Brinkoetter v. Pyramid Life Insurance Co.

377 S.W.2d 560, 1964 Mo. App. LEXIS 691
CourtMissouri Court of Appeals
DecidedApril 6, 1964
Docket23999
StatusPublished
Cited by10 cases

This text of 377 S.W.2d 560 (Brinkoetter v. Pyramid Life Insurance Co.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Brinkoetter v. Pyramid Life Insurance Co., 377 S.W.2d 560, 1964 Mo. App. LEXIS 691 (Mo. Ct. App. 1964).

Opinion

HUNTER, Judge.

This is a suit brought in the Circuit Court of Jackson County by Pearl Brinkoetter, plaintiff-appellant, against Pyramid Life Insurance Company, defendant-respondent, for certain hospital and medical expenses claimed to be covered by a “Health and Accident” insurance policy. Plaintiff obtained a jury verdict and judgment in the sum of *562 $560.00. The trial court set this judgment aside and entered judgment for defendant. F'laintiff has appealed.

The decisive question before us is whether the trial court erred in holding that plaintiff had not made a submissible jury case and in entering judgment for defendant. It is our general duty to review the pertinent evidence in the light most favorable to plaintiff and to give her the benefit of every inference reasonably deductible therefrom. Plaintiff is, of course, bound by her own testimony. Tomlin v. Alford, Mo.Sup., 351 S.W.2d 705(3).

Plaintiff previously had a “Health and Accident” insurance policy with the defendant which she had allowed to lapse. Shortly after this policy had lapsed plaintiff became ill and was hospitalized on July 10, 1960 for approximately ten days. We quote her testimony concerning her hospitalization: ' * * they took x-rays, they told me I had ulcers * * * gave me medication and some more, a series of x-rays.” She was then released thinking she was all right, but did go back a month later for more tests which she stated reassured her she was all right.

On October 7, 1960, after an agent of defendant had solicited her, she made an application for a new policy with defendant. The application form for the policy contained, among others, these questions and her answers: “6. Are you * * * now in good health and free from any physical or mental defect? Yes. 8. Have you * * * ever had any disease of the heart, lungs, kidneys, stomach, or bladder * * * ? No. 9. Have you, or any member of the Family Group to be insured, received medical or surgical advice or treatment within the past three years? Yes. If answer is ‘yes’, give details below: * * * Check files on H-14 lapse & # FR-158580. In 100% good health. * * * Do you represent these answers to be true and complete to. the best of your knowledge and belief? Yes.” After talking with plaintiff, the insurance agent had filled in these answers based on what she told him. The portion, “Check files on H-14 lapse & * FR-158580” was later added to the application by defendant’s agent. Nothing in that file in any way referred to ulcers or to any stomach illness or disease.

Plaintiff’s version of the occurrence is: “Q. Well, did you read the application before you signed it? A. Yes, I believe I did. Q. All right. And you knew the answers that were made, isn’t that correct? A. That is right. * * * Q. (Reading): ‘Have you or any member of your family group to be insure4 ever had any disease of the heart, lungs, kidneys, stomach, or bladder * * * ?’ Did you answer that question‘No.’? * * * I told him I never had no disease, of any kind, and none of the family didn’t. Q. You told him that you had never had any disease of the stomach, is that correct? A. That is right, I didn’t have no disease of the stomach”.

Plaintiff explained by saying that although her ulcers were located in her stomach she did not understand that having ulcers was a disease. “Well, sir, what I call a disease, is cancer or something like that. Q. I see. A. And that is what he asked me, and I said I had no disease. * * * Q. You never told this agent that you had been in the hospital just back in the previous July, for ulcers, had you? * * * A. I didn’t tell him because he didn’t ask me.” Thereafter, on October 7, 1960, the policy which is the subject of this suit was issued to plaintiff.

Plaintiff acknowledged that between July of 1960 and January of 1961 she had “a slight pain in the stomach” and was taking x-rays to see if she had a recurrence. In January, 1961, she reentered the hospital for a stomach operation for stomach ulcers that she had, and approximately two-thirds of her stomach was removed for that cause. Her resultant hospital and medical expenses totaled at least $560.00.

Defendant refused to pay her hospital and medical bill on the ground the men *563 tioned answers in the application for insurance were deliberately a false misrepresentation of a material matter upon which defendant had relied in issuing its policy.

In accordance with the view we have taken of the case it is unnecessary to state defendant’s evidence which, in the main, was to the same general effect as that given above by plaintiff. Defendant did adduce evidence that it relied on plaintiff’s quoted answers to its detriment, and would not have issued the policy without an exception of this disease if plaintiff had given true answers to the questions.

The health of an applicant for insurance upon his health is of vital importance to the insurer, and questions to elicit pertinent information on the subject in regard to what disease the applicant has or has had are proper to be asked and should be truthfully answered. Good faith on the part of both the insurer and the applicant is called for.

The pertinent general rule is that an intentional material misrepresentation made by an applicant for insurance for the purpose of obtaining the insurance in reliance upon which a policy is issued to him, renders the policy voidable. Dixon v. Business Men’s Assurance Co. of America, 365 Mo. 580, 285 S.W.2d 619, 625; Haman v. Pyramid Life Insurance Co., Mo.App., 347 S.W.2d 449, 454 ; 45 C.J.S. Insurance § 595 d(2), page 401. In accordance with the general rule an intentional or willful misrepresentation as to the existence of disease which is material to the risk will defeat recovery on the policy. 45 C.J.S. Insurance §§ 602, 663, pages 422, 585; Annotation, 96 A.L.R. 430.

In line with the general rule, a misrepresentation is deemed material where it is reasonably calculated to affect the action and conduct of the company in deciding whether or not to accept the risk by issuing its policy covering the risk. Trivial and temporary indispositions which do not af■fect the general health are ordinarily deemed not material.

In the instant case plaintiff has candidly admitted that she told the insurance agent she had never had any disease of the stomach, whereas in truth and fact less than three months earlier she had been hospitalized ten days for ulcer of the stomach, which diagnosis she fully knew, and, further, for which condition she continued to experience some pain and continued to have examinations.

Plaintiff attempts to justify answering “no” to the question whether she had ever had any disease of the stomach by saying she did not understand that having ulcers of the stomach is a disease of the stomach. Her attempted justification is wholly unreasonable and unacceptable.

We are of the view that the average person giving to the word “disease” its generally understood and ordinary meaning, upon reading it in an accident and health policy application, such as here, would understand it to include an ulcer located in the stomach.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Continental Casualty Co. v. Maxwell
799 S.W.2d 882 (Missouri Court of Appeals, 1990)
Fenwick v. Oklahoma State Penitentiary
1990 OK 47 (Supreme Court of Oklahoma, 1990)
MacAlco, Inc. v. Gulf Insurance Co.
550 S.W.2d 883 (Missouri Court of Appeals, 1977)
Wardle v. International Health & Life Insurance
551 P.2d 623 (Idaho Supreme Court, 1976)
Modisette v. Foundation Reserve Insurance Co.
427 P.2d 21 (New Mexico Supreme Court, 1967)
Irelan v. Standard Mutual Association of Cassville
379 S.W.2d 815 (Missouri Court of Appeals, 1964)

Cite This Page — Counsel Stack

Bluebook (online)
377 S.W.2d 560, 1964 Mo. App. LEXIS 691, Counsel Stack Legal Research, https://law.counselstack.com/opinion/brinkoetter-v-pyramid-life-insurance-co-moctapp-1964.