Free Complaint - District Court of Delaware - Delaware

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE METROPOLITAN LIFE INSURANCE COMPANY, Plaintiff, v. ANAGNOSTIS MATULAS, Defendant. : : : : : : CIVIL ACTION NO. ______ : : : :

COMPLAINT Plaintiff, Metropolitan Life Insurance Company ("MetLife"), by and through its attorneys, White and Williams LLP, by way of Complaint against Defendant, Anagnostis Matulas ("Matulas" or "Defendant"), hereby alleges as follows: I. 1. THE PARTIES

MetLife, at all times pertinent hereto, was and is an insurance company licensed

to do and doing business in the State of Delaware and organized and existing by virtue of the laws of the State of New York, having its principal place of business at 200 Park Avenue, New York, New York. 2. Matulas, at all times pertinent hereto was and is an individual adult resident of the

City of Wilmington, State of Delaware. Matulas resides at 109 Brook Meadow Road, Wilmington, DE. II. 3. JURISDICTION AND VENUE

Jurisdiction is in the District Court of the United States pursuant to provisions of

28 U.S.C. § 1332 by reason of diversity of citizenship and an amount in controversy, exclusive of interest and costs, which exceeds the sum of $75,000.00.

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4.

Venue is properly laid in the District of Delaware pursuant to provisions of 28

U.S.C. § 1391 as being the place where Matulas resides and the policy in question was delivered. III. 5. THE APPLICATION

On November 16, 2004, Matulas applied to MetLife for disability income

insurance coverage. 6. A true and copy of Application number signed by Matulas, and submitted to

MetLife, is attached hereto and incorporated by reference in this Complaint as Plaintiff's Exhibit "1" ("Application"). 7. In Part B of the Application, executed on November 16, 2004, Matulas made

factual representations regarding his then existing physical and mental condition and his past physical and mental condition, including, but not limited to the following representations of material fact: a. In response to question 2, Matulas denied that he had lost any time from

work during the past 5 years due to accident or sickness; b. In response to question 4(a), Matulas denied that he had any

personal/primary care physician; c. In response to question 4(b), Matulas denied that he had been examined or

treated by any Chiropractor, Counselor, Health Facility, Physician, Practitioner, Psychiatrist, Psychologist, Social Worker or Therapist in the previous 5 years; d. In response to question 5(b), Matulas denied that he had ever received

treatment, attention or advice for; been told that he had; or had any known indication of arthritis; any disease, disorder or deformity of the bones, muscles, tendons, or joints, including the spine; any neck or back problems or disorders; carpal tunnel syndrome; e. In response to question 7(d), Matulas denied that within the last 5 years,

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by a physician to take any medications, or that he was then taking any prescription medications or over the counter herbal medications; and f. Matulas left blank question 9 which asked him to provide details for any

"Yes" answer to Questions 5 through 8 (Use Supplementary Information Page, pg. 7 if more space is needed). 8. In signing the Application, Matulas certified that he had read the Application and

any supplemental applications or amendments, and to the best of his knowledge and belief, agreed that: a. b. c. All statements and answers are true and complete; and All of the information is correctly recorded in the application; and Such written statements may be relied on by MetLife in order to determine

if he qualified for issue of a policy. 9. 10. On December 8, 2004, Matulas executed a paramedical/medical exam form. A copy of the paramedical/medical exam form executed by Matulas on December

8, 2004 and submitted to MetLife, is attached hereto and incorporated by reference in this Complaint as Plaintiff's Exhibit "2" (Paramedical Exam"). 11. In the Paramedical Exam, Matulas made factual representations regarding his then

existing physical and mental condition and his past physical and mental condition, including, but not limited to, the following representations of material fact: a. In response to question 3 of the Paramedical Exam, Matulas denied that he

had a doctor, practitioner or health facility who could give MetLife the most complete and up to date information concerning his present health; b. In response to question 3 of the Paramedical Exam, Matulas further denied

that he had any consultations in the past 5 years;

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c.

In response to question 5(g) of the Paramedical Exam, Matulas denied that

he had ever received treatment, attention, or advice from any physician, practitioner or health facility for, or been told by any physician, practitioner or health facility that he had arthritis; gout; or disorder of the muscles, bones or joints; and d. In response to question 8(b), Matulas denied that during the past 5 years

he had any illness; injury; or health condition not revealed above; or had been recommended to have any treatment; hospitalization; surgery; medical test; or medication. 12. In signing the Paramedical Exam, Matulas certified that: a. b. him; c. That the answers to questions 2-14 are true and complete to the best of his He read the answers to questions 2-14 before signing; That the answers to questions 2-14 had been correctly written, as given by

knowledge and belief; and d. 13. That there are no exceptions to any such answers other than as written.

In justifiable reliance upon the representations made in the Application and

Paramedical Exam, and the consideration of the payment of the first premium, MetLife issued to Matulas, Disability Income Insurance Policy Number 6445299 AH with an effective date of December 17, 2004 ("Policy"). 14. A true and complete copy of the Policy is attached hereto and incorporated by

reference as Plaintiff's Exhibit "3." 15. The Policy provides that after two (2) years from the Effective Date of this Policy,

or of any policy change or reinstatement, no misstatements, except for fraudulent misstatements, made by the insured on the Application can be used to void this Policy or such policy change or reinstatement, or to deny a claim under this Policy or the policy change or reinstatement, for a Disability starting after the end of such 2-year period. -4WILDMS 139154v.1

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16. the Policy.

This action has been commenced within two (2) years after the Effective Date of

IV. 17.

MATULAS' MISREPRESENTATIONS

MetLife has learned that the statements made by Matulas at the time of the

Application and Paramedical Exam, set forth in paragraphs 7 and 11 of this Complaint were not accurate, not complete and otherwise false and untrue, to wit: a. Zerefos; b. At the office visit of December 24, 2001 with Dr. Zerefos, Matulas Matulas had an office visit on December 24, 2001 with Dr. Demetrios

provided a history of being involved in a motor vehicle accident on December 21, 2001 and a past medical history of being involved in a motor vehicle accident 15 years ago, no problems with his neck or back post-accident; c. Dr. Zerefos diagnosed Matulas on December 24, 2001 as suffering from

acute cervical, thoracic, lumbosacral muscle sprain-strain and tension headaches; d. Matulas underwent x-ray studies on January 7, 2002 at Papastavros

Associates which showed the cervical spine to be within normal limits and the lumbar spine showing first degree reversed spondylolisthesis; disc degeneration and spondylosis of L2-3; and suggestion of pars defect, L2 on the right side; e. Matulas continued treatment with Dr. Zerefos on January 31, 2002 and

complained of lumbar soreness; f. Matulas had an office visit at First State Orthopedics on August 16, 2002

and was seen by Dr. Hogan. Matulas reported that his chief complaint was lower back pain and that the date of his injury was December, 2001. He further reported that he was being treated by Dr. Zerefos for this problem;

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g

Matulas was seen in the office of Dr. Zerefos on September 9, 2002,

reported increasing low back pain, mostly on the left. Dr. Zerefos' plan was for exercise therapy at home and to continue with Celebrex; and h. Matulas was seen in the office of Dr. Zerefos on October 9, 2002 and

reported increased pain in the lower back, left side. It was Dr. Zerefos' opinion that Matulas had sustained mild permanency with lumbosacral spine due to his motor vehicle accident in December, 2001. 18. By letter dated October 9, 2006, MetLife advised Matulas that it was rescinding

the Policy due to material misrepresentations in the Application. Enclosed with this letter was a check representing a refund of premiums with interest. 19. check. COUNT I FRAUDULENT MISREPRESENTATION-APPLICATION 20. MetLife incorporates by reference paragraphs 1-19 of this Complaint as though As of the filing of this Complaint, Matulas has not negotiated the premium refund

the same were fully set forth at length herein. 21. In making the representations set forth in paragraphs 7 and 11 of this Complaint,

Matulas intentionally misrepresented various aspects of his past medical history and treatment, including, but not limited to, the misrepresentations identified in paragraph 17. 22. Matulas made these misrepresentations to induce MetLife to issue him a policy of

disability insurance. 23. MetLife justifiably relied on these misrepresentations in deciding to issue Matulas

the Policy of disability insurance.

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24.

Had MetLife known the facts set forth in paragraph 17 of this Complaint, or other

aspects of Matulas' true medical history and treatment as may be revealed during discovery, MetLife would not have issued the Policy to Matulas. WHEREFORE, MetLife respectfully demands the following relief: (a) a declaratory judgment adjudicating that the Policy was procured through

Matulas' misrepresentations of material facts and failure to accurately disclose information to MetLife and that MetLife has no legal obligation to pay any past, present and/or future disability benefits to Matulas; (b) (c) rescission of the Policy and declaration that the Policy is void ab initio; and such other and further relief and/or damages as deemed appropriate by the Court,

including, but not limited to, interest, costs and reasonable counsel fees. COUNT II INNOCENT MISREPRESENTATION ­ APPLICATION 25. MetLife incorporates by reference paragraphs 1-24 of this Complaint as though

the same were fully set forth at length herein. 26. In making the representations set forth in paragraphs 7 and 11 of this Complaint,

Matulas falsely stated various aspects of his true medical history and treatment, including, but not limited to, the misrepresentations identified in paragraph 17. 27. Matulas made these misrepresentations to induce MetLife to issue him a policy of

disability insurance. 28. the Policy. 29. Had MetLife known the facts set forth in paragraph 17 of this Complaint, or other MetLife justifiably relied on these misrepresentations in deciding to issue Matulas

aspects of Matulas' true medical history and treatment as may be revealed during discovery, MetLife would not have issued the Policy to Matulas. -7WILDMS 139154v.1

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WHEREFORE, MetLife respectfully demands the following relief: (a) a declaratory judgment adjudicating that the Policy was procured through

Matulas' misrepresentations of material facts and failure to accurately disclose information to MetLife and that MetLife has no legal obligation to pay any past, present, and/or future disability benefits to Matulas; (b) (c) rescission of the Policy and declaration that the Policy is void ab initio; and such other and further relief and/or damages as deemed appropriate by the Court,

including, but not limited to, interest, costs and reasonable counsel fees. COUNT III BREACH OF CONTRACT 30. MetLife incorporates by reference paragraphs 1-29 of this Complaint as though

the same were fully set forth at length herein. 31. By signing the Application for insurance and the Paramedical Exam, Matulas

entered into a contract for disability insurance coverage that imposed upon him certain contractual obligations, including, but not limited to, payment of premiums and providing true and complete information in the Application and Paramedical Exam. 32. In concealing and failing to disclose in the Application and Paramedical Exam

those aspects of his past medical history and treatment, including, but not limited to, the facts set forth in paragraph 17 of this Complaint, Matulas breached his contractual obligation to provide true and complete information and breached his duty of good faith and fair dealing.

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WHEREFORE, MetLife respectfully demands the following relief: (a) a declaratory judgment adjudicating that the Policy was procured through

Matulas' misrepresentation of material facts and failure to accurately disclose information to MetLife and that MetLife has no legal obligation to pay any past, present and/or future disability benefits to Matulas; (b) (c) a rescission of the Policy and declaration that the Policy is void ab initio; and such other and further relief as deemed appropriate by the Court, including, but

not limited to, interest, costs and reasonable counsel fees. WHITE AND WILLIAMS LLP

BY: James S. Yoder (DE 2643 Robert Wright (NY RW-0971) 824 N. Market Street, Suite 902 P.O. Box 709 Wilmington, DE 19899-0709 Phone: 302.654.0424 Attorneys for Plaintiff, METROPOLITAN LIFE INSURANCE COMPANY Dated: December 15, 2006

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IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE

METROPOLITAN LIFE INSURANCE COMPANY, Plaintiff, v. ANAGNOSTIS MATULAS, Defendant.

: : : : : CIVIL ACTION NO. ______ : : : : :

CERTIFICATE OF SERVICE I, James S. Yoder, Esquire, do hereby certify that a true and correct copy of the Summons & the Complaint was served, on the following individual, Mr. Anagnostis Matulas 109 Brook Meadow Road, Wilmington, DE 19807-2139 personally, or by leaving copies thereof at the individual's dwelling house of usual place of abode with some person of suitable age and discretion then residing therein.

James S. Yoder (#2643)

Dated: December 15, 2006

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