Life Investors Insurance Co. of America v. Smith

833 P.2d 864, 16 Brief Times Rptr. 831, 1992 Colo. App. LEXIS 221, 1992 WL 110009
CourtColorado Court of Appeals
DecidedMay 21, 1992
Docket91CA0213
StatusPublished
Cited by15 cases

This text of 833 P.2d 864 (Life Investors Insurance Co. of America v. Smith) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Life Investors Insurance Co. of America v. Smith, 833 P.2d 864, 16 Brief Times Rptr. 831, 1992 Colo. App. LEXIS 221, 1992 WL 110009 (Colo. Ct. App. 1992).

Opinion

Opinion by

Judge DUBOFSKY.

Life Investors Insurance Company of America (Life Investors) appeals a district court judgment affirming an adverse decision by the Division of Insurance for the State of Colorado (Insurance Division) in regard to Life Investors misrepresenting the availability of health insurance coverage. We affirm.

In the summer of 1982, Charles Cozza went to work for a construction company. After he began employment, the construction company discontinued its group health insurance coverage for employees. At the request of the employer, John Yannacito, an insurance selling agent (selling agent), spoke to the company’s employees, including Cozza, about the availability of individual health insurance.

The selling agent discussed with Cozza the possibility of obtaining medical/hospitalization insurance for Cozza and his wife, who was then approximately six months pregnant. After some initial discussions, the selling agent contacted Life Investors’ general agent in Colorado, Jerry Campbell (general agent), in regard to insuring the Cozzas. The selling agent informed the general agent that Mrs. Cozza was six months pregnant.

The general agent in turn called Life Investors’ home office and spoke with an employee about obtaining health insurance for the Cozzas. The company employee was not informed concerning the existing pregnancy. However, the general agent then advised the selling agent that health insurance was available for the Cozzas despite the wife’s pregnancy and, as a consequence, the selling agent told the Cozzas that such coverage was available.

Although the selling agent initially told Cozza that the health insurance would not be effective until the policy was approved by Life Investors, he subsequently informed the Cozzas that their expected twin babies would be covered by the policy in the event the children had significant post-delivery problems.

The selling agent provided Cozza with an application for a combination life and health insurance policy with Life Investors. On September 28, 1982, the application was completed by the Cozzas and returned together with the first month’s premium to the selling agent, who in turn gave it to the general agent, who forwarded it to Life Investors. It was received by Life Investors on October 4, 1982, and coverage was denied by the company on October 7, 1982.

On October 17, 1982, Mrs. Cozza prematurely delivered twin boys. On October 18, 1982, the selling agent was notified by Life Investors that it had denied the Cozzas coverage. The selling agent notified Cozza about the denial of coverage on October 20, 1982.

The Cozzas filed a complaint with the Insurance Division concerning Life Investors’ denial of health coverage. On December 12, 1986, the Insurance Division initi *867 ated administrative proceedings against Life Investors by issuing a Notice of Hearing and Charges. The notice set up two counts against Life Investors for alleged violations of the Colorado Insurance Code. Count I asserted that “that through its agent, Yannacito, respondent [Life Investors] misrepresented the benefits, advantages, conditions, or terms of its health policy coverage in violation of § 10-3-1104(l)(a)(I), C.R.S. [ (1987 Repl.Vol. 4A) ].” Count II asserted that the alleged violation in Count I was a “knowing violation” under § 10 — 3—1108(l)(a) and (b), C.R.S. (1987 Repl.Vol. 4A).

At the conclusion of the administrative proceedings, the Insurance Commissioner (Commissioner) issued a final agency order finding in favor of the Insurance Division and against Life Investors on both counts and imposed a $5,000 fine as a sanction for the violations.

Life Investors sought judicial review of that ruling, and the district court affirmed. This appeal followed.

I.

Life Investors argues that the Commissioner erroneously determined that the selling agent was Life Investor’s agent when he was actually the Cozzas’ agent. Life Investors claims that because the selling agent was Cozzas’ agent, it cannot be held responsible for his misstatements. We disagree with this contention.

An administrative agency decision is presumptively valid. People v. Gallegos, 692 P.2d 1074 (Colo.1984); St. Luke’s Hospital v. Colorado Civil Rights Commission, 702 P.2d 758 (Colo.App.1985).

The standard of review for a court reviewing agency actions on appeal is whether substantial evidence exists on the record to support the findings and conclusions of the agency. Lassner v. Civil Service Commission, 177 Colo. 257, 493 P.2d 1087 (1972). And, in order for a reviewing court to set aside a decision by an administrative agency, the court must find that there is no competent evidence in the record as a whole which supports the agency’s determination. Noe v. Dolan, 197 Colo. 32, 589 P.2d 483 (1979).

Here, in an initial administrative hearing, the administrative law judge (ALJ) found that the insurance agent was a “soliciting agent” who acted on Life Investors’ behalf in the transaction with the Cozzas. The AU’s finding in this regard was adopted by the Commissioner in the final agency order.

The evidence indicates that the selling agent had previously sold group health insurance to Charles Cozza’s new employer, and it was at the employer’s request, not Cozza’s, that he spoke with the employees. On this evidence, the ALJ could properly conclude that the selling agent was holding himself out, prior to any direct contact or solicitation by Cozza, as a person who worked with certain insurance companies and could provide health/life insurance to these employees.

Section 10-2-202, C.R.S. (1987 Repl.Vol. 4A) provides:

(1) Insurance agent means a person appointed by an insurer to solicit applications for a policy of insurance or to negotiate a policy of insurance on its behalf. ...

Also § 10-2-203(1), C.R.S. (1987 Repl. Vol. 4A) provides:

Every insurance agent or limited insurance representative who solicits or negotiates an application for insurance of any kind shall be regarded as representing the insurer and not the insured or his beneficiary in any controversy between the insured or his beneficiary and the insurer.

Applying these statutory provisions to the circumstances at issue, we conclude there is ample record support for the Commissioner’s finding that the selling agent was the agent of Life Investors.

In Northwestern National Casualty Co. v. State, 682 P.2d 486 (Colo.App.1983), this court considered whether an insurance agent who had acted as an insurance broker was the agent of the insured. Relying largely on the language in the employment policy which stated that the agent was *868

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833 P.2d 864, 16 Brief Times Rptr. 831, 1992 Colo. App. LEXIS 221, 1992 WL 110009, Counsel Stack Legal Research, https://law.counselstack.com/opinion/life-investors-insurance-co-of-america-v-smith-coloctapp-1992.