The insured took out a life insurance policy underwritten
by U.S. Life in 1998. As in all life insurance policies, if the insured passed
away while the policy was in force, then the insurer would pay the beneficiary
the scheduled benefit. The policy had a grace period provision, allowing the
policy to remain in force for 31 days after failure to pay the premium, unless
the grace period was extended by written notice.
The insured maintained the policy until 2007, when he
began obtaining quotes from other insurers for similar coverage. Around this
time, he failed to pay the premium due on May 15, 2007. The third-party
administrator of the policy, AMA Insurance Agency, Inc. (“AMAIA”), sent him
a “reminder notice” stating that the premium must be received no later than
sixty (60) days after the due date. Approximately a month later, AMAIA sent
the insured a “lapse notice” stating that coverage lapsed after the 31-day
grace period, and that to reinstate, he must complete an application for
reinstatement and provide proof of insurability. Rather than completing the
reinstatement form, on July 23, 2007, the insured paid the premium online
through a web bank account. The check was sent by the bank on July 25, 2007
and received by the AMAIA on July 30, 2007. Tragically, the insured was
killed in an accident on July 28, 2007. When AMAIA declined to pay on the
policy, the insured’s wife filed a breach of contract suit.
In finding in favor of the insured’s surviving spouse,
the Court ruled that the “reminder notice” served as sufficient “written
notice” under the policy to extend the 31-day grace period of coverage to 60
days. Therefore, the grace period was extended to July 15, 2007, at which
time it lapsed because the premium payment had not been made. At that point,
coverage could only be reinstated under the policy’s reinstatement clause
(not per the terms of the “lapse notice” letter). The reinstatement clause
allowed reinstatement if the premium payment was made within 31 days after
the end of the grace period, and mentioned no proof of insurability or
requirement for other forms to be completed. The Court concluded that the
requirements for reinstatement detailed in the “lapse notice” failed to
unilaterally alter the unambiguous terms of the insurance policy, and that
under the policy, the insured had until August 15, 2007 to merely pay the
overdue premium to reinstate the policy, which he did.
The twist, however, was whether the insured perfected
“payment” prior to his death. The Court rejected the insurer’s argument that
“payment” meant negotiation of the check by the insurer, which would have
been on July 30, 2007, which came after the insured’s death. The Court
applied the “mailbox rule” from contract law to conclude that payment was
made on July 25, 2007, when the insured’s bank remitted payment to AMAIA by
sending it a check. The Court held that the Policy was reinstated effective
July 25, 2007, three days before the insured died, and therefore, was in
force when he died. Consequently, the trial court properly granted summary
judgment in favor of the beneficiary.