Cullen v. Valley Forge Life Insurance

589 S.E.2d 423, 161 N.C. App. 570, 2003 N.C. App. LEXIS 2273, 2003 WL 22948961
CourtCourt of Appeals of North Carolina
DecidedDecember 16, 2003
DocketCOA02-1328
StatusPublished
Cited by35 cases

This text of 589 S.E.2d 423 (Cullen v. Valley Forge Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cullen v. Valley Forge Life Insurance, 589 S.E.2d 423, 161 N.C. App. 570, 2003 N.C. App. LEXIS 2273, 2003 WL 22948961 (N.C. Ct. App. 2003).

Opinion

*572 CALABRIA, Judge.

This appeal arises from the trial court’s granting of Anthony W. Cullen’s (“plaintiff’) 1 summary judgment motion awarding plaintiff $499,605.02 for breach of a life insurance contract, treble damages for unfair and deceptive practices, costs, and attorneys’ fees. We affirm in part and reverse in part.

In the early 1990’s, Marc Flur (“Flur”), plaintiff’s insurance agent and acquaintance, contacted him to discuss insurance policies. Plaintiff subsequently applied for a one million dollar life insurance policy. The application process required plaintiff to disclose his medical history. Although plaintiff listed prior surgeries, treatment for a skin disorder, and Crohn’s disease (a degenerative gastrointestinal disorder), his application was approved.

Each year, Flur and plaintiff met to discuss plaintiff’s insurance needs. In 1999, around the time of the existing life insurance policy’s conversion date, plaintiff asked Flur about increasing his life insurance coverage for the benefit of his children due to an increase in the size of plaintiff’s family and a more stable financial outlook. Flur explored the options available and presented a $500,000.00 life insurance policy (the “subject policy”) application with Valley Forge Life Insurance Company (“Valley Forge”). 2

On 2 April 1999, Flur and plaintiff met and filled out the application. Since plaintiff did not submit a premium with the application, the following provision applied: “insurance will not take effect until the application is approved and accepted by the Company... and the policy is delivered while the health of each person proposed for insurance and other conditions remain as described in this application and . . . the first premium . . . has been paid in full.”

On 14 April 1999, plaintiff submitted to a medical examination and provided blood and urine samples as required by the application. Plaintiff also authorized the release of his medical records. These records disclosed the existence of a “blood blister” he had noticed *573 on his back in late 1998. Valley Forge reviewed those records and “need[ed] to know what was the diagnosis, treatment and current condition.” Flur was asked to inquire concerning the blood blister. Despite the fact that Flur and plaintiff both agree plaintiff did not represent the blood blister had gone away, Moneymetrics, the company acting as Flur’s general agent, reported to Valley Forge the “blood blister went away without any treatment needed.” On 19 May 1999, the subject policy was approved, and Flur contacted plaintiff to inform him that he would collect the premium upon delivery of the subject policy.

On 26 May 1999, plaintiff had a regularly scheduled appointment with Dr. Kim Isaacs (“Dr. Isaacs”), his primary care physician since 1994, for his Crohn’s disease and inquired as to the blood blister on his back. Dr. Isaacs arranged for plaintiff to see a dermatologist to perform a biopsy and eliminate the possibility of melanoma, a form of skin cancer. An analysis of the biopsy revealed that the blood blister was in fact melanoma. Plaintiff was informed of the diagnosis on 2 June 1999.

On 11 June 1999, plaintiff and Flur met, Flur delivered the subject policy, and plaintiff paid the premium of $394.98. At some point in time, Flur and plaintiff completed a second life insurance application for additional coverage with Valley Forge. Plaintiff underwent a second medical examination arid submitted a medical supplement on 14 June 1999. The information in the medical supplement included that plaintiff had been treated for a “[disorder of the skin or lymph glands, cyst, tumor or cancer” and an additional handwritten answer further indicated “melanoma on back — will be removed 6/17/99 Dr. Benjamin Calvo UNC Hospitals.” Diane Waggoner, the nurse Valley Forge procured to conduct both medical examinations of plaintiff for the purposes of his applications for life insurance, witnessed the medical supplement.

Valley Forge deposited plaintiff’s premium payment, which cleared plaintiff’s bank account on 17 June 1999. On 9 July 1999, Valley Forge complied with plaintiff’s request to change the beneficiary named under the subject policy. Subsequently, in a letter from Valley Forge dated 21 September 1999, plaintiff learned his second application for insurance was declined. In addition, the letter informed him that, regarding the subject policy, “no coverage or contract was ever in effect” and that “no coverage ever existed.” Valley Forge included a refund check for the premium payment, which was eventually re-issued and deposited by plaintiff.

*574 Plaintiff filed suit on 11 June 2001 against Flur, Valley Forge, CNA, Moneymetrics, and Piedmont Carolinas Group, L.L.C. seeking a judgment declaring he was insured under the subject policy 3 and later amended his complaint to include a claim for unfair and deceptive practices arising out of the same transaction as the breach of contract action. Valley Forge answered asserting numerous defenses including, inter alia, accord and satisfaction and that plaintiffs health, when the policy was delivered and the premium paid, was not the same as his health as described in the application. On 18 and 24 January 2002, plaintiffs “Motion for Summary Judgment or Partial Summary Judgment” against Valley Forge was heard. Valley Forge opposed the motion, asserting discovery was not yet complete. On 8 March 2002, the trial court granted plaintiffs motion for summary judgment on his claims against Valley Forge, awarding plaintiff in excess of 2.2 million dollars for breach of contract and unfair and deceptive practices as well as attorneys’ fees and costs.

On appeal, we find the issue of waiver controlling on plaintiffs breach of contract claim. The ramifications of our holding concerning waiver and the undisputed surrounding circumstances are, moreover, dispositive of plaintiffs remaining claims and Valley Forge’s defenses. Summary judgment is appropriate where “the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that any party is entitled to a judgment as a matter of law.” N.C. Gen. Stat. § 1A-1, Rule 56(c) (2001). “The rule is designed to permit penetration of an unfounded claim or defense in advance of trial and to allow summary disposition for either party when a fatal weakness in the claim or defense is exposed.” Caldwell v. Deese, 288 N.C. 375, 378, 218 S.E.2d 379, 381 (1975). The party moving for summary judgment has the burden of showing that there is no genuine issue as to any material fact. Dixie Chemical Corp. v. Edwards, 68 N.C. App. 714, 715, 315 S.E.2d 747, 749 (1984).

I. Waiver

A life insurance policy is a contract. Motor Co. v. Insurance Co., 233 N.C. 251, 253, 63 S.E.2d 538, 540 (1951). As such, the parties entering into the insurance contract may agree upon “its terms, provisions and limitations.” Allen v. Insurance Co., 215 N.C.

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Bluebook (online)
589 S.E.2d 423, 161 N.C. App. 570, 2003 N.C. App. LEXIS 2273, 2003 WL 22948961, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cullen-v-valley-forge-life-insurance-ncctapp-2003.