Columbia Universal Life Insurance Co. v. Miles

923 S.W.2d 803, 1996 WL 263426
CourtCourt of Appeals of Texas
DecidedJune 20, 1996
Docket08-94-00060-CV
StatusPublished
Cited by11 cases

This text of 923 S.W.2d 803 (Columbia Universal Life Insurance Co. v. Miles) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Columbia Universal Life Insurance Co. v. Miles, 923 S.W.2d 803, 1996 WL 263426 (Tex. Ct. App. 1996).

Opinion

OPINION

McCLURE, Justice.

This appeal challenges the sufficiency of the evidence to support a jury finding that Appellant, Columbia Universal Life Ins. Co. (“Columbia”), canceled in bad faith the comprehensive health insurance policy issued to Appellee, Carl David Miles (“Miles”). We reverse and render judgment that Miles take nothing.

SUMMARY OF THE EVIDENCE

On November 23, 1987, Miles and his mother, Wanda Miles, met with Karen Poy-nor (“Poynor”) to discuss a change in the health insurance coverage for Miles and his family. The Mileses claim that they wished to. change coverage because they were dissatisfied with the handling of certain claims by their existing carrier. After considering several companies, the Mileses settled on Columbia. Poynor filled out the application by asking the Mileses the questions listed on the application form and by filling in the answers given by them. Considerable dispute exists as to what transpired during this process. Both Miles and his mother testified that the application process took over two hours, and that the health histories of Miles, his wife, Toni, and their daughter, Kira, were copiously related to Poynor. Specifically, they asserted that certain conditions from which Miles suffered were extensively explained to Poynor, and that they suggested that Poynor have Columbia contact Dr. John Bray for a more extensive explanation of the conditions. However, these conditions were not listed in the application as relevant medical history, and Columbia was not made aware of them by either Poynor or Miles. Miles stated that he signed the application without reading it, while Poynor testified that she listed the *805 medical histories precisely as they were related to her. She denied ever being made aware that Miles suffered from any chronic condition.

Nine days after the application was completed, Columbia called Miles to conduct a personal history interview and to confirm the information in the application. During this interview, Columbia discovered that Kira had been treated for an ear infection. Beyond this fact, Miles represented to Columbia that the medical information in the application was complete and accurate. He did not mention at this time anything about his chronic conditions. The policy was issued on December 1, 1987. On January 22, 1988, Poynor delivered an amendment containing a rider excluding conditions related to Kira’s ears. This amendment also required the insured to warrant that “since the date of the application no person to be insured under this policy has ... received treatment from or consulted any physician for any health condition not revealed in the application....” Miles claimed that he also signed this form without reading it. He did not inform Columbia that he had visited Dr. Bray for a sinus condition two days after the application was signed. Because he was under the impression that Columbia had contacted Dr. Bray and obtained his medical records, he did not feel obligated to discuss this condition over the telephone.

It is undisputed that Columbia did not know about Miles’ entire medical history as required by the application, and that it issued a comprehensive health policy covering Miles and his family based solely on the information contained in the application and elicited through the personal history interview. Throughout his life, Miles has amassed an extensive medical history. At two years of age, he contracted what appeared to be polio after receiving the polio vaccine. As a result, blood tests were performed and it was discovered that he suffered from IGA immune deficiency (“IGA”). In 1967 or 1968, he was diagnosed with agammaglobulinemia. These conditions prevented his immune system from creating specific antibodies to ward off infections, and he suffered from chronic sinusitis. The conditions also made Miles susceptible to many different illnesses, and he received treatment for these conditions throughout his life. Because of the rarity of his affliction, he was studied at Duke and at Baylor Universities. His mother was a member of a national organization that provided support for and raised awareness of immune deficiency problems.

Miles began seeing Dr. Bray for his immune deficiency problems in 1983 and treatment continued through the time that the dispute between Columbia and Miles arose. In 1986, Dr. Bray recommended that Miles receive a gamma globulin treatment, but Miles refused because of cost. 1 In 1987, Miles’ daughter received a live polio vaccine, and Dr. Bray insisted that Miles take the gamma globulin treatment in light of possible exposure to polio. He received the treatment as an outpatient at Women’s and Children’s Hospital in Odessa. This treatment was not reflected in the application. Indeed, the only mention in the application of a possible problem linked to the immune deficiency condition was in answer to a question inquiring about disorders of the nose or throat. While Miles responded that he received medication from Dr. Bray for a sinus infection, he did not relate the sinus infection to the chronic immune deficiency condition.

In May 1989, Miles was treated by Dr. Rex Reynolds for a hemogenic bladder related to his immune deficiency condition. He filed a claim with Columbia for the expense. Columbia requested a claimant statement from Miles; however, he delayed forwarding this statement to Columbia until it had made a third request. The bulk of the delay in processing the claim resulted from the tardiness of the statement from Miles. After the statement was received, Columbia requested Dr. Bray’s medical records relating to Miles because Dr. Bray was listed as the referring physician. Upon receiving these records, Columbia learned for the first' time that *806 Miles suffered from IGA and agammaglobu-linemia.

The claims department forwarded Miles’ claims file to the underwriting department to reunderwrite the policy. Columbia’s underwriting manual specified that applicants with agammaglobulinemia were not insurable. Columbia consulted with its medical and legal experts concerning Miles’ conditions and the omissions of any mention of those conditions in the application, the telephone interview, and the amendment to the policy. Based on the opinions of these experts and based on Miles’ conditions, the lack of any mention of them, and the fact that Miles had been denied coverage for it by another insurance company, Columbia concluded that Miles had intentionally concealed his conditions to induce Columbia to provide coverage. On this basis, Columbia decided to rescind the policy and refund all premiums Miles had paid to date. However, Columbia reached this conclusion without ever contacting Miles or Poynor to discuss the situation and confirm its conclusion.

Columbia’s attorney wrote to Miles informing him of Columbia’s intention to rescind the policy, and offering Miles an opportunity to agree to the rescission and an immediate refund of his premiums in exchange for a release of all claims Miles might have had against Columbia. Miles refused the offer. Columbia then filed a declaratory judgment action in Harris County to determine its rights under the policy and to effectuate a rescission. Specifically, it sought a judicial determination of Miles’ intent to deceive Columbia concerning his immune deficiency problem. Miles filed a breach of contract and bad faith action in Ector County.

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

Related

Rice v. Metropolitan Life Insurance Co.
324 S.W.3d 660 (Court of Appeals of Texas, 2010)
Wolford v. American Home Assurance Co.
263 S.W.3d 12 (Court of Appeals of Texas, 2006)
State Farm Lloyds v. Nicolau
951 S.W.2d 444 (Texas Supreme Court, 1997)
Universe Life Insurance v. Giles
950 S.W.2d 48 (Texas Supreme Court, 1997)
Jones v. Jones
944 S.W.2d 121 (Supreme Court of Arkansas, 1997)

Cite This Page — Counsel Stack

Bluebook (online)
923 S.W.2d 803, 1996 WL 263426, Counsel Stack Legal Research, https://law.counselstack.com/opinion/columbia-universal-life-insurance-co-v-miles-texapp-1996.