Crow v. Capitol Bankers Life Insurance

891 P.2d 1206, 119 N.M. 452
CourtNew Mexico Supreme Court
DecidedMarch 1, 1995
Docket21099
StatusPublished
Cited by14 cases

This text of 891 P.2d 1206 (Crow v. Capitol Bankers Life Insurance) is published on Counsel Stack Legal Research, covering New Mexico Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crow v. Capitol Bankers Life Insurance, 891 P.2d 1206, 119 N.M. 452 (N.M. 1995).

Opinion

OPINION

FROST, Justice.

In applying for a life insurance policy from Capitol Bankers Life Insurance Company (Capitol), Edward and Kathy Crow made misrepresentations about Kathy’s health history. As required by New Mexico law, the policy contained an incontestability’ clause, stating that, after two years from the date the policy was issued, the coverage could not be challenged. Kathy died of ovarian cancer less than two years after the policy was issued. Upon learning of the misrepresentations, Capitol denied payment of death benefits to Edward. Edward filed suit claiming that the incontestability clause prevented Capitol from challenging the policy.

We conclude that the incontestability clause should not be enforced because the language of the insurance contract required that the insured be alive for the entire two-year period. We also conclude that, because there is strong evidence in the record of fraud and misrepresentation on the part of the Crows, Capitol properly refused to award the death benefits to Edward.

I. FACTS

Kathy Crow, a registered nurse, was diagnosed with ovarian cancer in October 1985. From the date of the diagnosis through the time of her death in 1990, she was under almost continuous care for cancer. She first met with Dr. George Ritcher, a specialist in gynecologic oncology, on October 2, 1985. Upon discovery of the cancer, she soon thereafter underwent a hysterectomy and an oophorectomy. Kathy then began a series of chemotherapy treatments that ended in July 1986.

A month after concluding the chemotherapy, on August 6,1986, Dr. Richter performed a “second look” operation. Biopsies taken from various locations in her abdominal cavity revealed the continued presence of cancer. Dr. Richter suggested at trial that historically a large percentage of patients who have a positive second look will succumb to the disease. Kathy then underwent another year of chemotherapy which ended in August 1987. During the same year Kathy also had minor surgery to remove a kidney stone.

About the same time her chemotherapy treatments ended, in August 1987, Kathy married Edward Crow. The couple purchased a home the following month. In the mortgage paperwork they indicated they would like to be contacted by a life insurance agent. Shortly thereafter, Jean Cooley, an agent for Capitol, contacted the Crows offering to sell them a policy. They told Cooley to call back after the first of the year in 1988.

In December 1987 Kathy complained of lower abdominal pain. New tests revealed evidence of a possible recurrence of cancer including a suspicious soft tissue mass in her pelvis.

Cooley called in mid-January 1988 and scheduled an appointment for February 25, 1988, to sell life insurance to the Crows. She came to their house on the appointed day and personally prepared two life insurance applications, one for Kathy and one for Edward.

Kathy’s “HEALTH STATEMENT,” as completed by Cooley, was in “PART C” of the application. Question 2(f) asked, “To the best of your knowledge and belief has the proposed insured within the last 10 years been treated for or had any known indication of ... [a] stone or other disorder of kidney, bladder, prostate, or reproductive organs?” Cooley marked “Yes” to this question with the explanation that Kathy had suffered from a kidney infection and had a kidney stone removed. No problem with Kathy’s reproductive organs was noted.

Most significantly, question 2(j) asked about any treatments or indications of “[c]ancer, cyst, or any tumor disorder of skin or lymph glands?” To this, Cooley marked Kathy’s response: “No.” Question 9(a) asked, “Has the Proposed Insured ever had any disorder of menstruation, pregnancy, or of the reproductive organs or breasts?” and Kathy’s answer was “No.” Cooley submitted the completed application documents to Capitol.

On March 23, 1988, Capitol issued the Crow’s life insurance contract. Under the terms of the contract, this was the “Issue Date.” Cooley delivered the documents to the Crows the same day. As required by New Mexico law, NMSA 1978, Section 59A-20-5 (Repl.Pamp.1992), the portion of the contract insuring Edward’s life contained an incontestability clause. This clause provided that, “during the lifetime of the Insured,” Capitol could not contest statements made in the application after two years from the issue date. Appended to Edward’s insurance policy was the “OTHER INSURED RIDER” (Rider), which was a policy insuring Kathy’s life. The Rider also contained an incontestability clause. It differed from the one in Edward’s policy in that it lacked any reference to “the lifetime of the Insured.” Husband and wife were each covered for $77,-900.00.

On March 25, 1988, two days after Cooley delivered the insurance policies, Kathy was informed by Dr. Richter that her cancer had recurred. Biopsies taken March 31, 1988, confirmed this diagnosis. Dr. Ritcher met with both Kathy and Edward on April 15, 1988, to discuss the alternatives for treatment. Five days later Kathy called Dr. Ritcher to tell him she wanted to continue aggressively fighting the disease with chemotherapy.

Apparently she continued with the chemotherapy until she went to Corpus Christi, Texas almost two years later in February 1990, to be with her family. She died on February 26, 1990. Her death certificate listed the immediate cause of death as “Aspiration Pneumonia” with “Papillary Adeno Carcinoma” as the significant condition that contributed to her death.

In March 1990 Edward called Cooley and told her Kathy had died. Cooley was “flabbergasted” when she learned that cancer was the cause of death and that Kathy “had it before.” When Cooley asked Edward why the disease was not disclosed on the insurance application, he answered, “We thought she was all right.”

Within a day or two Edward again called Cooley to ask if Capitol would pay the claim since the death certificate listed the immediate cause of death as aspiration pneumonia rather than cancer. Cooley replied that she did not know and indicated that her authority was limited to sending in the claim. She asked Edward again why he and Kathy had not disclosed the cancer. This time he asserted that Cooley had never asked them about it.

On March 6, 1990, Capitol opened its “Death Claim Checklist.” Capitol mailed to Edward the “PROOFS OF DEATH — BENEFICIARY’S STATEMENT,” which he completed and returned to the insurance company on March 14, 1990. Edward listed the “Cause of Death” as “Aspiration Pneumonia.” In response to the question, “When did deceased first complain of or give other indications of his/her last illness?” he answered “1-27-89” though Kathy’s cancer was diagnosed in 1985. When asked, “When did deceased first consult a physician for his/her last illness?” he responded “2-2-90” though she had been treated by Dr. Richter as early as 1985. One question asked for the names of all physicians who attended Kathy during the final three years of her last illness, as well as the dates of attendance, and the condition treated. Edward listed a physician from the hospital in Corpus Christi where Kathy died as treating her from “2-2-90” to “2-26-90” for “Pneumonia Aspiration.” With remarkable understatement, Edward also listed Dr.

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Bluebook (online)
891 P.2d 1206, 119 N.M. 452, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crow-v-capitol-bankers-life-insurance-nm-1995.