Downs v. Prudential Ins. Co. of America

328 A.2d 20, 130 N.J. Super. 558, 1974 N.J. Super. LEXIS 564
CourtNew Jersey Superior Court Appellate Division
DecidedJune 4, 1974
StatusPublished
Cited by6 cases

This text of 328 A.2d 20 (Downs v. Prudential Ins. Co. of America) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Downs v. Prudential Ins. Co. of America, 328 A.2d 20, 130 N.J. Super. 558, 1974 N.J. Super. LEXIS 564 (N.J. Ct. App. 1974).

Opinion

130 N.J. Super. 558 (1974)
328 A.2d 20

EDWARD J. DOWNS, PLAINTIFF,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, DEFENDANT.

Superior Court of New Jersey, Law Division.

Decided June 4, 1974.

*560 Mr. Leonard Meyerson for plaintiff (Messrs. Miller, Hochman, Meyerson & Miller, attorneys).

Mr. Edward J. Russo for defendant (Messrs. Nugent, Russo & Tumulty, attorneys).

THURING, J.S.C.

Plaintiff seeks summary judgment on the ground that the incontestability provisions of a life insurance policy issued to his deceased wife became operative, barring defenses asserted by defendant insurance company. Plaintiff's motion is directed to whether the counterclaim for rescission based upon equitable fraud states a claim upon which relief can be granted.

Sometime prior to July 1, 1960 The Prudential Insurance Company of America issued a noncontributory group policy to the Board of Trustees, Teachers' Pension and Annuity Fund, State of New Jersey. Following the death of his wife on March 1, 1970 plaintiff received from defendant the benefits payable under the policy in the amount of $20,011.50.

On July 1, 1960 a contributory group policy designated as GC-14300, which is the subject of this litigation, was issued as between the same parties. That policy was later amended *561 to provide that its members had the right to apply for additional insurance by making contributions and furnishing evidence of insurability satisfactory to the insurance company. On January 5, 1970 plaintiff's wife, a teacher, applied for and subsequently received approval for the additional insurance coverage.

The amendment provided:

1. The section `Insured Members' appearing on pages 3 and 4 of the policy is enlarged to include the following provision:

Each person who is a Member on January 1, 1970 but is not then insured under this Policy may become insured hereunder by (x) making request, within the Enrollment Period described below, to participate on a date on which he is actively at work and performing all his regular duties at his customary place of employment, (xx) agreeing to make the contributions required by the Policyholder therefor pursuant to the section `Contribution of Individual Members' and (xxx) furnishing evidence of insurability satisfactory to the Insurance Company.

The insurance under the aforesaid policy became effective July 1, 1970.

Following the insured's death the Division of Pensions referred the claim to defendant in view of the fact that the member, Tina A. Downs, died within two years from the date of the issuance of the policy. Plaintiff's request for payment of the insurance policy proceeds was officially refused by defendant on September 15, 1972 on the ground that the insured had failed to truthfully set forth her health status at the time she made application for insurance.

The complaint demanding the proceeds of the policy was filed on July 5, 1973, and answer and counterclaim were filed July 30, 1973 seeking rescission of the insurance contract for misrepresentation by the insured of material facts concerning her health and on the ground of mutual mistake.

Each insured did not receive a copy of the group policy but received a certificate evidencing coverage under the group policy. A group life policy and the certificate issued thereunder together constitute the contract between the parties, Metropolitan Life Ins. Co. v. Poliakoff, 123 N.J. *562 Eq. 524 (Ch. 1938) and "[o]rdinarily an insured holding a certificate of insurance is held to have constructive knowledge of the group insurance policy," Wells v. Wilbur Driver Co., 121 N.J. Super. 185, 197 (Law Div. 1972). The certificate itself was silent as to the incontestability clauses in question; thus, reference must be made to the group policy provisions and to N.J.S.A. 17:34-15(c) to reach a determination as to whether the incontestability clauses operate to bar defendant's right to assert its defenses.

The group policy contains a caption which reads "INCONTESTABILITY OF POLICY," followed by the words:

The validity of this Policy shall not be contested, except for non-payment of premiums, after it has been in force for one year from the date of issue.

Immediately underneath the aforesaid language appears another caption reading "THE CONTRACT," followed by language identical with that required by N.J.S.A. 17:34-32(2)-(3), repealed by L. 1971, c. 144, which reads:

All statements made by the Policyholder or by the Members insured under this Policy shall be deemed representations and not warranties, and no statement made by any Member insured hereunder shall be used in any contest of the insurance hereunder unless a copy of the instrument containing the statement is, or has been furnished, to such Member or to his Beneficiary. No Statement made by any Member insured under this Policy relating to his insurability shall be used in contesting the validity of the insurance under this Policy with respect to which such statement was made after such insurance has been in force prior to the contest for a period of two years during such Member's lifetime nor unless it is contained in a written instrument signed by him. [Emphasis supplied]

Plaintiff alleges that the one-year incontestability clause applies or, if it does not, that the two-year clause requires that a contest must be initiated by the insurer within a two-year period following issuance of the policy.

Defendant insurance company answers by stating that (a) the one-year incontestability clause applies solely to the initial agreement between it and the Board of Trustees, Teachers' *563 Pension and Annuity Fund, dated July 1, 1960; (b) under the incontestability clause of the statute and under the policy itself decedent's coverage remained contestable after the two-year period because the insured died within two years of the date of issuance of the policy, and (c) defendant is entitled to rescission because the policy was obtained through a misrepresentation of material facts and mutual mistake.

The court recognizes its obligations and responsibilities in considering a motion for summary judgment and is familiar with the ground rules set forth in Judson v. Peoples Bank & Trust Co. of Westfield, 17 N.J. 67 (1954), and cases following thereafter. The law is that where a genuine issue as to a material fact exists, the court cannot decide the issue. Here defendant alleges misrepresentation of material facts by the deceased insured relative to insurability, which presents an issue of a material fact. However, for the purposes of this motion plaintiff is willing to concede that misrepresentation by the deceased insured did, in fact, occur. Accordingly, as a matter of law, the court can decide the issue of contestability.

A careful reading of the language contained in the group policy leads to the inescapable conclusion that the one-year incontestability clause refers solely to the one-year period following the effective date of the group policy, namely, from July 1, 1960 to June 30, 1961. That incontestability clause refers singularly and clearly to the agreement between the initial parties to the group policy and not to future individually covered insureds. The premiums referred to in that clause were paid by each insured to the Board of Trustees of the Teachers' Pension and Annuity Fund, who in turn made payment to defendant.

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Bluebook (online)
328 A.2d 20, 130 N.J. Super. 558, 1974 N.J. Super. LEXIS 564, Counsel Stack Legal Research, https://law.counselstack.com/opinion/downs-v-prudential-ins-co-of-america-njsuperctappdiv-1974.