Commercial Underwriters Insurance v. Hunt & Calderone, P.C.

540 S.E.2d 491, 261 Va. 38, 2001 Va. LEXIS 19
CourtSupreme Court of Virginia
DecidedJanuary 12, 2001
DocketRecord 000474
StatusPublished
Cited by73 cases

This text of 540 S.E.2d 491 (Commercial Underwriters Insurance v. Hunt & Calderone, P.C.) is published on Counsel Stack Legal Research, covering Supreme Court of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Commercial Underwriters Insurance v. Hunt & Calderone, P.C., 540 S.E.2d 491, 261 Va. 38, 2001 Va. LEXIS 19 (Va. 2001).

Opinion

JUSTICE LACY

delivered the opinion of the Court.

This appeal arises from a declaratory judgment action regarding coverage under a professional liability, claims made insurance policy.

On May 8, 1997, Hunt & Calderone, P.C. (H&C), an accounting firm, filed a renewal application for professional liability insurance with Commercial Underwriters Insurance Company (CUIC). On May 9, Dian T. Calderone, a partner in H&C, realized that she had missed a filing deadline for one of the firm’s clients, Michael Atalay. Calder-one knew that her error could potentially result in a loss of a $125,000 tax credit for the client, but she did not think that a claim would result because she was told by an administrator of the government tax credit program that sufficient funds would likely be available after all the timely applications had been processed. Furthermore, when told of the error, Atalay said he was satisfied with the assurances made by the government administrator. H&C did not inform CUIC of the error during the time the insurance application was pending.

After the CUIC policy became effective, H&C learned that sufficient funds were not available for Atalay’s tax credit. In August 1997, Atalay notified H&C that he intended to hold H&C responsible for the lost tax credit. Because the CUIC policy was a claims made policy, H&C requested coverage from CUIC for Atalay’s claim. CUIC denied coverage to H&C for the claim and refused to provide a defense for H&C in an action subsequently filed by Atalay against H&C. CUIC based its position on three separate grounds: (1) H&C failed to meet a condition precedent of the policy which required that, at the inception of the policy, H&C have no knowledge of an error or any other basis to reasonably anticipate a claim that would be covered by the policy; (2) the claim fell under an exclusion of the policy which disallowed coverage for a claim arising out of any error likely to give rise to a claim of which the insured had knowledge or a reason to anticipate prior to the policy’s inception; and (3) H&C’s *41 failure to inform CUIC of Calderone’s error during the pendency of the application constituted a material misrepresentation, voiding the policy.

H&C filed a motion for declaratory judgment, seeldng a declaration that CUIC was required to defend the claim and provide coverage under the policy. The trial court entered judgment in favor of H&C, holding that H&C provided sufficient evidence to show that it complied with the condition precedent to establish coverage, that coverage was not foreclosed under the policy exclusion, and that the policy was not void based on a misrepresentation of a material fact in the application. We awarded CUIC an appeal.

CUIC’s five assignments of error present two primary issues. The first is whether the policy was void because H&C failed to inform CUIC of Calderone’s error prior to the inception of the policy. The second is whether, prior to the inception of the policy, H&C had any basis to reasonably anticipate that Calderone’s error would result in a claim otherwise covered by the policy. We will address these issues in order.

I.

Question number ten of the insurance policy application asked, “After inquiry, does the Applicant. . . have knowledge of any actual or alleged act, error,, omission or circumstance which may result in a claim being made against them or any other basis to reasonably anticipate a claim being made against them.” H&C answered no to this question. The application also contained a notice that the Applicant had a continuing duty to update the insurance company, in writing, of any change to the application that may occur between the filing of the application and the proposed effective date. Finally, the policy itself recited in several places that the representations made in the application were material to the acceptance of the risk and the underwriting of the policy.

Based on these policy provisions, CUIC asserts that the policy was void because H&C failed to notify CUIC of Calderone’s error in a timely fashion and that such failure was a material misrepresentation as stated in the policy. The trial court, relying on Harrell v. North Carolina Mutual Life Insurance Co., 215 Va. 829, 213 S.E.2d 792 (1975), held that even if H&C’s failure to update CUIC did constitute a misrepresentation, CUIC failed to prove that it was a material misrepresentation.

*42 We have construed Code § 38.2-309 1 and its predecessors to require an insurance company contesting a claim on the basis of an insured’s alleged misrepresentation to show, by clear proof, two facts: (1) that the statement on the application was untrue; and (2) that the insurance company’s reliance on the false statement was material to the company’s decision to undertake the risk and issue the policy. Harrell, 215 Va. at 831-32, 213 S.E.2d at 794-95. To prove the falsity is not sufficient; the company must prove clearly that truthful answers would have reasonably influenced the company’s decision to issue the policy. See Mut. of Omaha Ins. Co. v. Echols’ Adm’rs, 207 Va. 949, 953-54, 154 S.E.2d 169, 172 (1967)(defining “material”)

We agree with the trial court that Harrell controls the case at hand. In Harrell, the applicant for a life insurance policy did not disclose that she had been hospitalized and had undergone operations for cancer numerous times during the five years prior to submitting her application. The application recited that her answers “ ‘are each material to the risk and that the Company believing them to be true will rely and act upon them.’ ” 215 Va. at 830, 213 S.E.2d at 794 (emphasis added). When cancer was found to be a cause of death and an investigation revealed her misrepresentations on the application, the insurance company denied the claim, relying upon the predecessor to Code § 38.2-309. 2

At trial, the insurance company offered into evidence the application language quoted above and the testimony of several agents of the company, but not one agent was in a position to testify to the materiality of the misrepresentations. This Court stated:

While it is incredible that any responsible insurance company would have issued a policy of life insurance to Mrs. Foxx with knowledge that she had recently been released from a hospital after a major operation for carcinoma of the breast, and with knowledge that she had a history of other hospitalizations for cancer, we will not take judicial notice of this fact. The burden *43 of clearly proving the affirmative defense of materiality of a misrepresentation is not carried when the court, to find the fact, must resort to assumption and conjecture.

Harrell, 215 Va. at 833, 213 S.E.2d at 795-96 (first emphasis added).

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Bluebook (online)
540 S.E.2d 491, 261 Va. 38, 2001 Va. LEXIS 19, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commercial-underwriters-insurance-v-hunt-calderone-pc-va-2001.