An insurance company is asking federal court to revoke a disability policy held by a Valhalla man who its claims repeatedly falsified his application.
Berkshire Life Insurance Company of America, of Pittsfield, Massachusetts, accused the man of misrepresenting his occupation and medical history, in a complaint filed March 27 in U.S. District Court, White Plains.
“Berkshire would not have issued the policy in the form it was issued,” the complaint states, “had it known the material facts and information fraudulently misrepresented.”
The Westchester County Business Journal is withholding his name because of sensitive and personal details about his health. Online records indicated that he is employed by a general contractor in Peekskill. Efforts to contact him for his side of the story failed.
The man applied for a disability policy in September 2019 that could potentially pay $15,450 a month.
He listed his work as “executive” and “senior vice president” and said he devoted 100% of his time to “management of firm.”
He answered “no” as to whether he performed manual labor or wore protective gear for work.
He repeatedly answered “no” on the health and medical history section to receiving treatment for any diseases in the past ten years.
He answered “no” to receiving advice or surgery or diagnostic tests in the past five years or to currently receiving any medical advice or treatment.
Later he amended the application to acknowledge that he had been using a medicine to help him urinate.
In October 2019 he declared that in the month since submitting the application he had not had a physical exam or checkup of any kind or been a patient in any health care facility.
The applicant attested that his answers were complete and true, the complaint states, and acknowledged that knowingly submitting false information is fraudulent.
Last year he submitted a claim for benefits beginning in January 2022 at age 55, according to the complaint, and potentially continuing to age 65 and totaling more than $1 million.
Berkshire says it notified the man’s attorney that it would begin paying the disability benefits. But it was still investigating the truthfulness of the insurance application and it was concerned about his occupation.
Now Berkshire alleges that many of the answers on the application were false.
The claim for benefits stated that his occupational duties were “job site;” he wore a hard hat and other protective gear; he used ladders and heavy equipment; he lifted from 50 to 75 pounds when unloading trucks at job sites; and he had been performing manual duties at job sites for 30 years.
Berkshire says it discovered that the man was diagnosed with arthritis in his left knee around 2011. He had incidents of coughing up blood in 2015 and 2016 but declined to undergo a test. He was diagnosed with a pituitary tumor around 2017 or 2018. A brain MRI “resulted in various abnormal findings” in 2019.
Ten days before he declared he had received no recent medical checkups he consulted with a doctor about breast swelling and was advised to undergo an ultrasound test and to see an endocrinologist and a surgeon.
“These misrepresentations were incorporated into the policy,” the complaint states, “and prevented Berkshire’s underwriters from properly evaluating and underwriting the risks in insuring defendant.”
Berkshire is asking the court to nullify the disability policy and to declare that is has no duty to make any disability payments to the policy-holder.
Berkshire is represented by Stamford attorney Patrick W. Begos.
