Moss v. Golden Rule Life Insurance Co.

OPINION

FRANKS, Judge.

In this action to recover benefits under a group major medical policy, the insurance company defended on the grounds that a material misrepresentation was made as to the insured’s weight in the application, which increased the risk but, assuming coverage, the insured was only entitled to recover the difference between the major medical benefits established in the policy and what was paid or payable by Medicare, since the insured was over age 65. The trial judge submitted as issues of fact to a jury whether the pertinent policy provisions were ambiguous and whether a…