Fritz v. OLD AMERICAN INSURANCE COMPANY

354 F. Supp. 514, 1973 U.S. Dist. LEXIS 15089
CourtDistrict Court, S.D. Texas
DecidedFebruary 2, 1973
DocketCiv. A. 71-G-146
StatusPublished
Cited by7 cases

This text of 354 F. Supp. 514 (Fritz v. OLD AMERICAN INSURANCE COMPANY) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fritz v. OLD AMERICAN INSURANCE COMPANY, 354 F. Supp. 514, 1973 U.S. Dist. LEXIS 15089 (S.D. Tex. 1973).

Opinion

*515 MEMORANDUM AND ORDER

NOEL, District Judge.

Plaintiff, Lois F. Fritz, seeks recovery under an accident insurance policy issued by defendant, Old American Insurance Company, for the death of her son, Loy L. Hooks, in an automobile accident. Defendant refuses to pay, claiming no policy was in effect because Hooks’ death occurred before the contract of insurance was consummated. Because the material facts are not in dispute, the parties submitted the case to the Court by means of cross motions for summary judgment.

In October or November of 1969, Hooks received by mail a one-page brochure and application soliciting his purchase of an accident insurance policy from defendant. A copy of the brochure is reproduced in the Appendix. The policy was to cover death or dismemberment resulting from accidents involving automobiles or public conveyances with maximum benefits of $15,000.00. The brochure described the policy in considerable detail. It included a schedule of benefits, a listing of exclusions, and indicated age requirements of from 16 to 70 years of age. As an introductory offer, the premium for the first 30 days was only $.25, due with the application. Thereafter, premiums were $6.25 for six months, or $12.00 per year.

The application required only four entries by the applicant; his date of birth, the beneficiary’s name and relationship to the applicant, and the applicant’s full signature. Hooks separated the application from the brochure, completed the form and mailed it to defendant along with the $.25 premium. No further action was necessary by Hooks to obtain coverage and none was taken.

The application reached defendant between noon, November 13 and noon, November 14 and was stamped by defendant’s employee. On November 17, the application was reviewed by an employee for completeness, legibility, signature and birth date. On November. 19, defendant’s electronic data processor searched into records to determine if Hooks had an excessive number of policies with the company. He did not. Defendant engaged in no other underwriting procedures. Defendant’s data processor printed a policy with an effective date of November 21. The policy was mailed to Hooks. The application was not part of the policy and was not returned to Hooks.

On November 15, Hooks was killed in an automobile accident. Plaintiff, as beneficiary of the policy, filed timely proof of the accident and demanded payment. Defendant refused. Plaintiff brought suit in state court and the case was removed to this Court under its diversity jurisdiction. 28 U.S.C. § 1332 (1970).

Having reviewed the arguments and authorities, presented by the parties, the Court concludes that although traditional Texas legal principles might support defendant’s position, defendant’s use of the mails as its insurance agent is a unique fact which must be considered. Upon weighing this factor, the Court finds (a) an insurance contract was consummated, (b) plaintiff’s decedent was covered at the time of the accident, and (c) plaintiff must prevail.

Defendant relies on the general rule that an insurance application is an offer by the individual to contract. American Life Insurance Co. v. Nabors, 124 Tex. 221, 76 S.W.2d 497 (1934). A completed application must be unconditionally accepted by the insurance company before a binding contract is made. Mutual Life Insurance of New York v. Anderson, 408 S.W.2d 335 (Tex.Civ.App. —Dallas, 1966, no writ).

Defendant claims to incorporate these principles in its procedures. The brochure refers to the document prepared *516 by the individual as an application. Immediately above the signature line on the application is the sentence, “I understand that the policy becomes effective when issued.” And toward the end of the brochure’s text is the statement “just as soon as your application is approved at the company’s home office, your policy will be put in force and mailed to you.” Thus, defendant’s mail-out is intended to be a proposal to contract. By completing and mailing the application, the individual offers to contract. Defendant accepts the offer by processing the application. No contract is consummated until the processing is complete. Under this view of the facts, because defendant’s procedures were not completed prior to Hooks’ death, no contract was ever effectuated and thus no recovery can be granted.

Plaintiff points to the application form and brochures’ conflicting statements as to when coverage begins. The above quoted sentences suggest two different dates — when the policy is issued and when it is approved. Another sentence in the brochure states, “And when you apply .... you are provided death and dismemberment coverage from accidents.” This indicates a third date for coverage — when the application is sent to the company. Plaintiff contends that because contractual ambiguities are to be construed against the draftsman, a rule of construction particularly appropriate in insurance situations, the insurance policy became effective when Hooks sent in the application. United Founders Life Insurance Co. v. Carey, 363 S.W.2d 236 (Tex.1962).

On balance, Texas cases support defendant’s position. Although defendant’s brochure could lead an individual to believe that coverage began when the application was sent in, the individual applicant’s understanding of the policy is apparently not the general standard of contract interpretation. Texas law generally allows the insurance company to set the terms and requirements of acceptance without regard to the expectations of the applicant. Smith v. Rio Grande National Life Insurance Co., 227 S.W.2d 579 (Tex.Civ.App. — Fort Worth, 1950, writ ref’d.). Because defendant apparently did not intend for the contract to be consummated until the application was processed, that intention would ordinarily control.

Nonetheless, a unique fact present in this case is defendant’s use of the mails in conducting its insurance business. The question here is whether this factor requires application of a different test. The several sentences concerning the completion date of the contract are ambiguous. Because defendant operated by mail, no human agent was available to refute or confirm the reasonable expectations engendered by the brochure in the mind of the applicant. Under these unique circumstances, the question arises as to what standard determines when the contract is made and coverage begins — the intention of the insurance company or the reasonable expectations of the applicant.

Unfortunately, there is no Texas precedent dealing with mail order insurance. The Court is without the usual Erie guideposts. Only two reported cases have been found which involve this new form of insurance solicitation. Klos v. Mobil Oil Co., 55 N.J. 117, 259 A.2d 889 (1969); Fuller v. Standard Oil Co.

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Bluebook (online)
354 F. Supp. 514, 1973 U.S. Dist. LEXIS 15089, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fritz-v-old-american-insurance-company-txsd-1973.