Kern v. John Hancock Mutual Life Insurance

8 A.D.2d 256, 186 N.Y.S.2d 992, 1959 N.Y. App. Div. LEXIS 8373
CourtAppellate Division of the Supreme Court of the State of New York
DecidedJune 2, 1959
StatusPublished
Cited by7 cases

This text of 8 A.D.2d 256 (Kern v. John Hancock Mutual Life Insurance) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kern v. John Hancock Mutual Life Insurance, 8 A.D.2d 256, 186 N.Y.S.2d 992, 1959 N.Y. App. Div. LEXIS 8373 (N.Y. Ct. App. 1959).

Opinion

Botéis, P. J.

Plaintiffs, as trustees of a welfare fund, appeal from an order which set aside a jury verdict of $22,292.34 in their favor and dismissed their complaint, and from the judgment for the defendant entered thereon.

Under a uniform collective bargaining* agreement between a union and a group of employers who were members of a trade association, the employers undertook to provide and maintain at their own expense life, accident and sickness, and hospital expense insurance policies covering approximately 6,500 employees. Appellants were designated as trustees and entrusted with funds furnished by the employer contributors, to be used for the acquisition and maintenance of group insurance for the employees.

The trustees procured from defendant, a Massachusetts mutual life insurance company authorized to do business in New York, a one-year group policy commencing* December 1, 1946, and subject to .annual renewal Premiums were paid monthly, varying with the fluctuations in the number of employees covered. At the end of each year, there was refunded to the trustees a sum which represented the excess of premiums paid over claims expense and administrative charges, in accordance with a policy provision which read: ‘ ‘ Annual Surplus Distribution. On each policy anniversary following a year during which this Policy shall have been in force there shall be distributed hereon such share of a divisible surplus as may be apportioned hereto by the Company.”

In 1951 the union demanded of the employers’ association that the scope of the coverage be broadened, and the trustees made inquiry to ascertain whether this could be done by defendant. Before a definitive answer was forthcoming the trustees informed defendant, in October, 1951, that the employers had acceded to the union’s demand and .that expanded coverage would be required. The existing policy was due to expire at the end of November. As the parties were still in the process of negotiating for the broadened coverage, the trustees demanded an interim renewal of the existing policy, with all the same rights, privileges and benefits, on a month-by-month basis. Defendant wrote a letter to plaintiffs on November 16, 1951, summing up the results of a previous discussion. The letter stated: “As the renewal date of your policy is December 1st, and obviously some time will be required to work out the details of a new plan, we offered to renew on its current terms on a month by month basis until you and we can reach the necessary decisions to implement the desired future course of action.” (Emphasis supplied.)

[259]*259Accordingly, plaintiffs continued paying premiums for the months of December, 1951 and January, February and March, 1952. Finally, when it appeared defendant was unable to supply the requested coverage, plaintiffs terminated their policy as of March 31, 1952 and obtained the desired insurance elsewhere.

When asked by plaintiffs to return the excess of premiums paid over the cost of the insurance, as had been done in every previous year, defendant refused because the renewed policy had not been in force for an entire year. This lawsuit thereupon ensued. The jury found plaintiffs were entitled to a refund of a proportionate share of the divisible surplus apportioned by defendant. The trial court, however, set aside the verdict on the ground that under section 216 of the Insurance Law, the policy language purporting to comply therewith and the annual resolution of the defendant’s board of directors apportioning the surplus, any policy which was terminated prior to its yearly anniversary date could not share in the year-end surplus distribution.

The procedure of mutual life insurance companies with respect to return of premiums to policyholders has been discussed at length in Penn. Mut. Co. v. Lederer (252 U. S. 523) and cases cited therein. While the annual return to the policyholder of part of the premium he has paid is generally called a dividend ”, it is not analogous to the distribution of profits to stockholders of a profit-making organization. The initial premium paid a mutual insurance company represents the estimated cost of the policy, with an adequate margin for reserves and charges. When these sums have been more definitively ascertained at the end of a year of operations, the company is required by section 216 of the Insurance Law to return the excess premium to the policyholder, in the form of a distribution of “ divisible surplus.”

The declaration of a dividend upon a policy reduces pro tanto the cost of insurance to the holder of the policy. That is its purpose and effect.” (Rhine v. New York Life Ins, Co., 273 N. Y. 1, 13; see, also, Matter of Toeplitz, 205 Misc. 869, 871; Wells v. Metropolitan Life Ins. Co., 171 Misc. 878, affd. 258 App. Div. 986.) The annual distribution of surplus, then, is not akin to a division of profits among stockholders of record at the year’s end. It is in actuality an adjustment of the premium — an adjustment contemplated by the parties to the policy — between the amount estimated at the year’s beginning to be ample to cover all contingencies and the amount found actually to have been necessary in retrospect (Scholem v. Prudential Ins. Co., 172 Misc. 664). After computation of the net premium the [260]*260dividend represents return of excess. Such insurance is actually sold on a net. cost basis; and prospective purchasers of policies are assured that the actual insurance costs may be considerably less than the stated premium.

Thus, in every previous period, after payment of claims, defendant had retained approximately 10% of the total premium to cover overhead and expenses and had returned the balance to plaintiffs. If it were not required to make any distribution of surplus to plaintiffs for the four-month period of renewals, defendant would retain 25% of the premium paid and no part thereof would be returned to the plaintiffs. If this were so, and had this been brought to the attention of the trustees, it is extremely unlikely that they would have continued negotiating with the defendant when they knew that the coverage they desired was available elsewhere and every extension of time granted to the defendant would cost them additional money.

The policy, which was renewed monthly on its current terms ”, included the provision that a share of the divisible surplus was to be distributed ‘1 On each policy anniversary following a year during which this Policy shall have been in force ’ \ Where language in an insurance policy is susceptible of varying interpretations, familiar rules of construction call for the resolution of such ambiguities in a manner most favorable to the insured. The language employed by the insurer here can reasonably be taken to mean that the policy having been in force for a period of four months during the year following the last policy anniversary, plaintiffs would be entitled to a share of the divisible surplus. More to the point, upon the trial the issue was presented squarely to the jury as to whether the parties hereto had agreed that the right to dividend distribution would be retained on the month-to-month renewals of the policy. The jury by its verdict answered in the affirmative.

The term of each renewal policy was one month.

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Bluebook (online)
8 A.D.2d 256, 186 N.Y.S.2d 992, 1959 N.Y. App. Div. LEXIS 8373, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kern-v-john-hancock-mutual-life-insurance-nyappdiv-1959.