McClelland v. Security Indus. Ins. Co.

426 So. 2d 665, 1982 La. App. LEXIS 8622
CourtLouisiana Court of Appeal
DecidedDecember 21, 1982
Docket82 CA 0237
StatusPublished
Cited by22 cases

This text of 426 So. 2d 665 (McClelland v. Security Indus. Ins. Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McClelland v. Security Indus. Ins. Co., 426 So. 2d 665, 1982 La. App. LEXIS 8622 (La. Ct. App. 1982).

Opinion

426 So.2d 665 (1982)

Mamie J. McCLELLAND
v.
SECURITY INDUSTRIAL INSURANCE COMPANY.

No. 82 CA 0237.

Court of Appeal of Louisiana, First Circuit.

December 21, 1982.
Rehearing Denied February 17, 1983.
Writ Denied March 25, 1983.

*667 John W. Anthony, Bogalusa, for plaintiff.

Victor L. Marcello, Donaldsonville, for appellant.

Before COVINGTON, LEAR and LANIER, JJ.

LANIER, Judge.

This is a suit in contract by the beneficiary of a policy of life insurance to collect the $1,250.00 face value of the policy and for statutory penalties. The insurer defended this action alleging that a false statement was made in the insured's application for coverage, that the insured was not in sound health when the policy was issued, and that the beneficiary was estopped from pursuing her claim under the doctrine of accord and satisfaction. The trial judge rendered judgment in favor of the beneficiary for the face value of the policy, but denied her claim for statutory penalties. The insurer took this suspensive appeal. The beneficiary answered the appeal alleging that the trial court committed error by not awarding statutory penalties and sought damages for a frivolous appeal.

I. FACTS

Pursuant to an application for insurance dated January 11, 1978, the Security Industrial Insurance Company (Security) issued a policy of insurance to Gaerdet Brooks[1] on January 15, 1978, with a death benefit of $1,250.00. Mamie J. McClelland was designated as the beneficiary of this policy. On October 25, 1978, Brooks died of a mediastinal shift, ruptured lung cyst, and bronchial asthma. On November 8, 1978, McClelland filed a claim with Security for the proceeds of the policy. Security determined that it would not pay the policy benefits and issued a check to McClelland dated February 20, 1979, in the sum of $62.00 representing a return of the ten monthly premiums of $6.20 that she had paid on behalf of Brooks. The following language appeared on the reverse side of this check:

"The endorsement of this check by the payee is in full and final settlement of all claims represented by Policy Number 2166756"

Immediately under this statement was a signature block designated "Payee". McClelland endorsed the check on the line designated "Payee" and cashed it. This suit followed.

II. GOOD HEALTH CLAUSE

Security resists liability in this case on the basis of the "good health" clause found in the policy. The policy specifically provides as follows:

"No obligation is assumed by the Company until the first premium has been paid in full and this Policy delivered and accepted by the Insured (or his/her guardian) and while the policyholder is alive and in good health."

Louisiana courts have recognized that good health clauses in life insurance policies are not contrary to public policy and are enforceable. Such provisions clearly evidence an intention of the insurer to make the insured's sound health a condition precedent to the viability of the contract. The burden is on the insurer to prove by clear and convincing evidence that the insured was not in good health on the effective date of the policy, which in this case is January 15, 1978. Ryan v. Security Industrial Insurance Company, 386 So.2d 939 (La.App. 3rd Cir.1980); Martin v. Security Industrial Insurance Co., 367 So.2d 420 (La.App. 2nd Cir.1979), writ denied 369 So.2d 1364 (La. 1979).

To show Brooks' medical condition at the time the policy was issued, Security introduced into evidence his medical records from the Washington-St. Tammany Charity Hospital. These records show that Brooks was a known asthmatic since 1963, and was admitted to the hospital on many occasions for this condition. He was admitted to the hospital on October 12, 1977, for diagnostic *668 studies and was discharged on October 14, 1977. His condition was diagnosed as bullous emphysema with mild pulmonary fibrosis and status asthmaticus. He returned to the hospital on November 9, 1977, December 14, 1977, and January 4, 1978, for prescription refills and followup examinations. On May 11, 1978, he was readmitted to the hospital and was subsequently discharged on May 20, 1978. During this period, he was treated for upper respiratory tract infection and chronic obstructive pulmonary disease. However, the insured's application for insurance shows that on January 11, 1978, he was employed as a truck driver for the Angie Lumber Company. There is no expert medical evidence in the record to explain the precise nature of the insured's medical condition at the time that the policy was issued. There is no expert medical testimony in the record as to whether or not his medical condition could be classified as good, fair, or bad health. See, for example, Audubon Life Insurance Co. v. Lauzervich, 242 So.2d 589 (La.App. 1st Cir.1970). Since Security's records indicate that the insured was employed immediately prior to the effective date of the policy, and because there is no medical evidence of record to classify or explain the medical condition of the insured on the effective date of the policy, the trial judge was not clearly wrong in determining that Security had failed to prove that the insured was not in good health by clear and convincing evidence. Arceneaux v. Domingue, 365 So.2d 1330 (La.1978).

III. FALSE STATEMENTS AFFECTING COVERAGE

Question 6A in Security's application for insurance provides as follows:

"6.A. Is proposed insured now in good health without any impairment? Yes [] No []"

The answer "Yes" is checked off.

Question number 10 provides as follows:
"10. When last sick or consulted a doctor: month, year, illness, disease, injury, etc."

The word "none" is written in reply to this question.

Question number 11 provides as follows:
"11. Has proposed Insured ever had tuberculosis, asthma, any disease of lungs, apoplexy, paralysis, heart disease, high blood pressure, mental or nervous disorder, epilepsy, convulsions, syphilis, rheumatism, arthritis, rupture, disease of circulatory system, stomach, intestines, liver, gall bladder, prostate, or thyroid gland, sugar, albumin or blood in urine, diabetes, cancer, tumor, ulcer, impaired sight or hearing, any imputation, deformity, operation? Yes No"

The answer "No" is circled on the original application. Security claims that the answers to these questions are false because Brooks was suffering from emphysema and bronchial asthma at the time that the application was submitted.

A false statement made by a prospective insured in an application for life or health and accident insurance will bar recovery if it is made with the intent to deceive or it materially affects the risk. La.R.S. 22:619(B); Coleman v. Occidental Life Insurance Company of North Carolina, 418 So.2d 645 (La.1982); Topps v. Universal Life Insurance Company, 396 So.2d 394 (La. App. 1st Cir.1981). The burden is on the insurer to prove this defense. Cousin v. Page, 372 So.2d 1231 (La.1979). Strict proof of fraud is not required, and the intent to deceive is to be determined from the attending circumstances indicating knowledge of the falsity and recognition of the materiality of the false statement, or from circumstances which create a reasonable assumption that the materiality of the misrepresentation was recognized. Thompson v. Business Insurance Life of America, 413 So.2d 331 (La.App. 3rd Cir.1982).

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Bluebook (online)
426 So. 2d 665, 1982 La. App. LEXIS 8622, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcclelland-v-security-indus-ins-co-lactapp-1982.