Life Insurance Claim Denial

If you live in Grand Prairie, Dallas, Fort Worth, Arlington, Grapevine, Crowley, Cleburne, Granbury, Weatherford, Mesquite, or anywhere else in Texas, and you have a life insurance policy the following case should be interesting to you.
On August 31, 2010, the Court of Appeals, Fort Worth, issued an opinion in a case regarding a live insurance policy. The style of the case is, Glenda and Larry Rice v. Metropolitan Life Insurance Company.
Here are some underlying facts of the case:
Glenda purchased group universal life (GUL) insurance for herself and a life insurance rider for her husband Larry, from Metropolitan Life Insurance Company (Metlife) through a plan offered by her employer, Avon Products, Inc. Larry’s rider provided $50,000 in coverage. Glenda retired from Avon in March 2003.
Metlife sent a letter dated May 10, 2003 that was addressed to Glenda and described her insurance options upon retirement. The letter contained information in its upper right corner, under the title of “Coverge Information as of 5/10/2003,” about the amount of Glenda’s own coverage and of Larry’s coverage (described specifically in the letter at $50,000). It then stated in part,
You’ve worked for many years to ensure a solid financial future. Now it’s time to relax and let us keep a promise that we made to you when you enrolled for Group Universal Life insurance. You trusted MetLife to provide a flexible life insurance benefit that would meet a lifetime of protection needs. Now, at this very important stage of your life, we’d like to continue to offer you a menu of coverage options. Most likely, your coverage needs have changed since you first enrolled in GUL. The enclosed brochure and options sheet explains the options now available to you.
Please review these options carefully. Please note that your current coverage will remain effective while you assess your choices … To choose an option, simply complete the attached election form, sign where indicated, and return to MetLife in the envelope provided …
We look forward to continuing to serve your needs and help you keep your promises. Again, congradulations and our best wishes during your retirement!
The election form explained Glenda’s group life insurance options: (1) “CONTINUE MY GUL COVERAGE,” (2) “ELECT A PAID-UP BENEFIT,” (3) “ELECT A METLIFE ANNUITY,” or (4) “SURRENDER YOUR COVERAGE & RECEIVE YOUR CASH FUND BALANCE.” Glenda initially sent MetLife a fax in which she chose the fourth option, but later on the same day she sent the first fax, after speaking with MetLife employee named Summer, Glenda sent another fax stating that she wanted to continue her coverage under the first option. The second fax that Glenda sent stated in part, “I just discussed my decision to retain my coverage with Summer, your customer service associate. She has assured me my coverage will neither lapse not be cancelled.”
The certificate of insurance for Glenda’s group life insurance plan states that term life insurance for dependents ends on the date of the employee’s retirement. However, for about two and a half years after Glenda’s retirement, MetLife continued to bill and accept quarterly premium payments for both Glenda’s coverage and Larry’s rider coverage. Glenda received a “Group Universal Life Report” for the period of January to December 2005 that mentioned Larry’s $50,000 in coverage.
In July 2005, MetLife discovered that it had billed the Rices for Larry’s coverage since Glenda’s retirement in 2003, so in the latter part of 2005, MetLife stopped billing the Rices for that coverage without notice to Glenda. When Glenda received the bill for the final quarter of 2005, she saw for the first time that MetLife had stopped billing for Larry’s coverage. When she called MetLife in December 2005, MetLife’s employee, Angelica Ridge, explained to her that MetLife did not cover term life insurance for dependants under the Avon group policy upon an employee’s retirement and that Larry’s coverage had been cancelled “effective July 2005.” Glenda told Angelica that no one notified her of Larry’s coverage cancellation. Despite this, according to Glenda, Angelica told her that the premiums that Glenda had paid for Larry’s coverage would not be refunded and that Larry’s coverage was in place through July 2005.
The above shows relevant facts.
Procedurally, the Rice’s sued MetLife under numerous theories of law including violations of the Texas Deceptive Trade Practices Act, violation of the Texas Insurance Code, breach of contract, promissory estoppel, and various other related causes of action. The trial judge dismissed the case in a Summary Judgment hearing and this appeal followed.
On appeal, this court re-instated the case, allowing it to go forward on all but a few of the original causes of action. Only an experience Insurance Law Attorney would have been able to save this case. The opinion is lengthy and goes into good detail on each of the causes of action and why they were still good and that the trial judge made a mistake by having the case dismissed.