Louis Harold Nichols, Individually and as of the Estate of Doris Maxine Nichols, Deceased v. Shelter Life Insurance Company

923 F.2d 1158, 1991 U.S. App. LEXIS 2678, 1991 WL 11444
CourtCourt of Appeals for the Fifth Circuit
DecidedFebruary 21, 1991
Docket90-1119
StatusPublished
Cited by11 cases

This text of 923 F.2d 1158 (Louis Harold Nichols, Individually and as of the Estate of Doris Maxine Nichols, Deceased v. Shelter Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Louis Harold Nichols, Individually and as of the Estate of Doris Maxine Nichols, Deceased v. Shelter Life Insurance Company, 923 F.2d 1158, 1991 U.S. App. LEXIS 2678, 1991 WL 11444 (5th Cir. 1991).

Opinions

WISDOM, Circuit Judge:

Today we decide whether, under Mississippi law, the Shelter Life Insurance Company (“Shelter”) may be held liable for the misrepresentations made by its agent to one of its insureds as to whether a particular claim would be covered. We conclude that a Mississippi jury can find Shelter liable. Accordingly, we find that the district court did not err in refusing to grant a directed verdict in favor of Shelter on the grounds that the contract between Mr. Nichols and Shelter allowed Shelter to deny payment of medical bills incurred as a result of a pre-existing condition. We further find that the district court did not err by failing to grant a partial directed verdict on punitive damages and emotional distress. We AFFIRM.

[1160]*1160BACKGROUND

In this case the plaintiff alleged and the jury found that, in the spring of 1986, Randy Holland, while employed as an agent for the defendant Shelter, made a fraudulent or grossly negligent misrepresentation to Mrs. Doris Maxine Nichols in an attempt to induce her to purchase an insurance policy from Shelter. The testimony showed that in response to a question from Mrs. Nichols, Holland told her that her previous condition and treatment for leiomyosarcoma would not be considered pre-existing under the terms of a particular Shelter policy. In reliance on this statement, the Nichols purchased the Shelter policy and cancelled an existing policy which would have covered many of Mrs. Nichols’s medical expenses if the cancer recurred, which it did. When Mrs. Nichols filed a claim for medical expenses incurred because of cancer treatment, Shelter denied coverage based on the clause in the policy which excluded from coverage losses occurring within two years after the policy was issued and were attributable to conditions which pre-existed the effective date of the policy.

The Nichols filed suit in Mississippi state district court seeking damages for Shelter’s denial of Mrs. Nichols’s claims. Shelter had the case removed to federal court. Mrs. Nichols died during the pendency of the lawsuit. The district court substituted Mr. Nichols, as executor of her estate, to represent her claims. After a three day trial, the jury answered special interrogatories and found that Mr. Nichols was entitled to recover under the insurance contract in the amount of $50,247.84; that Mr. Nichols was entitled to emotional distress and mental anxiety damages of $75,000; and that Mr. Nichols was entitled to recover punitive damages of $200,000. The district court denied Shelter’s motions for a judgment notwithstanding the verdict and a new trial.

Shelter now appeals to us, contending that the district court should have directed a verdict because, under Mississippi law, the Nichols were bound by the language in the insurance contract, no matter what Shelter’s agent told them. Shelter further maintains that, even if we uphold the verdict on liability, the punitive damage award should not stand. We disagree with Shelter’s position.

DISCUSSION

A. Compensatory Damages

Shelter contends that the provisions in its insurance application and policy that specifically exclude pre-existing conditions entitle it to judgment as a matter of law, citing National American Life Insurance Co. v. Williams, 204 So.2d 174 (Miss.1967), to support its contention. There is no dispute that Shelter’s policy exclusion for pre-exist-ing conditions is ordinarily valid and enforceable in Mississippi, assuming no misconduct on the part of the insurer or its agents occurred. See Blue Cross & Blue Shield of Miss., Inc. v. Mosley, 317 So.2d 58 (Miss.1975).

The issue, however, is whether the preexisting condition exclusion in the contract between Mr. Nichols and Shelter can be altered by any statements made by Shelter’s agent Randy Holland. The Nichols alleged, and the jury believed, that Holland made certain promises to Mrs. Nichols concerning the insurability of her condition in the event it should re-manifest itself. Although it was disputed at trial, Mrs. Nichols testified that she made full disclosure to Holland of her medical history and told him who her doctors were. The doctors’ names and addresses are listed on the application. Holland gave Shelter only scant information concerning Mrs. Nichols’s doctors, thereby failing to follow Shelter’s guidelines for taking applications. Only Mr. Nichols signed the application, and neither of the Nichols read it.

Shelter first argues that any misrepresentations made were made to Mrs. Nichols, not Mr. Nichols, and that Mrs. Nichols was not a party to the contract since she did not sign it. Mr. Nichols certified the contents of the application as being true, and he possessed a brochure and a copy of the insurance policy which clearly defined pre-existing condition. Shelter cites au[1161]*1161thority holding that to substantiate a claim for fraudulent inducement, misrepresentations as to post anniversary date coverage must have been made to the insured. See Gorman v. Southeastern Fidelity Ins. Co., 621 F.Supp. 33, 39 (S.D.Miss.), aff'd, 775 F.2d 655 (5th Cir.1985). Shelter argues that Mr. Nichols could not have relied on any misrepresentations since no misrepresentations were made to him, and one who has not relied directly on a misrepresentation does not have a cause of action for misrepresentation. See Baroni v. United States, 662 F.2d 287, 289 (5th Cir.1981). Consequently, Shelter argues, since Mr. Nichols was not fraudulently induced to read the contract or have it read to him, he must abide by its terms. See Pedersen v. Chrysler Life Ins. Co., 677 F.Supp. 472, 475 (N.D.Miss.1988).

These arguments are an attempt by Shelter to create a false distinction between the Nichols. The cases cited by Shelter, while stating general principles of law, do not address situations analogous to the Nichols’s. Mrs. Nichols was a party to the insurance contract with Shelter. Mrs. Nichols was handling the purchase of a policy for herself and Mr. Nichols. Mrs. Nichols was shown as spouse on the application, and premiums were paid for her coverage. She was a “covered person” under the policy. Contrary to Shelter’s position, Mrs. Nichols was anything but a stranger to the contract. Shelter’s argument that the Nichols did not rely on any misrepresentations because Mrs. Nichols possessed the brochure and the policy must also fail because Mrs. Nichols asked Holland to explain a specific clause in the policy which she had read.

Shelter next argues that the Nichols did not make out a case for misrepresentation because all they showed was that Holland rendered an opinion that the cancerous tumor Mrs. Nichols had in 1985 would not be considered a pre-existing condition. Mississippi law holds that the expression of opinion cannot be the basis of an action for misrepresentation. See Davidson v. State Farm Fire & Casualty Co., 641 F.Supp. 503, 514 (N.D.Miss.1986).' In Davidson, the court found that the statements that (1) State Farm had offered the best insurance the plaintiffs could purchase and (2) if the plaintiffs ever had a loss, State Farm would pay, were unenforceable opinions on which the plaintiffs had no right to rely. Davidson

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923 F.2d 1158, 1991 U.S. App. LEXIS 2678, 1991 WL 11444, Counsel Stack Legal Research, https://law.counselstack.com/opinion/louis-harold-nichols-individually-and-as-of-the-estate-of-doris-maxine-ca5-1991.