Central National Life Insurance Co. v. Peterson

529 P.2d 1213, 23 Ariz. App. 4, 1975 Ariz. App. LEXIS 457
CourtCourt of Appeals of Arizona
DecidedJanuary 7, 1975
Docket2 CA-CIV 1619
StatusPublished
Cited by20 cases

This text of 529 P.2d 1213 (Central National Life Insurance Co. v. Peterson) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Central National Life Insurance Co. v. Peterson, 529 P.2d 1213, 23 Ariz. App. 4, 1975 Ariz. App. LEXIS 457 (Ark. Ct. App. 1975).

Opinion

OPINION

HOWARD, Chief Judge.

This case involves an application for accident and health insurance which admittedly contained incorrect answers.

*6 The case was tried to a jury which returned a verdict in appellee’s favor in the sum of $9,776.25.

Appellant claims the court erred by not directing a verdict in its favor; in giving plaintiff’s instruction No. 10; and granting a judgment to the appellee based upon a finding that a heart attack constitutes an accidental bodily injury.

It is undisputed that when appellee applied for the insurance policy in question he signed an application representing, inter alia, that he had never been diagnosed as having any disease or disorder of the heart, blood or blood vessels, and that he had never had any disease or disorder of the muscles, bones, joints, limbs or back. The evidence at trial was conflicting as to what, if any, representations were made by Mr. Cohen, agent of appellant, to the appellee concerning the purpose and effect of the application. The undisputed evidence does show, however, that appellee had .been hospitalized in 1963 for a back condition and also that hospital records showed a prior diagnosis of a heart condition although the medical evidence adduced by appellee at trial established that the physical findings disclosed by these records did not justify a heart condition diagnosis.

Appellee was employed by a company which had contracted with the Arizona Public Service to overhaul its electric turbines and generators. The day of the heart attack, he was assisting in the disassembly of a steam turbine. The deck from which he was working was approximately five stories high or about fifty feet from ground level. Appellee was using a twenty pound hammer to break loose bolts weighing approximately 100-150 pounds each. These bolts, plus various other parts, some weighing 150 to 400 pounds, then had to be lifted out of the turbine, lowered to ground level, and then placed on wooden blocks and covered. Appellee or a co-employee had to descent to ground level each time and unload the part that was to be stored. On the day of the attack and up until the time of the attack, which was about noon, appellee had made some fifteen trips up and down the five-story height, climbing or descending by ladder.

As appellee was lifting a baffle from one of the bearings, he suddenly got weak and had a sharp pain in his chest that felt as though someone had stuck a hot wire down the center of his chest and both arms ached and went limp. This was his last recollection until approximately ten days later.

The evidence is undisputed that appellee had a myocardial infarction which left him totally and permanently disabled.

Appellee made a claim for benefits under the policy in question but was turned down by appellant which contended that his application for insurance misrepresented his prior medical history by failing to disclose his hospitalization at the Veteran’s Hospital in Tucson in 1963 for a back strain or sprain, the hospital records for which included a third diagnosis of some sort of untreated heart problem.

This suit followed appellant’s refusal to pay benefits under the policy.

FAILURE TO GRANT A DIRECTED VERDICT

It is appellant’s position that since appellee was guilty of at least legal fraud and such fraud was material to the acceptance of the risk, the court should have directed a verdict in its favor. We do not agree.

There was a dispute in the facts regarding what the insurance agent told appellee. Appellee claims he told Mr. Cohen that he had been hospitalized at the VA Hospital in 1963 and that Cohen then told him it was not necessary to go back any further than five years in answering the questions on the application for insurance. On the witness stand Cohen denied having made this statement.

Accepting appellee’s version of the facts for the purposes of a directed verdict, the weight of authority supports the rule that the insurer is bound by an incor *7 rect answer entered in the application by or at the direction of its agent, pursuant to such agent’s suggestion or advice, or his interpretation of the question following the disclosure of the true facts by the applicant who acts in good faith. See, Annot. 26 A.L.R.3d 6, 96-103 (1969). We agree with this rule.

ERROR IN GIVING INSTRUCTION NO. 10

Over appellant’s objection, the trial court instructed the jury that it was “to disregard any testimony . . . regarding [appellee’s] back condition” since this testimony had “no bearing on [appellee’s] right to recover for his heart condition.”

Can a misrepresentation as to a back condition be material to a claim for a heart condition? We believe the answer to be in the affirmative if the revelation of the back condition would have disclosed information concerning the heart condition.

A.R.S. § 20-1109 provides as follows:

“All statements and descriptions in any application for an insurance policy or in negotiations therefor, by or in behalf of the insured, 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 unless:
1. Fraudulent.
2. Material either to the acceptance of the risk, or to the hazard assumed by the insurer.
3. The insurer in good faith would either not have issued the policy, or would not have issued a policy in as large an amount, 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 otherwise.”

The test of materiality is whether the facts, if truly stated, might have influenced a reasonable insurer in deciding whether to accept or reject the risk. First National Benefit Soc. v. Fiske, 55 Ariz. 290, 101 P.2d 205 (1940). Appellee’s instruction is premised upon A.R.S. § 20-1109(3) which was added to the statute after the decision in First National Benefit Soc. v. Fiske, supra, and appears to be a statutory overruling of that case. It held that it was not necessary for an insurer to prove it would have rejected the application if it had been given knowledge of the facts. See, Continental Casualty Co. v. Mulligan, 10 Ariz.App. 491, 460 P.2d 27 (1969). In 1950 the Fiske case was construed as meaning it was not necessary that there be any causal connection between the cause of death and the misrepresentation. See, Mutual Life Ins. Co. v. Morairty, 178 F.2d 470 (9th Cir. 1949), cert. denied 339 U.S. 937, 70 S.Ct. 673, 94 L.Ed. 1355 (1950).

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

Related

Medical Protective Co. v. Pang
606 F. Supp. 2d 1049 (D. Arizona, 2008)
Mann v. New York Life Insurance
83 F. App'x 877 (Ninth Circuit, 2003)
Valley Farms, Ltd. v. Transcontinental Insurance
78 P.3d 1070 (Court of Appeals of Arizona, 2003)
Mann v. New York Life Insurance & Annuity Corp.
222 F. Supp. 2d 1151 (D. Arizona, 2002)
York Mutual Insurance v. Bowman
2000 ME 27 (Supreme Judicial Court of Maine, 2000)
State v. Arbuckle
941 P.2d 181 (Alaska Supreme Court, 1997)
Centrust Mortgage Corp. v. PMI Mortgage Insurance
800 P.2d 37 (Court of Appeals of Arizona, 1990)
Massachusetts Mut. v. Manzo
560 A.2d 1215 (New Jersey Superior Court App Division, 1989)
Hardy v. Prudential Insurance Co. of America
763 P.2d 761 (Utah Supreme Court, 1988)
State Compensation Fund v. Mar Pac Helicopter Corp.
752 P.2d 1 (Court of Appeals of Arizona, 1987)
Security Insurance Co. of Hartford v. Andersen
763 P.2d 251 (Court of Appeals of Arizona, 1986)
Equitable Life Assurance Society of United States v. Anderson
727 P.2d 1066 (Court of Appeals of Arizona, 1986)
Wickersham v. John Hancock Mutual Life Insurance
413 Mich. 57 (Michigan Supreme Court, 1982)
In Re Certified Question
318 N.W.2d 456 (Michigan Supreme Court, 1982)
Howard v. Aid Ass'n for Lutherans
272 N.W.2d 910 (Supreme Court of Minnesota, 1978)
Keplinger v. Mid-Century Insurance
565 P.2d 893 (Court of Appeals of Arizona, 1977)

Cite This Page — Counsel Stack

Bluebook (online)
529 P.2d 1213, 23 Ariz. App. 4, 1975 Ariz. App. LEXIS 457, Counsel Stack Legal Research, https://law.counselstack.com/opinion/central-national-life-insurance-co-v-peterson-arizctapp-1975.