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Entitlement to Disability Benefits

Robert Gladney applied for disability insurance from Paul Revere Life Insurance Co., enclosing with the application a check for $3,100, which represented the first semi-annual premium. The issuance of the policy was conditional on the insurance company's receipt of a medical form that was to be completed by Gladney's doctor following a physical examination. Gladney was a busy man and kept putting off the physical examination. Over a month later, Gladney submitted a second application, because the first one was too old. The insurance agent advised Gladney to leave the application undated so that if Gladney failed to have the physical examination within a month, he would not have to submit yet a third application. Gladney told the agent that he would notify him when the examination was completed. Soon thereafter, Gladney fell ill. His doctor examined him but did not conduct all the tests normally required by Paul Revere for disability insurance. A month later, Gladney was hospitalized and underwent heart surgery. Gladney never told the insurance agent about his visit to the doctor and the fact that the doctor had examined him. Gladney now claims that he is entitled to disability benefits under the policy because he paid the premium and would have been approved for insurance had he notified the insurance company of his examination. Will the court agree? Discuss fully.

Solution Preview

We have to take a few different elements into consideration, in this scenario. Let's outline the facts that are the most important, in an abbreviated form.

Robert applied for a disability insurance policy. He filled out his application and sent it in with the first premium, in the form of a check. If accepted and insured, another check would be due from Robert in six months. The policy issuance was conditional based on -

-- Receipt of a medical form
-- A physical examination by his doctor

One month later, he submitted a second application, due to the time lapse from the original application. The second application was an undated application.

Robert gets sick and seeks medical care. He received a physical exam because he fell ill. This was the reason why the necessary medical exams and tests, as required by the insurance company, were not completed. This is an ...

Solution Summary

This solution discusses the entitlement to disability benefits that Robert may or may not have. A comprehensive discussion is provided, covering all aspects of this case and all related legal elements.