Inter-Ocean Insurance Company v. Ross

315 S.W.2d 71, 1958 Tex. App. LEXIS 2125
CourtCourt of Appeals of Texas
DecidedJune 6, 1958
Docket15919
StatusPublished
Cited by14 cases

This text of 315 S.W.2d 71 (Inter-Ocean Insurance Company v. Ross) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Inter-Ocean Insurance Company v. Ross, 315 S.W.2d 71, 1958 Tex. App. LEXIS 2125 (Tex. Ct. App. 1958).

Opinion

BOYD, Justice.

James S. Ross recovered judgment against Inter-Ocean Insurance Company for $270.05 hospital insurance, and for penalties, interest and attorney’s fees. Appellant defended on the ground that the policy had been obtained by false representations in the application, as appellee represented that neither he nor any member of his family had any hospital insurance at the time, when, in *73 truth and in fact, appellee had a number of hospital insurance policies which provided for about $44 per day in benefits should he be confined in a hospital. Appellant pleaded that if truthful answers had been made to the questions in the application as to other insurance, it would not have issued the policy. Trial was to the court, and findings of fact and conclusions of law were made and filed.

The material parts of the application are as follows:

“I hereby apply to the Inter-Ocean Insurance Company, Cincinnati, Ohio, for a policy of insurance and for that purpose make the following statements. * * * 6. Do you, or any member, have hospital insurance? (If so, who and in what company and what amount) No. * * * In applying to the Inter-Ocean Insurance Company for this insurance I agree that it shall be based upon the above representation of facts. * * * (Signed) James S. Ross.”

The application was attached to and made a part of the policy.

The court found that appellee’s answer to the question as to whether he or any member of his family had hospital insurance was false, but that it was not material to the risk and did not actually contribute to the contingency or event which matured the claim; it was further found that prior to the making of the application, appellant’s agent delivered to appellee literature explaining the advantages of its policy, which contained these words: “Pays in addition to Workmen’s Compensation, group insurance and other insurance in force”; that a similar statement appeared in the receipt for the application and the first premium; and that if the representation were material, appellant “expressly waived the same in writing when on his receipt for the money he paid for his premium, the company agreed to pay the sums provided in said policy in addition to workmen’s compensar tion insurance and other insurance.” It was concluded that the false representation did not void the policy.

Appellee concedes that he never pleaded or relied upon a waiver or estoppel and makes no contention with reference to appellant’s Point 4 that in the absence of a plea of waiver or estoppel it was error to base a judgment for appellee on that theory.

The test of materiality is said to be whether knowledge of the true facts would have influenced a prudent insurer in determining whether to accept the risk, or in fixing the amount of premiums. 24-B Tex. Jur. p. 417, sec. 187; 45 C.J.S. Insurance § 595, subd. (3), p. 406; Aetna Life Ins. Co. v. King, Tex.Civ.App., 208 S.W. 348, writ refused. “If the applicant makes statements that are material, which are untrue, it will avoid the policy, unless the company knew that those identical statements were untrue.” Franklin Life Ins. Co. v. Dossett, Tex.Civ.App., 265 S.W. 259, 262. Although this case was reversed by the Commission of Appeals on other grounds, the above statement of the law was expressly approved. Dossett v. Franklin Life Ins. Co., Tex.Com.App., 276 S.W. 1097. See, also, Fidelity Mutual Life Ins. Ass’n v. Harris, 94 Tex. 25, 57 S.W. 635; Indiana & Ohio Live Stock Ins. Co. v. Smith, Tex.Civ.App., 157 S.W. 755, writ refused.

The general rule seems to be that a statement in an application for insurance as to the existence of other insurance is material as a matter of law, and- if false, it voids the policy. Guinn v. Phoenix Ins. Co. of Brooklyn, Tex.Civ.App., 31 S.W. 566; Mutual Life Ins. Co. v. Ford, 61 Tex.Civ.App. 412, 130 S.W. 769, writ refused; 29 Am.Jur., p. 477, sec. 587. Also, a statement by an applicant as to prior applications or rejections is material as a matter of law-, and if false, voids the policy regardless of the good faith of the applicant and regard,less of whether the statement constitutes actual fraud. State Mutual Life Ins. Co. v. Rosenberry, Tex.Com.App., 213 S.W. 242; 29 Am.Jur., p. 475, sec. 586. It has been *74 ' held that a false statement in an application for accident insurance that applicant has never received indemnity for any accident or sickness, except on one occasion, is material to the risk and avoids the policy, notwithstanding a statute providing that such 'statements shall be regarded as representations and shall not avoid a policy unless material to the risk. Union Indemnity Co. v. Dodd, 4 Cir., 21 F.2d 709, 55 A.L.R. 735.

’ “And, on the other hand, it does not disprove that a fact may have been material to the risk because it had no actual subsequent relation to the manner in which the .event insured against did occur.” Penn Mutual Life Ins. Co. v. Mechanics’ Savings Bank & Trust Co., 6 Cir., 72 F. 413, 429, 38 L.R.A. 33. See, also, Ohio Casualty Ins. Co. v. Stewart, Tex.Civ.App., 76 S.W.2d 873; Jeffries v. Economical Mutual Life Ins. Co., 22 Wall. 47 89 U.S. 47, 22 L.Ed. 833; Keeton v. Jefferson Standard Life Ins. Co., 4 Cir., 5 F.2d 183; Missouri State Life Ins. Co. v. Guess, 4 Cir., 17 F.2d 450.

In Maniatis v. Texas Mut. Life Ins. Co., Tex.Civ.App., 90 S.W.2d 936, it was held that where the application states that representations were made for the purpose of obtaining- the insurance, it is not necessary to . prove that a false representation was intentionally made -for the purpose of deceiving the insurer. To the same effect is Mutual Life Ins. Co. of New York v. Hilton-Green, 241 U.S. 613, 36 S.Ct. 676, 60 L.Ed. 1202.

In view of the authorities cited, we think appellee’s false representation was material to the risk, and that the policy was thereby invalidated.

We do not think that the fact the literature contained the words, “Pays in addition to Workmen’s Compensation, group insurance and other insurance in force,” dispensed with the necessity of appellee’s telling the truth about his having other hospital insurance. Such insurance was to reimburse appellee for expenses incurred if illness caused his confinement in a hospital. Courts must not aid an insured to convert his policy into a gambling contract, when by false representations he deliberately deceives the insurer into granting excess coverage whereby it becomes profitable to be confined in a hospital. Had appellee told appellant about his other insurance, and had appellant, with knowledge of the facts, issued the policy, or had appellant known the facts were not as represented, another question would be presented. Ordinarily, life insurance is payable in addition to other insurance in force; but truthful answers must be made when an applicant is asked about his other insurance.

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Bluebook (online)
315 S.W.2d 71, 1958 Tex. App. LEXIS 2125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/inter-ocean-insurance-company-v-ross-texapp-1958.