Anderson v. Metropolitan Life Insurance

69 Misc. 2d 205, 329 N.Y.S.2d 197, 1972 N.Y. Misc. LEXIS 2264
CourtCivil Court of the City of New York
DecidedJanuary 31, 1972
StatusPublished
Cited by4 cases

This text of 69 Misc. 2d 205 (Anderson v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering Civil Court of the City of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anderson v. Metropolitan Life Insurance, 69 Misc. 2d 205, 329 N.Y.S.2d 197, 1972 N.Y. Misc. LEXIS 2264 (N.Y. Super. Ct. 1972).

Opinion

Bentley Kassal, J.

This action is to recover life insurance proceeds on the life of plaintiff’s wife, who died two days after plaintiff had applied for insurance covering his wife, his daughter and himself. The basis of the claim is a “ Temporary [206]*206Insurance Agreement ”, embodied in the receipt given to plaintiff by defendant’s agent. Defendant denies liability, on the ground that the agreement never became effective because, contrary to the agreement, (1) the required one month’s premium had not been fully paid at the time of the application,

(2) the deceased had not undergone the medical examination required under company rules for her age and type of policy and

(3) neither of these conditions was or could have been modified or waived by the company’s agent, as expressly stated on the receipt and the application.

There is no claim by the defendant of any fraud or misrepresentation or of an improper signature on the deceased’s application.

The case was tried before a jury and, pursuant to CPLR 4111, I directed that the jury return a special verdict on stipulated questions, which the parties had mutually prepared for submission.

Briefly, the facts are these: At plaintiff’s request, an agent from defendant’s local office went to his home and, that evening, three insurance applications were signed. Regarding the wife’s policy, the subject of this action, plaintiff initially asked for coverage in the amount of $2,000 on a 20-year payment basis (which did not require a medical examination), but, relying upon the agent’s advice, he decided upon a $5,000 policy on a whole life basis (which did require a medical examination). All three applications were filled out by the agent from information supplied by plaintiff and his daughter. Plaintiff and his daughter testified that the deceased was upstairs and signed her own application, but the jury found otherwise.

The agent testified that he requested full quarterly premiums “ somewhere around $99 ” for all three policies, but after a brief discussion of plaintiff’s financial position, the agent asked, “ Would $30 be all right? ” and continued, Fine, I’ll put $10 on each application. ’ ’ When asked, ‘ ‘ Did you tell him at any time you wanted more than $30? ” the agent answered, “No.”

The agent testified he then stated that a medical examination was required for the wife, by the rules in the company’s life and annuity rate book, his ‘ ‘ bible ’ ’, because of the $5,000 amount at her age of 48 years. This was denied by plaintiff and his daughter, who claimed the agent said no medical examination was required for any of them. The jury made a finding of fact that the agent had not “told Mr. Anderson that there [207]*207would be no life insurance coverage on Agnes Anderson’s life until she had a medical examination. ”

The jury found that three receipts were issued to plaintiff, except that no figure was inserted next to the words “ Amount Received Dollars Although the plaintiff did not retain the receipt forms, he did acknowledge he had received some papers but did not know if they were receipts.

The crux of the case is the effectiveness of this one-page printed form, consisting of the receipt and temporary insurance agreement. Apparently, the language of this type of instrument has not been interpreted by the courts, although differently worded conditional binders have been the subject of litigation in this and other jurisdictions. (See Allen v. Metropolitan Life Ins. Co., 44 N. J. 294.)

The top part of defendant’s form is entitled “Receipt” and in bold type reads: “ Important. This receipt does not provide any coverage unless the required payment is made. Moreover, if a physical examination is required, no coverage (except against accidental death) is provided until such examination has been completed.”

The middle part of the form, enclosed in a box, is entitled “Temporary Insurance Agreement ”. It provides for immediate insurance coverage under certain conditions, one of which reads as follows: “A. Death Benefit. If the amount received is at least equal to one monthly premium on the policy applied for and * * # the company will pay a Temporary Insurance benefit ”.

The next section (B) of the temporary insurance agreement defines the term of the temporary insurance as beginning “ on the date of this Receipt except that, if a medical examination of the Proposed Insured is required by the Company rules, it will begin upon the completion of such examination.”

The last part of the agreement provides: “ C. Agent’s Authority. No agent or other Company representative is authorized to make any statement changing the terms and conditions of this Agreement and of this Receipt, and any such statement will not bind the Company.”

At the very bottom of this form, separated from the above, is the following clause: “ If the amount received is less than one monthly premium on the policy applied for, the Temporary Insurance Agreement above will not apply, and no coverage of any.type or kind will be provided under this Receipt.”

With the exception of item C, none of these terms are contained in the application itself, which incidentally is the only document [208]*208that the applicant signs or might examine before he pays the first premium.

I. SUFFICIENCY- OF PAYMENT

An analysis of the receipt/agreement discloses some critical features which call for careful scrutiny. Although the receipt states in general terms that there is no coverage unless the required payment is made, there is nothing in the receipt which states the actual amount in dollars and cents. The agreement portion contains a similar stipulation and it, too, is silent as to the specific amount. Moreover, this receipt (signed only by the agent) was not delivered to plaintiff until after the transaction had been completed.

In fact, the total monthly premium for the package of three policies was $33.14, and $30 was paid to and accepted by the agent, without qualification, further demand, or disclaimer of coverage. Undoubtedly, if plaintiff had had knowledge from the receipt or the agent of noncoverage as a consequence of his failure to pay the full sum, he would have paid the three additional dollars. The responsibility for advising him of the amount of the monthly premium and of the necessity for payment as a condition of coverage properly remains with the insurance company.

Therefore, defendant is estopped from asserting this defense, since it accepted payment and failed to fulfill its duty to warn plaintiff of the results of his act.

II. REQUIREMENT OF A MEDICAL EXAMINATION

As stated, the jury made the specific finding that the agent had not informed plaintiff that a physical examination of his wife was required, and the receipt itself contains no indication as to whether an examination is necessary for the particular applicant (see par. B of agreement). Of the three applications made, apparently the only policy requiring a medical was the wife’s.

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Bluebook (online)
69 Misc. 2d 205, 329 N.Y.S.2d 197, 1972 N.Y. Misc. LEXIS 2264, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anderson-v-metropolitan-life-insurance-nycivct-1972.