Claborn v. Washington National Insurance Co.

1996 OK 8, 910 P.2d 1046, 67 O.B.A.J. 392, 1996 Okla. LEXIS 6, 1996 WL 21388
CourtSupreme Court of Oklahoma
DecidedJanuary 23, 1996
Docket78682
StatusPublished
Cited by25 cases

This text of 1996 OK 8 (Claborn v. Washington National Insurance Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Claborn v. Washington National Insurance Co., 1996 OK 8, 910 P.2d 1046, 67 O.B.A.J. 392, 1996 Okla. LEXIS 6, 1996 WL 21388 (Okla. 1996).

Opinions

HARGRAVE, Justice.

Certiorari to Court of Appeals, Oklahoma Division IV, to review an unpublished order of the Court of Appeals. The issues addressed in the present matter is whether: (1) Claborn’s evidence sufficiently supports a claim of breach of contract, in the face of Washington National’s defense of misrepresentation; and (2) The trial court erred as a matter of law in submitting the bad faith claim to the jury.

SUMMARY OF FACTS AND PROCEDURAL HISTORY

This matter arises out fi*om a health insurance application with Washington National completed by Mr. Claborn on September 12, 1988. This new policy was to replace Mr. Claborn’s then current policy with State Farm Insurance Company. When asked by the agent whether in the preceding five years he had been admitted to the hospital or treated for alcoholism, Claborn testified at deposition that when he was making the application he told the agent “not any more.” When contacted by a representative of the insurance company by phone, calling to confirm the answers on the application, Claborn answered “no” to both questions. These statements were not true as, in the five years preceding the application, Claborn had been admitted twice to the hospital for a seizure disorder related to alcoholism, and had three times been treated for alcoholism. The insurance policy Mr. Claborn held with State Farm contained a rider excluding coverage for seizure disorders. Nevertheless, Cla-bom’s negative answers to the medical questions on his application resulted in the issuance of a health insurance policy which was effective October 1,1988.

In January of 1989, Claborn learned that he had oral cancer. With the advice and assistance of his brother-in-law, an experienced insurance agent, Claborn informed Washington National about the misrepresentations on his policy application. This letter was dated January 27, 1989. Washington National’s underwriting rules called for the automatic rejection of an applicant who had been treated for alcoholism within the five-year interval preceding the application, and consequently, Claborn was informed at the end of March of 1989 that his policy was rescinded as a result of his misrepresentations, and premium refunded. Claborn then brought this action to recover actual and punitive damages in tort, based on insurer’s bad faith in rescinding his policy. At trial, the jury returned a verdict for Claborn for $127,000.00 in actual damages and $110,-000.00 in punitive damages.

On appeal to the Court of Appeals, the court reasoned that there was evidence in the record from which the jury could have found for Claborn on the contract claim. The court opined that the Washington National agent could have examined the existing State Farm policy which contained the seizure rider, thus Washington National would have been alerted to Clabom’s problem with alcoholism. The Court of Appeals held that Washington National’s reliance on Claborn’s misrepresentations was not reasonable because of its failure to investigate, thus Washington National did not use reasonable diligence in discovering the alcoholism.

The Court of Appeals also concluded that the imposition of tort liability was inappropriate and the issue of bad faith should not have been submitted to the jury. The Court of Appeals determined that a bad faith claim could not lie as there was a legitimate dispute, and that an insurer clearly had the right to resist payment and litigate any claim to which there is a reasonable defense, since, under Oklahoma law, an insurer has the right to seek rescission of a health insurance policy procured under an application containing a single misrepresentation. The court held that actual damages were proven under the contract action were $77,000.00 concluding that the remaining $50,000.00 of actual damages and the $110,000.00 had to have a basis in the tort claim.

[1049]*1049FALSE INFORMATION PROVIDED BY APPLICANT FOR HEALTH INSURANCE POLICY, WHICH CONCEALED HIS HISTORY OF ALCOHOL-RELATED SEIZURES AND TREATMENT FOR ALCOHOLISM, AMOUNTED TO MISREPRESENTATION AND ENTITLED THE INSURER TO A RESCISSION OF THE POLICY.

Uncontroverted evidence was presented at trial that the decedent, Clabom, made misrepresentations both at the time of the application and when reached by telephone by the insurance company to confirm the answers. These misrepresentations regarded his problems with alcohol. Uneontroverted evidence was also presented that had the insurance company known of these problems, no policy would have been issued to the decedent. Therefore, the trial court erred in not granting the Washington National’s motion for directed verdict made at the close of the evidence.

36 O.S.1991, § 3609, grants insurer a right to rescind a policy if there are misrepresentations contained in the application and the misrepresentations are material to the risk assumed by the insurer under the policy. This provision applies if the insurer would not have issued the policy had it been aware of the actual fact misrepresented.1 Thus, in order for an insurer to escape liability under this section for misrepresentation in the application process, the insurer bears the burden of proof to show not only that the statements were untrue, but also that the misrepresentations were either fraudulent, material to the risks or hazards assumed by the insurer, and, in good faith, the insurer would not have issued the policy, or covered the hazard if the true facts had been known in the application. Failure to disclose a latent condition of which the person making application has no knowledge or reason to know does not constitute a defense to an action on the policy. Mass. Mut. Life Ins. Co. v. Allen, 416 P.2d 935 (Okl.1965); Farmers and Banker’s Life Ins. Co. v. Lemon, 204 Okl. 218, 228 P.2d 634 (1951).

Where the evidence is conflicting as to either insured’s state of health at the time of application, or the falsity of insured’s statements in the application process, or the intent of the insured, the issues are properly tendered to the jury for resolution. Brunson v. Mid-Western Life Ins. Co., 547 P.2d 970 (Okl.1976); Atlas Life Ins. Co. v. Eastman, 320 P.2d 397 (Okl.1957). On review, if we find evidence in the record reasonably supporting the jury verdict on such questions, we are bound to affirm. Atlas Life Ins. Co. v. Eastman, 320 P.2d 397 (Okl.1957). We do not find such evidence in the record in this matter. There was evidence presented at trial showing that the misrepresentations made by Claborn were indeed a known falsity to Clabom, and that had Washington National known of these misrepresentations, the insurance company would not have issued the policy to Clabom. Therefore, we must reverse.

In Massachusetts Mutual Life Insurance Co. v. Allen, 416 P.2d 935, 940 (Okl.1966), this Court when faced with a similar question dealing with 36 O.S.1961, § 3609, relied upon the following sections of 29 Am. Jur., Insurance:

Sec. 698. * * * “A ‘misrepresentation’ in insurance is a statement as a fact of something which is untrue, and which the insured states with the knowledge that it is untrue and with an intent to deceive, or which he states positively as trae without [1050]*1050knowing it to be true, and which had a tendency to mislead, where such fact in either case is material to the risk.”
Sec. 701.

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Cite This Page — Counsel Stack

Bluebook (online)
1996 OK 8, 910 P.2d 1046, 67 O.B.A.J. 392, 1996 Okla. LEXIS 6, 1996 WL 21388, Counsel Stack Legal Research, https://law.counselstack.com/opinion/claborn-v-washington-national-insurance-co-okla-1996.