Hays v. Jackson National Life Insurance

105 F.3d 583
CourtCourt of Appeals for the Tenth Circuit
DecidedJanuary 27, 1997
Docket96-5089
StatusPublished
Cited by2 cases

This text of 105 F.3d 583 (Hays v. Jackson National Life Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hays v. Jackson National Life Insurance, 105 F.3d 583 (10th Cir. 1997).

Opinion

STEPHEN K. ANDERSON, Circuit Judge.

Plaintiffs are beneficiaries of James T. Hays under a life insurance policy issued by Jackson National Life Insurance Company. In this diversity action, they appeal the district court’s order granting Jackson National summary judgment on plaintiffs’ contract and tort claims, which generally alleged that Jackson National wrongfully refused to pay death benefits under the policy. Jackson National denied payment because of alleged misrepresentations and omissions on the insurance application regarding Mr. Hays’ medical history.

We hold that Oklahoma law requires a finding that the insured intended to deceive the insurer before a misrepresentation or an omission on an insurance application can serve as grounds for nonpayment. Because a genuine issue of material fact exists with respect to Mr. Hays’ intent, we reverse the dismissal of the breach of contract claim. We affirm, however, the dismissal of plaintiffs’ bad faith, outrage, and reformation claims.

BACKGROUND

In the fall of 1991, with the help of Jackson National’s agent, Mr. Hays completed an application for a Jackson National life insurance policy. Part Two of the application required Mr. Hays’ responses to a series of questions regarding his medical history. The agent filled out Part Two based on responses provided by Mr. Hays. Part Two contains the following pertinent questions and answers:

3. Have you, in the past five years:
*585 a. Consulted or been treated by a phy-sieian or other medical practitioner? Yes
c. Had an electrocardiogram, X-ray or other diagnostic test? No
d. Been advised to have any diagnostic test, hospitalization, or surgery which was not completed? No

Appellants’ App. Vol. I at 39. The application instructed Mr. Hays to provide the following explanatory details with respect to any “yes” response: the diagnosis and treatment; the results; the dates and durations; and the names and addresses of all attending physicians and medical facilities. Having answered “yes” to question 3.a., Mr. Hays provided these details: “S.a.1967 — Ulcer operation — Dr. Meekly — Sacramento, CA.” Id. The only other information disclosed on Part Two relating to Mr. Hays’ medical history is the name, address, and telephone number of his personal physician, Dr. Martin, along with a notation that Mr. Hays last consulted Dr. Martin for a broken right foot.

Two days after Mr. Hays and the agent completed Part Two, Jackson National sent a paramedic to Mr. Hays’ home to complete Part Three — the “Medical Examination Report.” On Part Three, in response to the same questions posed on Part Two, Mr. Hays again mentioned the 1967 ulcer operation, explaining that it was a gastric resection which had required ten to twelve days in the hospital. He also stated that he wore corrective lenses; that in 1990 he sprained his knee skiing; that he had recently broken his right foot; and, finally, that in 1989 he had had a complete physical by Dr. Martin with normal results. Mr. Hays signed both Part Two and Part Three.

Jackson National issued Mr. Hays a $500,-000 life insurance policy on November 8, 1991. Approximately five months later, Mr. Hays was diagnosed with' cancer of the esophagus. He died from that cause on August 31,1992. 1

After plaintiffs made their claim on the policy, Jackson National discovered that Mr. Hays had not provided information on the application relating to the condition of his esophagus. Medical records' show that between -1989 and 1991 Mr. Hays had his esophagus examined on at least four occasions by three different doctors. During these examinations, Mr. Hays underwent an esophagram, three EGDs, 2 and multiple biopsies of the esophagus. The examinations revealed an esophageal ulcer, and Mr. Hays was diagnosed with Barrett’s Esophagus. 3 The biopsies proved negative for cancer, but at least two different doctors informed Mr. Hays that regular surveillance of his esophagus would be required. 4 Based on Mr. Hays’ failure- to disclose any of this information, Jackson National refused to pay benefits under the policy and returned all premiums to plaintiffs.

Plaintiffs filed suit, claiming breach of contract, bad faith, outrage, and reformation. Jackson National moved for summary judgment, arguing that Mr. Hays’ failure to disclose the information relating to! his esophagus entitled "Jackson National to refuse payment under Okla. Stat. Ann. tit. 36, § 36Ó9. 5 Jackson National argued that had *586 it known Mr. Hays’ true medical history, it would have denied coverage or issued a different policy, citing its underwriting manual which instructs that applicants with Barrett’s Esophagus should have their applications rated, or denied, depending on the adequacy of medical follow-up.

In reply, plaintiffs argued there were several genuine issues of material fact precluding summary judgment. Plaintiffs asserted that Mir. Hays’ response to question 3.a. (on Part Two) disclosed he had been treated within the last five years in relation to his 1967 ulcer operation. They claimed Mr. Hays’ esophageal problems were directly related to that ulcer operation. Therefore, they reasoned, the response to 3.a. was not a misrepresentation, but was in fact sufficient to impose upon Jackson National an affirmative duty to conduct its own investigation before issuing a policy, a' duty which es-topped Jackson National from relying on inadequacies in the application.

In a connected argument, plaintiffs contended that the agent who filled out the application was a personal friend of Mr. Hays and knew more about Mr. Hays’ health than disclosed oh the application. They claimed the agent told Mr. Hays that his responses on the application were sufficient because Jackson National would contact Dr. Martin and conduct its own investigation. Finally, plaintiffs argued that in order for Jackson National to rely upon section 3609 as a defense, it had to prove that Mr. Hays made the misrepresentations or omissions with an intent to deceive. They claimed that a genuine issue of material fact existed with respect to Mr. Hays’ intent in providing information on the application.

The district court held that Oklahoma law did not require Jackson National to prove an intent to deceive. Appellants’ App. Vol. II at 558. The court noted that section 3609 refers to omissions that are fraudulent or material, not fraudulent and material. Therefore, the court held that Jackson National need only prove Mr. Hays “knew or should have known that he omitted facts from his application which were material to Defendant’s acceptance of the risk.” Id. at 558-59.

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Related

United States v. Alejandro Gonzalez
683 F.3d 1221 (Ninth Circuit, 2012)
Hays v. Jackson National Life Insurance Company
105 F.3d 583 (Tenth Circuit, 1997)

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105 F.3d 583, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hays-v-jackson-national-life-insurance-ca10-1997.