Wiener v. Axa Equitable Life Ins Co
- Edgardo Ramos
- 1:16-cv-04019
- U.S. District Court · Southern District of New York
- 6
In Wiener v. AXA, Judge Ramos denied reconsideration of an order precluding two medical experts from testifying about insurance underwriting.
Malcolm H. Wiener was affected because the court denied his request to reconsider the preclusion of testimony from two proposed medical experts. The ruling also concerned AXA Equitable Life Ins. Co., David Hungerford, AXA Advisors, L.L.C., and AXA Network, L.L.C., the defendants in the case.
What happened
Malcolm H. Wiener sued AXA Equitable Life Insurance Company, David Hungerford, AXA Advisors, L.L.C., and AXA Network, L.L.C., alleging that they improperly allowed his life insurance policies to lapse and refused to reinstate them. The court had previously precluded testimony from two of Wiener's proposed medical experts.
Wiener asked the court to reconsider that decision. He argued that the doctors could explain his medical records, albumin levels, and health condition, and could show that AXA used faulty procedures and wrongly assessed his medical information when it denied reinstatement.
Judge Ramos denied the motion. The court said the central question was whether AXA reasonably applied insurance-industry underwriting standards, not whether the doctors could independently evaluate Wiener's medical condition. The court also found that Wiener offered no new law, evidence, or facts justifying reconsideration.
The detailed version
- Wiener v. Axa Equitable Life Ins Co · No. 1:16-cv-04019
- Edgardo Ramos
- Jan. 24, 2020
Background
Wiener sued AXA Equitable Life Ins. Co., David Hungerford, AXA Advisors, L.L.C., and AXA Network, L.L.C. He alleged that the defendants allowed his three flexible-premium life insurance policies to lapse and failed to reinstate them. AXA sent Wiener notices of policy termination in December 2013. Wiener then applied for reinstatement and submitted medical evidence of insurability. AXA declined the application in March 2014.
During discovery, Wiener learned that Hallie Hawkins, AXA's chief underwriter, rather than the medical director identified in AXA's letter, made the decision to deny reinstatement. Hawkins relied on a Senior Applicant Medical Checklist and a life-insurance underwriting manual. The checklist stated that an underwriter should usually decline an application when an applicant's albumin level was 3.8 or less, among other conditions. Wiener did not contest that his albumin level met that threshold.
Defendants moved to exclude testimony from three proposed experts: Dr. Ori Ben-Yehuda, Dr. Barry Boyd, and actuary Larry Stern. In a March 15, 2019 order, the court found Larry Stern qualified to testify about damages but precluded Dr. Boyd's and Dr. Ben-Yehuda's testimony. The court concluded that the two doctors were not qualified to testify about whether AXA's underwriting decisions were arbitrary and capricious.
Motion for reconsideration
Wiener moved to reconsider the doctors' preclusion. He argued that the doctors were medically qualified to interpret his medical records, explain the medical significance of his albumin levels, clarify conflicting or illegible entries, and show that AXA used faulty procedures. He also argued that Hawkins's analysis of the records was incorrect.
The court explained that reconsideration is an extraordinary remedy. Under the governing standard, a court may revisit an earlier ruling when there has been an intervening change in controlling law, new evidence has become available, or reconsideration is necessary to correct a clear error or prevent manifest injustice. A reconsideration motion is not a chance to present arguments or facts that were previously available, and it is not a substitute for an appeal.
Court's analysis
The court held that Wiener focused on the wrong issue. The relevant question was whether AXA denied reinstatement arbitrarily and capriciously within the framework of insurance-industry underwriting standards. In this context, an arbitrary and capricious decision is one made without reason, without substantial supporting evidence, or based on a legal error.
The court said that liability would ultimately turn on whether AXA reasonably relied on Wiener's albumin level from an underwriting or insurance-risk perspective. That was an underwriting question rather than a medical question. Because Dr. Boyd and Dr. Ben-Yehuda lacked expertise in life-insurance underwriting guidelines, the court concluded that their medical credentials did not qualify them to address the issue before the court.
The court also found that Wiener presented no new case law, evidence, or facts supporting reconsideration.
Disposition
The court denied Wiener's motion for reconsideration. It directed the parties to appear for a status conference on February 12, 2020, and directed the clerk to terminate the motion.
Read the full 6-page opinion on CourtListener, the free public archive maintained by the Free Law Project.