General Motors Acceptance Corp. v. Martinez

668 P.2d 498, 1983 Utah LEXIS 1057
CourtUtah Supreme Court
DecidedMay 24, 1983
Docket18072
StatusPublished
Cited by26 cases

This text of 668 P.2d 498 (General Motors Acceptance Corp. v. Martinez) is published on Counsel Stack Legal Research, covering Utah Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
General Motors Acceptance Corp. v. Martinez, 668 P.2d 498, 1983 Utah LEXIS 1057 (Utah 1983).

Opinions

STEWART, Justice:

This is an action by General Motors Acceptance Corporation (GMAC) for repossession of an automobile and for damages arising from the defendant’s default on his promissory note given for the purchase of [500]*500the automobile. Defendant, Hector Martinez, and his father, Manuel M. Rivera, filed a third-party complaint against Great Equity Insurance Co. to enforce a credit insurance policy written to insure the amount of the loan after Martinez’ default because of illness. The trial court entered judgment in favor of GMAC and against Martinez and Rivera, and against Martinez and Rivera on their third-party complaint against Great Equity. The only issue on this appeal is whether a pre-existing illness clause in the insurance policy excluded Hector Martinez from coverage under the policy-

On September 12, 1978, Hector Martinez purchased an automobile on a conditional sales contract from Streator Chevrolet. Martinez was told that as a condition of obtaining a financing contract he had to purchase a credit life and disability insurance policy from Great Equity. The policy designated Martinez as the insured and Streator as the beneficiary, and provided that if because of death, accident, or illness Martinez was unable to make his car payments, Great Equity would pay the remainder of the debt then owing. The premium for the policy was added to the face of the sales contract for the car, and the contract was later assigned by Streator Chevrolet to GMAC, making GMAC the new beneficiary under the policy.

At the time Martinez purchased the insurance, he did not learn about the exclusion for pre-existing conditions. Streator’s agent, Mr. Elton, did not ask him about his past or present health. Martinez was not asked to sign the credit insurance application, which stated the coverage exclusions, nor was he given a copy of the insurance application or the certificate of insurance, although it was Streator’s normal business practice to have an insured sign the application and to give him a copy of the insurance certificate. Apparently, Mr. Elton was unable at the time to find the blank credit insurance certificates. Nor were any of the policy exclusions explained to Martinez orally.

The insurance certificate states the policy exclusions. The “pre-existing condition” exclusion provides: “No insurance is provided hereunder ... if disability results from ... injury sustained or sickness contracted for which medical diagnosis or treatment was required ... within six months prior to the effective date [of coverage] of this certificate and which causes a loss within six months after such effective date.”

Although it is undisputed that Martinez suffered from high blood pressure prior to his purchase of the insurance policy, Martinez did not misstate or misrepresent his state of health. On the contrary, the agent who filled out the Great Equity insurance application form seemed totally indifferent to Martinez’ prior health.

Martinez made two monthly payments on the car prior to suffering a complete kidney failure which resulted in his total disability. He then made a demand on the insurance company to pay the balance owing on the car to GMAC. Pending the outcome of the insurance company’s investigation, GMAC deferred collection on its contract. As a result of its investigation, Great Equity denied coverage on the ground that Martinez had suffered high blood pressure prior to his purchase of the car, and the subsequent kidney failure fell within the exclusionary clause of the policy for pre-existing diseases.

GMAC then brought this suit against Martinez. Martinez filed a third-party complaint against Great Equity alleging that it was liable under the insurance contract for the car payments. Great Equity admitted the existence of the insurance contract and denied coverage under the preexisting sickness exclusion.

The trial court granted judgment against Martinez as a matter of law on the contract for the purchase of the car, and awarded GMAC $4,717.50 plus interest, costs, and attorney’s fees. On the issue of Great Equity’s liability under the policy, the trial court submitted seven special interrogatories to the jury. Based on the answers to [501]*501those interrogatories, the trial court entered judgment for Great Equity.

In 1961 the Legislature enacted the Model Act for the Regulation of Credit Life Insurance and Credit Accident and Health Insurance. Laws of Utah 1961, Chap. 67, § 1. That act is now found in Title 81, Chap. 34 of U.C.A., 1953. Section 31-34-6(1) states:

All credit life insurance and credit accident and health insurance shall be evidenced by an individual policy, or in the case of group insurance by a certificate of insurance, which ... shall be delivered to the debtor.

Subsection 2 of that provision specifies what information must be included in the individual policy or group certificate issued to the debtor. Among other things, the policy or group certificate must state the “term and coverage including any exceptions, limitations and restrictions.”

Credit life and accident insurance are generally contracts of adhesion which are not negotiated at arms length and which usually contain various provisions for protection of the interests of the insurance company. Because those who purchase such policies rely on the assumption that they are covered by the insurance they buy, the Legislature, in the interest of fair dealing, has deemed it mandatory that an insured be given a copy of the policy so that he can take whatever action is appropriate to protect his interests and be assured that the coverage which he thinks he has contracted for is actually provided. It is not consonant with our statute for an insurance company to accept premiums and then deny liability on the ground of an exclusion of which the insured was not aware because the insurance company had never informed him of the exclusion or given him the means to ascertain its existence.

The purpose of the statutory provision is plain: the insured is entitled to be informed in writing of the essential terms of the insurance contract, especially the exclusionary terms. Because of the reliance that people place on credit insurance policies to mitigate the hardships that often result from inability to pay a debt, the policy of the law is to prevent mistake or misunderstanding as to the terms of the insurance contract, or what in some cases may amount to sharp practice. Frieze v. West American Insurance Co., 188 F.2d 331, 334-335 (8th Cir.1951) (applying California law). See also Colvin v. Louisiana Hospital Service, Inc., La.App., 321 So.2d 416 (1975); Traders & General Insurance Co. v. Pacific Employers Insurance Co., 130 Cal.App.2d 158, 278 P.2d 493, 495 (1955).

In view of these reasons and the unequivocal nature of the duty imposed by § 31-34-6, we hold that an insurance company is estopped from relying upon an exclusion in a policy if the company has failed to deliver the policy or certificate of insurance to the insured or any other document stating the exclusion.

Gardner v. League Life Insurance Co., 48 Mich.App. 574, 210 N.W.2d 897

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General Motors Acceptance Corp. v. Martinez
668 P.2d 498 (Utah Supreme Court, 1983)

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Bluebook (online)
668 P.2d 498, 1983 Utah LEXIS 1057, Counsel Stack Legal Research, https://law.counselstack.com/opinion/general-motors-acceptance-corp-v-martinez-utah-1983.