Helfaer v. John Hancock Mutual Life Insurance

51 Misc. 2d 869, 274 N.Y.S.2d 494, 1966 N.Y. Misc. LEXIS 1416
CourtNew York Supreme Court
DecidedOctober 20, 1966
StatusPublished
Cited by5 cases

This text of 51 Misc. 2d 869 (Helfaer v. John Hancock Mutual Life Insurance) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Helfaer v. John Hancock Mutual Life Insurance, 51 Misc. 2d 869, 274 N.Y.S.2d 494, 1966 N.Y. Misc. LEXIS 1416 (N.Y. Super. Ct. 1966).

Opinion

Michael Catalano, J.

Plaintiffs move for summary judgment of $10,000.

Parties agree on the facts. May 8, 1964 deceased applied for life insurance. May 11, 1964 defendant United Funds, Inc., issued its Periodic Investment Plan with insurance to acquire united accumulative fund shares ” number 31-4-22165 in the face amount of $10,000 to deceased and his wife, providing for insurance on the life of the plan holder under a group form policy, which was issued by defendant Hancock. May 27, 1965 deceased died. Claim was made against Hancock on said policy, but on August 6,1965 Hancock denied liability because deceased did not reveal his true medical history as requested in the application for insurance, representing that he had never had any ailment, injury or disease within the last five years which had resulted in his being away from work 10 or more consecutive working days.

Plaintiffs contend that the defense of misrepresentation is not available unless the insured’s application or a copy thereof is returned to the insured or received by him pursuant to sections 142 and 161 of the Insurance Law; such was not done here.

The deceased, himself a physician, was hospitalized in the Buffalo General Hospital May 24 to 26,1961 for two days; June 4 to 16, 1961 for 12 days; June 3 to 12, 1963 for nine days; June 20 to 25, 1964 for five days; March 13 to May 27, 1965, when he died.

While deceased was hospitalized, his attending physician, Dr. Marvin Bloom, states in the hospital progress notes: ‘ ‘ With his knowledge of the fact that he has lymphosarcoma he has requested that sterilization be accomplished. Dr. Milch and Dr. Kutzman and I have agreed to support his request.” Each hospitalization was for lymphosarcoma, from which cause he died.

After being in the hospital from June 4, to 16, 1961, deceased did not return to work for one more week thereafter; after being hospitalized from June 3 to 12, 1963, he did not work for four more weeks thereafter.

Article 7 of the Insurance Law, “ The Insurance Contract,” covers all kinds of insurance (§§ 140-174). “ The term ‘ insurance contract,’ as used in this chapter [Cons. Laws, ch. 28] shall, [871]*871except as provided in subsection two, be deemed to include any agreement or other transaction whereby one party, herein called the insurer, is obligated to confer benefit of pecuniary value upon another party, herein called the insured or the beneficiary, dependent upon the happening of a fortuitous event in which the insured or beneficiary has, or is expected to have at the time of such happening, a material interest which will be adversely affected by the happening of such event. A fortuitous event is any occurrence or failure to occur which is, or is assumed by the parties to be, to a substantial extent beyond the control of either party.” (Insurance Law, § 41, subd. 1.)

Section 46 of the Insurance Law, ‘‘ Kinds of insurance authorized,” provides:

“ The kinds of insurance which may be authorized in this state, subject to the other provisions of this chapter, are set forth in the following paragraphs. * * * Each of the following paragraphs indicates the scope of the kind of insurance business specified therein;

“ 1. ‘ Life insurance, ’ meaning every insurance upon the lives of human beings and every insurance appertaining thereto. The business of life insurance shall be deemed to include the granting of endowment benefits; additional benefits in the event of death by accident or accidental means; additional benefits operating to safeguard the contract from lapse, or to provide a special surrender value, in the event of total and permanent disability of the insured; and optional modes of settlement of proceeds.”

Group life insurance is included within this definition of life insurance;” no specific mention of “ group life insurance ” is made in said section 46, except that it clearly is covered in catchall subdivision 23 of that section: “ ‘ Substantially similar kind of insurance, ’ meaning such insurance which in the opinion of the superintendent is determined to be substantially similar to one of the foregoing kinds of insurance and thereupon for the purposes of this chapter shall be deemed to be included in that kind of insurance.”

Group life insurance is life insurance; it is not substantially similar to any other type of insurance authorized by section 46. (See the 22 varieties contained in section 46.)

Section 204 of the Insurance Law, ‘ Group life insurance defined” * * * provides: “ 1. The term group life insurance, ’ as used in this chapter, shall mean that form of life insurance covering any one of the groups hereinafter specified in this subsection, which is written under a policy issued to the policyholder ah hereinafter defined, and which in all other respects conforms to the requirements of this subsection. The term [872]*872‘ certificate holder/ as used in this chapter in relation to a group life insurance policy, shall mean the person to whom a certificate evidencing such insurance is issued under any such policy, as hereinafter provided. Any life insurance company authorized or licensed to do business in this state may deliver in this state policies of group life insurance only as follows: ”.

Here, the deceased held a certificate evidencing life insurance under a policy held by the Fund and issued by Hancock.

Here, the type of life insurance authorized is the “ optional modes of settlement of proceeds.” (See Insurance Law, § 46, subd. 1.) The certificate issued to the deceased and his widow by the Fund states: ‘ This is to certify that in consideration of the payment by Bertram M. Helfaer (Insured) & Sally A. Helfaer, JTN BOS of (500.00) Dollars to United Funds, Inc., at Kansas City, Missouri (hereinafter referred to as Corporation ’), receipt of which amount is hereby acknowledged, it is hereby agreed that from the net proceeds of any and all payments which may be made hereon”; and under “ Terms and Conditions, ’ ’ the certificate states: 10. Insurance. Arrangements have been made with a life insurance company for insurance on the life of the Planholder under a group form of policy * * * insurance is furnished at group cost . to the Corporation.”

Here, the deceased was called ‘Insured ’ ’ under his certificate, which to him was his policy or evidence of insurance contract, ultimately to be paid by a life insurance company.

Section 142 of the Insurance Law, “ Policy to contain entire contract ” provides: “ 1. Every policy of life, accident or health insurance, or contract of annuity, delivered or issued for delivery in this state shall contain the entire contract between the parties, and nothing shall be incorporated therein by reference to any constitution, by-laws, rules, application, or other writings, unless a copy thereof is endorsed upon or attached to the policy or contract when issued. No application for the issuance of any such policy or contract shall be admissible in evidence unless a true copy of such application was attached to such policy when issued. ’ ’

This statute covers three kinds of insurance; (1) “ Life insurance,” (2) “Annuities,” and (3) “Accident and health insurance,” as defined in section 46 of the Insurance Law. It merely mentions “ the parties ” to the “ entire contract.” No mention is made of “policyholder,” “certificate holder,” “insured,” “ insurer,” “beneficiary,” or the like; they are read into the statute by definition and legislative intent.

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Bluebook (online)
51 Misc. 2d 869, 274 N.Y.S.2d 494, 1966 N.Y. Misc. LEXIS 1416, Counsel Stack Legal Research, https://law.counselstack.com/opinion/helfaer-v-john-hancock-mutual-life-insurance-nysupct-1966.