Golden Rule Insurance v. Hopkins

788 F. Supp. 295, 1991 U.S. Dist. LEXIS 19970, 1991 WL 328779
CourtDistrict Court, S.D. Mississippi
DecidedJanuary 14, 1991
DocketCiv. A. J89-0350(W)
StatusPublished
Cited by7 cases

This text of 788 F. Supp. 295 (Golden Rule Insurance v. Hopkins) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Golden Rule Insurance v. Hopkins, 788 F. Supp. 295, 1991 U.S. Dist. LEXIS 19970, 1991 WL 328779 (S.D. Miss. 1991).

Opinion

MEMORANDUM OPINION AND ORDER

WINGATE, District Judge.

I. CASE

This lawsuit was heard before the court sitting without a jury on October 25 and 26, 1990. The court has jurisdiction over this case on diversity grounds pursuant to 28 U.S.C. § 1332. 1 The parties in the suit are the plaintiff, Golden Rule Insurance Company (hereinafter referred to as “Golden Rule”), and the defendant, Brian Keith Hopkins (hereinafter sometimes referred to as “Hopkins”). Plaintiff is a company incorporated under the laws of and operating its principal place of business in the State of Illinois. Brian Hopkins was an adult citizen of the State of Mississippi. After the death of Hopkins, his mother (hereinafter referred to as “Ms. Hopkins”), acting as the administrix of his estate, was substituted as the proper party in this action. By its lawsuit, plaintiff Golden Rule asks this court to hold that on account of alleged material misrepresentations within the application form by Hopkins, Golden Rule may now rescind its health insurance policy between it and Hopkins, rendering the policy null and void. In response, alleging that Golden Rule has breached its contract, Hopkins countersued for full payment of medical expenses under said policy, plus $50,000 in punitive damages for Golden Rule’s alleged bad faith efforts to terminate the policy. However, Hopkins’ counterclaim for bad faith and his associated claim for punitive damages were subsequently dismissed via Golden Rule’s summary disposition motion. Thus, only Hopkins’ counterclaim for breach of contract remains before the court for resolution.

II. STATEMENT OF FACTS

On September 29, 1989, Brian Hopkins died from complications arising from Acquired Immune Deficiency Syndrome (hereinafter referred to as “AIDS”). Previously, on June 27, 1987, Hopkins had submitted an application to Golden Rule for Individual Inflation Guard Major Medical Expense Policy and Decreasing Term Life Insurance Rider. Based on the contents of this application, which only revealed a medical history consisting of surgery to remove tonsils and hemorrhoids, Golden Rule issued policy No. 052324922 in Hopkins’ name.

On October 24, 1988, the defendant was hospitalized at the Mississippi Baptist Medical Center (hereinafter referred to as “MBMC”). During his stay at the hospital, Hopkins was diagnosed as suffering from pneumocystic fever, diseases of the lungs, unspecified mycoses, cavitary lung disease with fungal infection, functional heart murmur, and AIDS. Medical expenses incurred in connection with the treatment and diagnosis of defendant’s health condition were submitted to Golden Rule under its issued policy. This was the first of several times that Hopkins would be admitted to MBMC in order to receive treatment for his fatal condition. Hopkins was hospitalized at MBMC from December 29, 1988, through January 12, 1989, and again from February 7, 1989, through February 24, 1989. Between October 24,1988, and January 30, 1989, Golden Rule paid a total of $6,553.34 in claims for medical expenses arising from defendant’s hospitalizations during that same period.

On February 15, 1989, Golden Rule informed Hopkins that prior to the expiration of the policy’s two-year contestability period, the insurance company would exercise its right to investigate his medical history to determine if a full and complete history had been reported on the application for insurance. As a result of said investiga *298 tion, Golden Rule has refused to pay for any further medical expenses which were incurred by Hopkins until the court makes a decision concerning the validity of the issued policy.

III. GOLDEN RULE CONTENTIONS

On June 20, 1989, Golden Rule filed a complaint for declaratory judgment against the defendant Hopkins. Golden Rule wants the Court to clarify the parties’ rights and obligations under the health insurance policy which was issued to Hopkins, or alternatively, to rescind the disputed policy because the determinative application submitted by Hopkins contained material misrepresentations precluding further inquiry into pre-existing conditions. Defendant answered “no” to questions 15(a), (b), (c), and (f) on the application for health insurance which asked whether the applicant had had within the last ten years, any indication, diagnosis, or treatment of the following conditions: heart murmur, growth of any kind, skin disorder or disease, immune deficiencies, sexually transmitted disease, or any disorder of the glands. In response to application questions 19, 20, and 21, which requested information about any past surgery, defendant only reported a tonsillectomy performed by Dr. George E. Abraham in 1980 and a hemorrhoidectomy by Dr. John P. Culpep-per in 1984.

Golden Rule contends that prior to submission of an application, Hopkins had suffered from the following health conditions: (1) a history of skin disorders; (2) a diagnosed heart condition (mitral valve prolapse and heart murmur); (3) a history of chronic lymphadenopathy; (4) past surgery for removal of rectal warts (sometimes referred to by the medical term-“condylomata acu-minata”); and (5) a history of positive testing of the Human Immunodeficiency Virus (hereinafter referred to as “HIV”). Golden Rule says since these health conditions were not mentioned in the application for the insurance policy, such nondisclosures amounted to material misrepresentations when: (a) the knowledge that defendant had a prior heart condition and problem with his lymph nodes would have triggered other concerns of Golden Rule; (b) the knowledge of the surgery for the rectal warts would have prompted Golden Rule to attach an indefinite rider for sexually transmitted diseases; and (c) the knowledge that defendant had tested HIV positive or exhibited indications of an immune system deficiency would have caused Golden Rule to decline to insure Hopkins at the time he applied for such insurance. Golden Rule supports its position that Hopkins was HIV positive by citing to the recurrent episodes of skin disorders, of sore throats and swollen lymph glands, and of rectal warts (a sexually transmitted disease). Taken together, these symptoms indicated an immune system deficiency, says Golden Rule.

Golden Rule requested and received pursuant to defendant’s authorization, copies of his medical reports from physicians who had treated him in the past. In 1983, Dr. Hilton H. Sessums and Dr. Barry M. Holcomb treated defendant for the skin disorders of urticaria and tinea cruris. That same year, as part of a preparation examination for the tonsillectomy, Dr. Holcomb discovered that Hopkins had a mitral valve prolapse, accompanied by a pulmonary outflow murmur. Dr. Holcomb wrote in his consultation note that this condition would require “follow-ups every 6 months or so.” In 1984 and 1985, Hopkins received treatment at the Urgent Care Center in Hatties-burg, Mississippi, for sore throat and swollen lymph nodes. After this lawsuit was filed, Golden Rule received medical reports from Dr. Culpepper which revealed that in January 1986, in conjunction with the hem-orrhoidectomy operation, defendant had undergone surgery to remove rectal warts. The medical records confirmed that Hopkins had received subsequent follow-up treatment for this same condition. Also contained in these records was a discharge summary by Dr. William A.

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788 F. Supp. 295, 1991 U.S. Dist. LEXIS 19970, 1991 WL 328779, Counsel Stack Legal Research, https://law.counselstack.com/opinion/golden-rule-insurance-v-hopkins-mssd-1991.