Kaufman v. Mutual of Omaha Ins. Co.

681 So. 2d 747, 1996 WL 425720
CourtDistrict Court of Appeal of Florida
DecidedJuly 31, 1996
Docket94-1233
StatusPublished
Cited by12 cases

This text of 681 So. 2d 747 (Kaufman v. Mutual of Omaha Ins. Co.) is published on Counsel Stack Legal Research, covering District Court of Appeal of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kaufman v. Mutual of Omaha Ins. Co., 681 So. 2d 747, 1996 WL 425720 (Fla. Ct. App. 1996).

Opinion

681 So.2d 747 (1996)

Jane KAUFMAN, individually and as mother, next friend and natural guardian of Laurel Kaufman, a minor child, Appellant,
v.
MUTUAL OF OMAHA INSURANCE COMPANY, Appellee.

No. 94-1233.

District Court of Appeal of Florida, Third District.

July 31, 1996.

*748 H.C. Starkweather, Miami Springs, for appellant.

Magill & Lewis and R. Fred Lewis, Miami, for appellee.

Before BARKDULL, COPE and GODERICH, JJ.

CORRECTED OPINION

COPE, Judge.

Jane Kaufman appeals an adverse summary final judgment. We reverse.

I.

On March 27, 1991, appellee Mutual of Omaha ("the insurer") issued a major medical insurance policy to appellant Jane Kaufman (the "insured" or the "mother"). Ms. Kaufman, a widow, purchased the policy to provide coverage for her 14-year-old daughter. The policy would provide reimbursement for medical or hospitalization expense after a $2,000 deductible was satisfied.

Two years and forty-five days after the policy was issued, the insurer delivered a letter to the insured which purported to rescind the policy and which returned the premiums the insured had paid. The insurer asserted that there were fraudulent misstatements in the application. The insurer took the position that under a provision of the incontestability clause contained in the insurance policy, the insurer was entitled to void the coverage even though the basic two-year incontestable period had expired.

The mother brought suit for (I) declaratory judgment; (II) reinstatement of the insurance contract; (III) breach of contract; and (IV) outrageous conduct causing severe emotional distress. The mother asserted that the insurance policy was in conflict with section 627.607, Florida Statutes (Supp.1992).[1] She contended that when the policy was brought into conformity with Florida law, the insurer had no right to cancel the policy. Alternatively, she asserted that if the insurer did have the right to cancel, there were in any event no fraudulent misstatements.

The trial court granted summary judgment for the insurer and the mother has appealed.

II.

The parties agree that under Florida law, this medical insurance policy must have an *749 incontestability clause. See § 627.607, Florida Statutes (Supp.1992). The Insurance Code requires the insurer to choose one of two statutory alternatives. The insurer can select subsection (1), or subsection (2), but not both.[2]

The insurance policy actually issued in this case impermissibly combines alternatives (1) and (2).[3] Although the statute requires the insurer to select either alternative 1 or alternative 2, the insurer has selected elements of both. The insured is correct in saying that this insurance policy provision violates Florida law.[4]

If an insurance policy does not comply with the Insurance Code, the policy is to be construed in a way which brings it into compliance:

627.637. Construction of noncomplying contracts
If any insurer writes or issues in this state any health insurance contract, as contemplated by this chapter, and the form of such contract is not authorized by or in conformity with the provisions of this chapter, the contract shall nevertheless be a valid and binding contract of the insurer, and shall be construed as though its terms and provisions were in conformity with those required by this chapter, any provision in the contract to the contrary notwithstanding.

§ 627.637, Fla. Stat. (1991)(emphasis added); see also 18 Couch on Insurance 2d § 72:22, at 296-97 (Rev. ed.1983). Likewise, the insurance policy itself states that if it varies from state law, the policy is amended to conform to state law.

How, then, should the policy be modified? The policy can be corrected by reading it to include solely subsection (1)(the alternative favorable to the insurer), or solely subsection (2)(the alternative desired by the insured).

The Florida Supreme Court has said that "[i]ncontestability clauses in insurance policies are favored in the law, and the courts are ever ready to construe them, if possible, in favor of the insured." Prudential Ins. Co. v. Prescott, 130 Fla. 11, 176 So. 875, 878 (1937); see also Winer v. New York Life Ins. Co., 140 Fla. 534, 190 So. 894, 900-01 (1938)(construing incontestability clause); Prudential Ins. Co. v. Prescott, 115 Fla. 365, 156 So. 109, 111-12 (1933)(same); Aetna Life & Casualty Co. v. Thorn, 315 So.2d 219, 221 (Fla. 3d DCA 1975)(same); Prudential Ins. Co. v. Rhodriquez, 285 So.2d 689, 690 (Fla. 3d DCA 1973)(same); 31 Fla. Jur.2d Insurance § 659 (1981). The alternative must be chosen which is the most favorable to the insured, subsection (2).

*750 As a matter of law, therefore, the insurance policy must be deemed to read as follows:

Incontestable:
(a) Misstatements in the Application: After this policy has been in force for 2 years during the insured's lifetime (excluding any period during which the insured is disabled), the insurer cannot contest the statements in the application.
(b) Preexisting Conditions: No claim for loss incurred or disability starting after 2 years from the issue date will be reduced or denied because a sickness or physical condition, not excluded by name or specific description before the date of loss, had existed before the effective date of coverage.

§ 627.607(2), Fla. Stat. (Supp.1992). Under this alternative, the policy is incontestable after two years.

No action was taken by the insurer to rescind this insurance policy until after the two-year time period had run. Consequently, the insurance policy had become incontestable and the insurer was not allowed to rescind it on the basis of alleged misstatements in the insurance application.[5] The summary judgment must be reversed. The insured is entitled to a declaratory judgment stating that the purported rescission by the insurance company was legally ineffective, and that the insurance policy remains in force.[6]

III.

The insurance company appears to argue alternatively that even if the incontestability clause precluded outright rescission of this policy, the insurer is nonetheless allowed to refuse coverage for preexisting conditions.

The insurance policy contains a preexisting condition limitation as follows:

PREEXISTING CONDITION LIMITATION

Subject to the Time Limit on Certain Defenses provision, preexisting conditions are not covered unless disclosed on the application and not excluded by name or specific description. A preexisting condition is a condition misrepresented or not shown in your application for which medical advice or treatment was recommended by or received from a physician prior to the Policy Date.

(Emphasis added). Under this provision, coverage can be denied for a preexisting condition "for which medical advice or treatment was recommended by or received from a physician prior to the Policy Date," in this case March 27, 1991.

The prohibition on preexisting conditions is, however, "subject to the Time Limit on Certain Defenses provision." The "Time Limit on Certain Defenses provision" is, of course, the incontestability clause considered earlier in this opinion. As determined above, properly construed it provides in relevant part:

*751

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Cite This Page — Counsel Stack

Bluebook (online)
681 So. 2d 747, 1996 WL 425720, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kaufman-v-mutual-of-omaha-ins-co-fladistctapp-1996.