Aetna Life Insurance v. McCullagh

215 S.W. 821, 185 Ky. 664, 1919 Ky. LEXIS 356
CourtCourt of Appeals of Kentucky
DecidedNovember 11, 1919
StatusPublished
Cited by22 cases

This text of 215 S.W. 821 (Aetna Life Insurance v. McCullagh) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aetna Life Insurance v. McCullagh, 215 S.W. 821, 185 Ky. 664, 1919 Ky. LEXIS 356 (Ky. Ct. App. 1919).

Opinion

Opinion of the Court by

Judge Settle

Affirming.

This is an appeal from .a judgment of $1,275.00, entered upon a verdict for that amosnt recovered hy appellee against appellant in the court below in an action on a policy of insurance No. B. Gr. 23629, issued to him by appellant, December 20, 1916, whereby, in consideration of $12.50, then paid its agents, Stanley and Banks, by him, it undertook to insure the appellee for a term of six months from the date mentioned, against loss resulting directly and independently of all other causes, from bodily injuries effected solely through external, violent- and [666]*666accidental means. ■ Part 1 of the policy provided for the payment of the principal snm of insurance, or fractional parts thereof, for injuries resulting in the loss of life, or of certain members of the insured’s body. Part 2 provided : “If such injuries do not result in any of the losses provided for in Part 1, but alone, totally disable the insured, that is from date of accident continuently and wholly prevent him from prosecuting any and every kind of business pertaining to his occupation, the company will pay the sum of 25 and no 100 dollars per week so long as he shall live and suffer such disability.”

December 22, 1916, two days after the policy was issued and. delivered, the appellee had an accidental fall causing severe injuries to his leg and knee, which necessarily resulted in a surgical operation. He was totally disabled by the fall, and such disability continued a period of fifty-one weeks and down to the bringing of the action. Although appellee made proper proofs of loss and demand upon appellant for payment of the amount due, it denied liability, which led to the institution of this action. The appellant by its answer resisted the recovery sought on the grounds that the policy was issued on an application made to it by appellee in which appellee made false answers to several of. the questions therein asked him with the purpose to deceive appellant; that the answers were material to the risk and that the policy would not' have been issued if the true facts had been made known to appellant by appellee. The alleged false answers were: (1) That appellee stated that no application of his for a life, health or accident policy had ever been declined,"nor had such a policy issued to him ever been cancelled or a renewal thereof refused; when in fact a policy issued to him had been cancelled. ' (2) That he had never received indemnity for any injury or illness except as stated,- which amount of indemnity stated was false. (3) That his habits were temperate, when in fact he was, and for many years had been, addicted to the excessive and intemperate use of alcoholic stimulants, and was often so greatly under the influence of such stimulants as' to be in a state of semi-unconsciousness. (4) That he had not received medical attention within the past five years, except for small local disorders — last serious illness being in childhood — when, in fact, at the time the application was made and for a long time prior thereto, plaintiff’s leg and knee, for which indemnity was [667]*667claimed, had been diseased and infirm, for which he had received medical and surgical attention.

All averments of the answer setting up the alleged facts relied on by appellant in avoidance of liability on the policy were specifically denied by the appellant’s reply ; which, in addition, alleged that the answers made by appellee to the questions asked in the application for the policy of insurance in question were all written by appellant’s agent, Banks, and from- his knowledge of the facts as well as that of appellee; and that none of the answers was false or made with the purpose of deceiving the appellant. The reply also set forth what was said and done both by appellee and Banks at the time the application was written, and, in substance, alleged that whatever errors of fact were contained in its statements were mere mistakes, in no sense material to the risk; that appellee’s answers to all questions asked in the application or policy were made upon Banks’ advice and written by him; that his knowledge of the facts stated in such answers, and as to their truth or falsity, was equal to appellee’s knowledge of them; and that such knowledge on the part of Banks as appellant’s agent constituted knowledge thereof on the part of appellant, which estops it to disavow the acts of Banks as its agent, and prevents it from escaping liability on the policy; which estoppel was formally pleaded in the reply and, together with all other affirmative matter of the reply, was controverted by the appellant’s rejoinder.

Kentucky statutes, section 629, declares:

“All statements or descriptions in any application for a policy of insurance shall be deemed and held representations, and not warranties, nor shall any misrepresentation, unless material or fraudulent, prevent a recovery on the policy.”

It will be found that the following definition of the word “representation” as used in the law- of insurance, does not differ materially from those given in the text books: A representation is an oral or written statement, which precedes the contract of .insurance and becomes a part thereof, if so stipulated, made by the assured or his authorized agent to the insurer or its authorized agent and relates'to facts necessary to enable the insurer to determine whether it will accept the risk and at- what premium. A representation is material when it communicates any fact important to the nature, of the risk, that [668]*668may be reasonably supposed to influence the judgment of the insurer in undertaking the risk or calculating the premium.

Of the many excellent definitions of a “misrepresentation” contained in the text books on the law of insurance, we regard the following the clearest in expression and meaning:

“A misrepresentation, according to the law of insurance, is the statement of something as a fact which is untrue, and which the assured states, knowing it to be untrue, and with intent to deceive, or which he states positively as true, not knowing it to be true, and which has a tendency to mislead; such fact being in every case material to the risk.” '

Cooley’s Briefs on Insurance, Yol. 2, 1158.

With the above definitions of the terms under consideration in mind and keeping in view the rule that the burden is on the appellant to establish the defense that certain answers contained in appellee’s application for the policy of insurance sued on were false and material, let us more particularly consider the character of those answers and the evidence regarding the making of the application.

Appellant’s contention that appellee falsely stated in the application that no application of his for a life, health or accident policy had ever been declined, nor that such a policy issued to him had ever been cancelled or a renewal refused, is unsupported by the evidence found in the record.

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Bluebook (online)
215 S.W. 821, 185 Ky. 664, 1919 Ky. LEXIS 356, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aetna-life-insurance-v-mccullagh-kyctapp-1919.