Case v. RGA Insurance Services

521 S.E.2d 32, 239 Ga. App. 1, 99 Fulton County D. Rep. 2807, 1999 Ga. App. LEXIS 1288
CourtCourt of Appeals of Georgia
DecidedJuly 8, 1999
DocketA99A0262
StatusPublished
Cited by9 cases

This text of 521 S.E.2d 32 (Case v. RGA Insurance Services) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Case v. RGA Insurance Services, 521 S.E.2d 32, 239 Ga. App. 1, 99 Fulton County D. Rep. 2807, 1999 Ga. App. LEXIS 1288 (Ga. Ct. App. 1999).

Opinions

McMurray, Presiding Judge.

Patricia Case gave JOA Marine (“JOA”) $500 toward the purchase of a ski boat during a January 1996 boat show in Atlanta, Georgia. When she went to JO As place of business to complete the transaction on January 17, 1997, a JOA employee persuaded her at closing to pay Hanover Insurance Company (“Hanover”) a $412 premium in exchange for insurance coverage for her new boat. Ms. Case signed a blank insurance application and a “bunch of” other papers at the closing and, later that day, orally completed this insurance application during a telephone interview with an employee of RGA Reinsurance Company (“RGA”) — apparently an independent insurance agency. Ms. Case later received a Hanover insurance policy covering her boat, but she did not receive a copy of her insurance application.

Ms. Case’s boat sank on Lake Lanier shortly after its maiden voyage. Upon investigating this loss, Hanover discovered that Ms. Case’s adult daughter, Andrea Case, was residing with her mother when Ms. Case applied for coverage and that Andrea Case had been involved in an automobile collision and had received several traffic citations within five years before Ms. Case applied for insurance. Hanover denied Ms. Case’s property damage claim based on these findings, alleging that she duped Hanover into insuring her boat by checking the “no” box next to the following question on her insurance application — “Has any member of the household had a motor vehicle [2]*2or boating accident or loss or been convicted of a moving violation within the past 5 years?”

Ms. Case brought an action against Hanover to recover under her policy and sued RGA for negligent submission of her insurance application, alleging that RGA’s agent, Vicki Arnold, failed to record Ms. Case’s disclosure that Andrea Case would likely be operating her boat. This appeal followed the trial court’s order granting RGA’s and Hanover’s respective motions for summary judgment. Held:

1. Ms. Case contends that genuine issues of material fact remain as to the materiality of the inaccurate negative response on her insurance application. An incorrect statement in an insurance application will not prevent recovery under the policy unless the insurer, with knowledge of the true facts, would not in good faith have issued the policy, not have issued a policy in as large an amount or at the given rate, or would not have provided coverage with respect to the hazard resulting in the loss. Pa. Life Ins. Co. v. Tanner, 163 Ga. App. 330, 333-334 (293 SE2d 520). The only evidence in this regard, in the case sub judice, is Hanover’s expert underwriter’s affidavit that the company would not have issued Ms. Case an insurance policy “[h]ad Hanover been aware of the previous moving violations and automobile accident of Andrea Joyce Case. . . .” The problem with this statement is that such “opinion testimony is always a question of acceptance or nonacceptance on the part of the jury.” Pa. Life, 163 Ga. App. 330, 334, supra. We take issue with the dissent’s statement that we ignore “a long line of cases” (five panel decisions of the Court of Appeals of Georgia). The “opinion testimony” rule upon which we rely is not only based on this Court’s factually indistinguishable decision in Pa. Life, but is grounded upon venerable Supreme Court of Georgia authority providing that “summary judgment can never issue based upon opinion evidence alone.” Ginn v. Morgan, 225 Ga. 192 (2) (167 SE2d 393). In our view the dissent, without explanation, would ignore this rule and adopt a holding which provides that summary judgment must go to the insurer if the insurer’s employee provides his employer with a favorable opinion in the requisite affidavit.

The test for materiality of a representation in an insurance application should not be based upon such procedural gaming, but must be grounded upon a weighing of whether the representation varied from the truth so as to substantially change the nature, extent, or character of the risk. Preston v. Nat. Life &c. Ins. Co., 196 Ga. 217, 228-236 (26 SE2d 439). Although such factual scrutiny was avoided in Sanders v. Southern Farm &c. Ins. Co., 174 Ga. App. 888 (332 SE2d 33), when this Court disregarded the “opinion evidence” rule and mistakenly elevated the insurer’s employee’s prediction (as to what would have happened regarding coverage) into something other than opinion evidence, we have no power in the case sub judice to [3]*3undo any resulting harm because, unlike Sanders and other decisions which may ignore the “opinion evidence” rule, there is proof in the case sub judice that Hanover placed no reliance on Ms. Case’s insurance application. To this extent, it is undisputed that Hanover agreed to cover Ms. Case even though several questions in the insurance application, which were relevant to the risk of coverage, were left blank and a response in the insurance application indicated that Ms. Case’s boat would be used for an unusually high risk activity. Specifically, the policy application’s “UNDERWRITING INFORMATION” section indicates that Ms. Case’s ski boat would be used for “racing” and the application’s “SUPPLEMENTAL QUESTIONNAIRE” section was left completely blank. This section’s inquiry concerns additional boat owners, the existence of a survey or statement as to the boat’s condition, any prior damage, needed repairs or deterioration, the boat’s last inspection date, the existence of kitchen or bathroom facilities on the craft, and the conditions under which the boat would be stored.

This Court affirmed a jury’s verdict for the insured in Pa. Life, 163 Ga. App. 330, 334, supra, holding that similar policy application omissions authorized the jury’s finding that any policy application misrepresentation was not material to the insurer’s acceptance of the risk under the policy. For the same reasons, we find genuine issues of material fact as to whether Hanover actually relied on Ms. Case’s insurance application before issuing her an insurance policy. The trial court therefore erred in granting Hanover’s motion for summary judgment. If the movant for summary judgment fails to show an entitlement to a judgment as a matter of law, with the evidence viewed in favor of the non-moving party, a prima facie case has not been shown. Dental One Assoc. v. JKR Realty Assoc., 269 Ga. 616, 617 (1) (501 SE2d 497).

2. Citing Jackson Nat. Life Ins. Co. v. Snead, 231 Ga. App. 406 (499 SE2d 173), cert, denied at 231 Ga. App. 908, Ms. Case contends that Hanover’s insurance application’s “yes” or “no” question regarding the boating and driving history of members “of the household” would authorize a jury’s finding that the negative response in her application did not constitute a misrepresentation.1

[4]*4In Jackson Nat. Life, supra, this Court adopted the general rule that answers to questions on insurance applications that are ambiguous and call for “yes” or “no” answers cannot be false as a matter of law. Id. at 410, 411 (4), supra. This holding is based on a deceased insured’s negative responses to a life insurance application’s questions regarding her status as a smoker.

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Case v. RGA Insurance Services
521 S.E.2d 32 (Court of Appeals of Georgia, 1999)

Cite This Page — Counsel Stack

Bluebook (online)
521 S.E.2d 32, 239 Ga. App. 1, 99 Fulton County D. Rep. 2807, 1999 Ga. App. LEXIS 1288, Counsel Stack Legal Research, https://law.counselstack.com/opinion/case-v-rga-insurance-services-gactapp-1999.