AMERICAN FAMILY L. ASSUR. CO. OF COLUMBUS v. Reeves

455 S.W.2d 932, 248 Ark. 1303, 1970 Ark. LEXIS 1365
CourtSupreme Court of Arkansas
DecidedJune 29, 1970
Docket5-5286
StatusPublished
Cited by11 cases

This text of 455 S.W.2d 932 (AMERICAN FAMILY L. ASSUR. CO. OF COLUMBUS v. Reeves) is published on Counsel Stack Legal Research, covering Supreme Court of Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
AMERICAN FAMILY L. ASSUR. CO. OF COLUMBUS v. Reeves, 455 S.W.2d 932, 248 Ark. 1303, 1970 Ark. LEXIS 1365 (Ark. 1970).

Opinions

Frank Holt, Justice.

This is a suit by appellee to recover benefits provided by a Franchise Group Cancer Policy issued by appellant.

On August 17, 1966, appellee signed an application for a policy of insurance covering both himself and his wife which provided benefits for hospital services and other expenses caused by cancer. Appellant issued this policy, dated September 1, 1966, to appellee for which the premium was paid. According to the terms of the policy, it was issued solely and entirely upon the written answers to the questions contained in the application. The questions, and portions thereof pertinent to the present suit, are as follows:

1. To the best of your knowledge, does any member of the family group to be insured now have or ever had cancer?
2. To the best of your knowledge, has any member of the family group to be insured ever had:
(a) lumps, growths, or swellings;
(b) sores that have not healed;
(c) coughed or vomited blood;
* * *
3. To the best of your knowledge, has any member of the family group to be insured, been under medical treatment during the past six (6) months?
4. If the answer to Question 1, 2 or 3 is “yes ”> use this space to indicate the name of the person treated, date treated,, name and address of the attending physician, cause for hospitalization or treatment.

Appellee answered questions 1, 2 and 3 in the negative, leaving question 4 blank.

Approximately ten months subsequent to the issuance of the policy, it was discovered that appellee’s wife, Mrs. Reeves, was suffering from what appeared to be cancer. Appellee filed a claim which was promptly denied by appellant. On June 26, 1968, appellee filed suit against appellant and prayed damages in the amount of $5,070.00, 12% penalty, reasonable attorney’s fee, and costs. Appellant answered with a general denial. Mrs. Reeves died from cancer on November 19, 1968, and thereafter appellee amended his complaint to allege damages of $7,020.00, 12% penalty, attorney’s fee, and costs. Appellant filed an answer to this amended complaint, asserting by way of affirmative defense that appellee had made misrepresentations in his application for the policy which were fraudulent and material to the risk and that if the true facts were known, the certificate of insurance would not have been issued to insure appellee’s wife. Also, it was pleaded in. the alternative that sufficient diagnosis was not furnished and, further, that the benefits claimed exceeded the benefits payable. The case was submitted to the court sitting as a jury; and the court granted judgment for appellee in the amount of $2,064.00, plus 12% penalty of $247.68, plus attorney’s fee of $500.00. From that judgment appellant brings this appeal.

We discuss in inverse order the first two points which appellant asserts for reversal, namely:

I
The court erred in excluding the testimony of Pekar [a soliciting agent] concerning the underwriting rules of appellant.
II
The uncontroverted evidence shows that there was a misrepresentation in the application which was material to the risk and that if the true facts had been made known, the policy would not have been issued and judgment should therefore have been for appellant.

A determination of these two points requires an examination of Ark. Stat. Ann. § 66-3208 (Repl. 1966). This statute provides:

(1) All statements in any application for a life or disability insurance policy or annuity contract, or in negotiations therefor, by or in behalf of the insured or annuitant, shall be deemed to be representations and not warranties. Misrepresentations, omissions, concealment of facts, and incorrect statements shall not prevent a recovery under the policy or contract unless either:
(a) Fraudulent; or
(b) Material either to the acceptance of the risk, or to the hazard assumed by the insurer; or
(c) The insurer in good faith would either not have issued the policy or contract, or would not have issued a policy or contract in as large an amount or at the same premium or rate, or would not have provided coverage with respect to the hazard resulting in the loss, if the true facts had been made known to the insurer as required either by the application for the policy or contract or otherwise.

Subsections (a), (b) and (c) constitute affirmative defenses which the insurer must plead and prove by a preponderance of the evidence if it is to prevail. Continental Cas. Co. v. Campbell, 242 Ark. 654, 414 S. W 2d 872 (1967).

Appellant contended at trial and argues here on appeal that there were two misrepresentations perpetuated by appellee in that he answered “no” to questions 1 and 2 in the application for insurance. To support its position, appellant introduced evidence tending to show that Mrs. Reeves had had her left eye removed because of a malignant tumor or growth some seven or eight years prior to the effective date of the policy. Appellee, however, testified that neither he nor his wife had ever been informed that the eye was removed as a result of a cancerous condition. In the application form provided by the appellant, the pertinent questions relative to the alleged misrepresentations are qualified by the prefacing words: “To the best of your knowledge * * *.” Ark. Stat. Ann. § 66-3208 provides that answers to the questions in an application are representations and not warranties; therefore, in view of the above quoted prefacing words to the questions in the application, a misrepresentation could occur only if the applicant answered those questions contrary to his knowledge of the true facts.

We have had previous occasion to state:

“The questions propounded in the application * * * call for answers founded on the knowledge or belief of the applicant, and in such cases a misrepresentation * * * will not avoid the policy unless willfully or knowingly made with an attempt to deceive.”

Metropolitan Life Ins. Co. v. Johnson, 105 Ark. 101, 150 S. W. 393 (1912). Although this case, since it was decided long before the enactment of § 66-3208, distinguishes the effect of representations from that of warranties, its rationale is, nonetheless, cogent to the case at bar where the application for insurance expressly required answers only to the best of the applicant’s knowledge. The trial court here, in granting judgment for appellee, necessarily found that the questions were not fraudulently answered; and certainly we cannot say, as a matter of law, that this finding was against the weight of the evidence. Aetna Life Ins. Co. v. Mahaffy, 215 Ark. 892, 224 S. W. 2d 21 (1949).

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AMERICAN FAMILY L. ASSUR. CO. OF COLUMBUS v. Reeves
455 S.W.2d 932 (Supreme Court of Arkansas, 1970)

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Bluebook (online)
455 S.W.2d 932, 248 Ark. 1303, 1970 Ark. LEXIS 1365, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-family-l-assur-co-of-columbus-v-reeves-ark-1970.