Koin v. Mutual Benefit Health & Accident Ass'n

41 P.2d 306, 96 Colo. 163, 1935 Colo. LEXIS 375
CourtSupreme Court of Colorado
DecidedJanuary 7, 1935
DocketNo. 13,395.
StatusPublished
Cited by2 cases

This text of 41 P.2d 306 (Koin v. Mutual Benefit Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Koin v. Mutual Benefit Health & Accident Ass'n, 41 P.2d 306, 96 Colo. 163, 1935 Colo. LEXIS 375 (Colo. 1935).

Opinion

Mr. Justice Hilliard

delivered the opinion of the court.

This is an action on a health and accident policy. A jury returned a verdict in favor of the insuring company, and to judgment entered thereon plaintiff assigns error.

The policy, issued November 1, 1929, insured against loss of time—fixing the rate and duration of payment— “resulting from disease, the cause of which originates thirty days after the date of this policy.” The application, a copy of which was attached to and made part of the policy, contained the following questions and answers: “Are you sound physically and mentally?” “Yes.” “Have you received medical or surgical advice or treatment or had any local or constitutional disease within the past five years?” “No.” “Do you hereby apply to the Mutual Benefit Health &> Accident Association for a policy to be based upon the foregoing statements of facts, and do you understand and agree that the falsity of any statement in this application shall bar the right to recover if such false statement is made with intent to deceive or materially affects either the acceptance of the risk or the hazard assumed by the Association, and do you agree to notify the Association promptly of any change in your occupation, or if you take additional insurance, and do you hereby authorize any physician or other person who has attended or may attend you to disclose any information thus acquired?” “Yes.”

*165 Plaintiff claimed total disability, due “solely as a result of disease, to-wit, multiple sclerosis,” wbicb he sets forth in three counts, alleging in the first, disability from June 4,1931; in the second, from February 1,1932; and in the third, from July 14, 1932. In separate defenses, the company alleged that the contract was obtained through plaintiff’s active fraud and wilful deceit, and that if plaintiff suffered from sclerosis, as he alleged, it was the result of an accident suffered by him before applying for the policy, a fact he fraudulently and falsely concealed, which concealment was material to the risk; that the policy was issued pursuant to plaintiff’s written application, in which appeared the questions and answers already quoted. The company alleged the fact and plaintiff’s knowledge of the falsity of the statement, and his expectation that it would be believed to be true, and which the company did believe, and on which it acted. Further answering’ it said that had plaintiff answered truthfully, the defendant would not have issued said policy ; that in fact at the time plaintiff made such answers he had previously sustained an accident from which he was then suffering, a fractured cervical vertebra, which it is alleged is the true and proximate cause of the disorder from which he is now suffering, to wit, transverse myelitis; that said condition was concealed; that a pressure was exerted upon the spinal cord of plaintiff, which fact was also concealed by him from the defendant by said application. Plaintiff replied in general denial.

It appears that June 7, 1925, plaintiff, diving in a lake, struck the bottom so violently that he suffered a fracture of the fifth cervical vertebra, partial paralysis resulting; that for a time he was confined in a hospital and longer still at his home, being attended by physicians and receiving medical attention and treatment; that although at the end of a yfear plaintiff was so far recovered as to be able to work in his father’s store and later still in a store of his own, it is undisputed that in 1927 he was examined relative to the injury by three Denver physicians; that an *166 other-Denver physician and two of those who examined plaintiff in 1927, examined him in 1933, and testified to the effect that the illness for which he claimed compensation was attributable to the injury of 1925. In an application for disability benefits made November 16, 1932, to another insurance company, plaintiff stated that his health was first affected June 7, 1925. In February, 1932, plaintiff was examined in the Methodist Hospital, Indianapolis, and final diagnosis there showed “transverse myelitis,” the probable cause being, “Old fracture, cervical vertebra. Last few weeks has acute cord condition involving right side especially right arm.”

On the other hand, physicians testified that prior to his application for the policy on which recovery is sought, plaintiff had fully recovered from the injury of 1925, and that the illness on which he based his claim originated more than thirty days after the date of the policy. Not only so, but laymen testified to the work plaintiff had done, his mountain climbing* and other physical accomplishments, occurring after the injury of 1925, both before and subsequent to the date of the policy, all tending to indicate his recovery from that injury. Pictures of plaintiff taken at various times and places, in many poses, all indicating strength and vigor, were introduced. In addition to what plaintiff’s witnesses deposed, he himself testified at length as to his condition, relating many physical activities in which he had engaged, and attested his belief that before he took out the policy sued on, he had fully recovered from the injury of 1925.

In illuminating instructions, none objected to by plaintiff, and in addition to which neither party made request, the court submitted for jury determination the question of whether the illness from which plaintiff was suffering originated thirty days after November 1, 1929, the date of the policy, or prior to the date thereof. In a formal verdict the jury made return to the effect that plaintiff’s illness antedated the policy. Preceding the *167 judgment, plaintiff’s motions for judgment notwithstanding the verdict and for new trial were denied.

We discuss the two principal propositions presented by plaintiff. The first is based on the contention that the company’s agent taking the application had knowledge of the injury which plaintiff had suffered in 1925, and although such fact was not disclosed in the written answer to a question fairly calling for disclosure, the agent’s knowledge operated to estop the company from claiming it was deceived to its undoing. Both plaintiff and the agent testified to the agent’s knowledge of the injury. It appears' that when the agent was making out the application, plaintiff was so busy in the store which he was operating, that he gave only slight attention to the questions and answers, all answers being written by the agent; that the agent of his own motion, without asking the questions material to this inquiry, wrote answers that were untrue, based, as he testified, on his belief that plaintiff had fully recovered from the injury. If this were the entire story the case might be said to come within the doctrine announced by Colorado decisions, the cases resting on varying facts, to the general effect that an insurance company may not be heard to say it was not apprised of what its agent knew. See New York Life Ins. Co. v. Fukushima, 74 Colo. 236, 220 Pac. 994; Northwestern M. L. I. Co. v. Farnsworth, 60 Colo. 324, 153 Pac. 699; Pacific Life Co. v. Van Fleet, 47 Colo. 401, 107 Pac. 1087. But there is more to the record. After the soliciting agent had made his own answers to the controlling* questions, clearly false, plaintiff was still so occupied with his merchandising duties that he could neither look at the prepared application nor pause to sign it.

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Cite This Page — Counsel Stack

Bluebook (online)
41 P.2d 306, 96 Colo. 163, 1935 Colo. LEXIS 375, Counsel Stack Legal Research, https://law.counselstack.com/opinion/koin-v-mutual-benefit-health-accident-assn-colo-1935.