Question
Security Insurance, Inc., issued an insurance policy to a company providing an employee, Jessica Garcia, with disability insurance. Soon thereafter, she was diagnosed with panic
Security Insurance, Inc., issued an insurance policy to a company providing an employee, Jessica
Garcia, with disability insurance. Soon thereafter, she was diagnosed with "panic disorder and
phobia of returning to work." Garcia lost her job and sought disability coverage. Security denied
coverage, doubting the diagnosis of disability. Garcia and her employer sued Security. During
pretrial discovery, the insurer learned that Garcia had stated on the policy application that she had
never been treated for any "emotional, mental, nervous, urinary, or digestive disorder" or any kind
of heart disease. In fact, before she filed out the application, Garcia had visited a physician for
chest pains and general anxiety, and the physician had prescribed an antidepressant and
recommended that she stop smoking.
1. Did Garcia commit a misrepresentation on her policy application? Explain.
2. If there was any ambiguity on the application, should it be resolved in favor of the
insured or the insurer? Why?
3. Assuming that the policy is valid,doesGarcia's situation fall within the terms of the
disability policy?
4. If Garcia is covered by the policy but is also disqualified by her misrepresentation on the
application for coverage, might the insurer still e liable for bad faith denial of coverage?
Explain.
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