respond by applying to have the policies reinstated, rather than simply sending in the missing payments. Millburn sent in a premium check with a request for policy reinstatements.

AXA Equitable ended up refunding the checks, saying that it does not send out premium reminder notices during policy late-payment grace periods, and saying that policy reinstatements were subject to Wiener providing evidence of medical insurability.

After Wiener had a physician send AXA Equitable medical records, AXA Equitable rejected the medical reinstatement requests based on the medical records.

The 2nd Circuit Reasoning

The 2nd Circuit panel found that the district court was right to side with AXA Equitable on the policy termination issue, because Wiener had received many premium notices at the address selected by his advisor without objecting and that there was no evidence that a breach of notice obligations had caused the policies to terminate.

"Even if AXA's failure to send premium notices on or around November 1, 2013, amounted to a breach, on this record, no reasonable factfinder could find that the breach caused Wiener to suffer damages," according to an opinion by U.S. Circuit Judge Beth Robinson.

When AXA Equitable had sent past notices recommending that Wiener make payments to keep the policies in force, the Millburn employees who received the notices had never sent in premium payments, Robinson writes.

The panel also found that the advisor had no duties to contact Wiener about the termination notices or Wiener's and Millburn's premium payment practices.

AXA Equitable said it based the reinstatement denials on reports of low serum albumin levels.

Wiener contends that AXA Equitable provided the serum albumin level justification after he fought the denials and that the actual reasons for the denials "bear many of the hallmarks of an arbitrary and capricious decision," Robinson writes.

The 2nd Circuit panel suggested that the reinstatement claims are different from the policy termination procedure claims because, under New York state law, an insurer cannot deny reinstatement in an arbitrary and capricious manner.

"AXA stresses that insurance companies should be afforded significant deference when it comes to reinstatement denials," but AXA Equitable's letter explaining the denials was vague, Robinson writes.

Because a reasonable jury could conclude that AXA Equitable's underwriter used an arbitrary reason to deny the reinstatement applications, the company is not entitled to summary judgment on that point, Robinson writes.

The 4th Circuit Litigation

Wiener alleged in a suit filed in 2018 in a federal court in North Carolina that AXA Equitable had caused him to become uninsurable by reporting false information about his health to an underwriting information clearinghouse.

A jury at the court ruled in Wiener's favor in 2020 and awarded him $8 million. The judge, U.S. District Judge Robert Conrad Jr., dismissed the verdict, finding that Connecticut law governed the case and that the court lacked jurisdiction over the suit's subject matter.

A three-judge panel at the 4th U.S. Circuit Court of Appeals reversed the dismissal and sent the case back to the North Carolina court.

Conrad issued an order in April that set aside the original $8 million jury damages award. He awarded Wiener $1 in damages. Wiener is appealing that ruling.

Credit: Sergign/Adobe Stock

NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

Related Stories

Resource Center