Estate of Rivera v. North American Co. for Life & Health Ins.

635 A.2d 598, 269 N.J. Super. 418, 1993 N.J. Super. LEXIS 886
CourtNew Jersey Superior Court Appellate Division
DecidedAugust 26, 1993
StatusPublished

This text of 635 A.2d 598 (Estate of Rivera v. North American Co. for Life & Health Ins.) 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
Estate of Rivera v. North American Co. for Life & Health Ins., 635 A.2d 598, 269 N.J. Super. 418, 1993 N.J. Super. LEXIS 886 (N.J. Ct. App. 1993).

Opinion

ALLEY, J.S.C.

A. Introduction:

This opinion deals with the effect, if any, that the inability of an applicant for insurance to communicate in English should have when the court is considering whether the insurer has a right (under Massachusetts Mutual Life Insurance Co. v. Manzo, 122 N.J. 104, 111, 584 A.2d 190 (1991)), to rescind a policy of insurance within the contestability period. This question arises in the context of a motion by defendant North American Company for Life and Health Insurance (“insurer”) for summary judgment dismissing plaintiffs’ complaint and allowing it to rescind a life insurance policy that it issued to the decedent, Juan Rivera. Defendants Charles Kimber and the Tribus Agency join this motion, which plaintiffs oppose.

B. Facts:

Plaintiffs seek to recover insurance proceeds under the subject policy, which the insurer issued on the life of Mrs. Rivera’s late husband, Juan P. Rivera, in March 1988. Plaintiffs have joined as defendants the insurer and Charles Kimber, the insurance producer who sold the policy. By way of counterclaim, the insurer seeks rescission of the policy due to alleged material misrepresentations by the insured in his application for insurance.

The policy was issued as part of an enhancement of Juan Rivera’s benefits package that was being undertaken by his employer, Dynamic Metals. The present record would support a finding that Rivera was not responsible for paying the policy’s premiums and that this expense would be paid by Dynamic Metals.

There were specific questions on the application dealing with pre-existing medical conditions. The answers stated that Rivera had not been treated by a physician in the last five years nor had he ever been treated for high blood pressure. In fact, Rivera had been treated by a physician for high blood pressure during that. period. The insurer asserts that these incorrect answers consti[421]*421tuted knowing misstatements by Rivera, the applicant, that were material to the risk insured and relied upon by the insurer in its issuance of the policy. Rivera died of cancer in December 1988.

Plaintiffs have set forth facts from which the trier of fact could find that the issuing agent came to Rivera’s place of employment, questioned each worker, and completed each worker’s application himself. There is deposition testimony to the effect that Kimber, the issuing agent, read the application to Rivera and filled it out for Rivera, and that Rivera simply signed the application where Kimber indicated. Plaintiffs have set forth facts tending to show that Rivera’s understanding of the English language was extremely limited, that he read and spoke Spanish almost exclusively, and that he never had any formal training in English and had only an eighth grade education, which he completed in Puerto Rico. These allegations in turn raise issues of fact concerning Rivera’s ability to understand the insurance application and to knowingly misrepresent the fact he had been treated for hypertension, and the question for the court on this motion is whether those facts are material.

C. Discussion:

The insurer seeks to rescind Rivera’s policy on the basis of equitable fraud. The New Jersey Supreme Court has affirmed the well-established law of this State that equitable fraud will support rescission of an insurance policy:

In sum, we hold that equitable fraud should be available as a grounds for post-loss rescission and that within the period of contestability an insurer may rescind a policy if the insured knowingly misrepresented facts that would have affected the estimate of the risk and the premium charged.
[Massachusetts Mutual Life Ins. Co. v. Manzo, 122 N.J. 104, 111, 584 A.2d 190 (1991).]

Except for the issue of the applicant’s inability to communicate in English, the Manzo decision has expressly addressed the material issues of law raised on this motion. For example, in Manzo, the applicant denied having been advised of, treated for or having had any known indication of diabetes. Id. at 109, 584 A.2d [422]*422190. This was false. He denied consulting a physician other than for a routine check-up in the five years prior to the application. Id. This was also false. The evidence at trial was that if the company had known the truth it would have issued a rated policy with moderate to high premiums instead of a policy at standard rates. Id. Knowledge of Manzo’s diabetes would have affected the underwriter’s judgment in approving the application, estimating the risk, and fixing the premium. Id.

The Supreme Court stated:

The principle that equitable fraud, like legal fraud, is available to rescind a life insurance policy even after the death of the insured is, however, “firmly embedded in the jurisprudence of this State.” Formosa v. Equitable Life Assurance Soc’y, 166 N.J.Super. 8,13 [398 A.2d 1301] (App.Div.), certif. denied, 81 N.J. 53 [404 A.2d 1153] (1979) (citations omitted).

[Id- at 111, 584 A.2d 190.]

Here, as well, the application in material respects was not factual, and the insurer would not have issued the same policy for the same premium if it had known the facts.

The insured in Manzo did not die of the condition which he misrepresented. He was shot to death. His representatives asserted that the policy could not be rescinded because of the lack of a causal link between the misrepresentation and the loss. The Supreme Court rejected this assertion, stating:

By requiring a causal connection between the disability misrepresented and the insured’s death, the decision below conflicts not only with Formosa, but also with the general rule that “in the absence of a statute establishing a different rule, there need be no causal connection between the cause of death and the misrepresentation.” Couch, supra § 37:110 at 632. This rule is accepted by a majority of jurisdictions. Couch, supra, §§ 37:38 at 102 and 37:110 at 632; Appleman, supra, § 245 at 125; R. Keaton and A. Widiss, Insurance Law, A Guide to Fundamental Principles, Legal Doctrines and Commercial Practices 572 n. 20 (West 1988) (the “clear majority rule” is that no causal connection is required); see, e.g., Shafer v. John Hancock Mut. Life Ins. Co., 410 Pa. 394, 399,189 A.2d 234, 237 (1963) (“It is of no consequence that the death ensued from a cause unconnected with the false representations.”). We are persuaded that the majority rule is the correct one. An insurer is entitled to relief when it relies on incorrect information provided by an insured in an insurance application if the information was material either to the insurer’s decision to insure or to the terms of the contract.

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Related

Formosa v. Equitable Life Assurance Society of US
398 A.2d 1301 (New Jersey Superior Court App Division, 1979)
Massachusetts Mutual Life Insurance v. Manzo
584 A.2d 190 (Supreme Court of New Jersey, 1991)
Rudbart v. North Jersey District Water Supply Commission
605 A.2d 681 (Supreme Court of New Jersey, 1992)
Ciampoli v. the Prudential Ins. Co. of America
68 A.2d 883 (New Jersey Superior Court App Division, 1949)
Shafer v. John Hancock Mutual Life Insurance
189 A.2d 234 (Supreme Court of Pennsylvania, 1963)

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Bluebook (online)
635 A.2d 598, 269 N.J. Super. 418, 1993 N.J. Super. LEXIS 886, Counsel Stack Legal Research, https://law.counselstack.com/opinion/estate-of-rivera-v-north-american-co-for-life-health-ins-njsuperctappdiv-1993.