Milligan v. Continental Life & Accident Company

418 P.2d 554, 91 Idaho 191, 1966 Ida. LEXIS 259
CourtIdaho Supreme Court
DecidedSeptember 29, 1966
Docket9719
StatusPublished
Cited by5 cases

This text of 418 P.2d 554 (Milligan v. Continental Life & Accident Company) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Milligan v. Continental Life & Accident Company, 418 P.2d 554, 91 Idaho 191, 1966 Ida. LEXIS 259 (Idaho 1966).

Opinions

McFADDEN, Chief Justice.

Mr. and Mrs. Milligan, the plaintiffs and respondents herein, instituted this action for recovery of sums they claim due under the provisions of a group health and accident policy issued by the Continental Life & Accident Company, defendant and appellant herein, to the Davidson Service Company, Mrs. Milligan’s employer. Mrs. Milligan, who had previously been an employee of the Davidson Service Company, was re-employed by that company in 1959. At the time she resumed her employment with this company she was covered by the group health and accident policy, although her husband was not, as they felt they could not afford it.

On March 7, 1961, Mr. Milligan lost consciousness and was taken to the hospital. He was examined by his physician, and released the third day following hospitalization. On the day following his admission to the hospital, Mrs. Milligan informed her employer of this occurrence, and it was suggested that she make claim under the group policy, which she could not do, because she had never claimed Mr. Milligan as a dependent. It was then that Mrs. Milligan first discovered that her employer had previously commenced paying premiums for dependents’ cover[193]*193age under this policy in lieu of a salary raise, and it was suggested she take out this insurance on her husband as a dependent, and she obtained forms from her employer. Mrs. Milligan filled out appellant’s form of “Health Statement with respect to Dependents,” answering all questions thereon, and gave it to her employer, who submitted it to the appellant company for dependent coverage of her husband. Under the provisions of the group policy the insurance did not become effective until the employee furnished evidence of in-surability satisfactory to the company for each person claimed to be dependent on such employee.

The policy provided:

“If such evidence is submitted with respect to a dependent, the employee shall become insured with respect to such dependent on the date the Insurance Company determines the evidence to be satisfactory.”

On April 14, 1961, appellant determined the application and statement submitted for Mr. Milligan was satisfactory, and executed a change in the certificate of insurance to include Mr. Milligan in the coverage under the group policy, as a dependent of Mrs. Milligan.

Mr. Milligan consulted with his doctor on March 16, 1961, to learn the results of the tests and X-rays taken during his confinement in the hospital. His doctor informed him that the X-rays showed an indication of an ulcer. Milligan doubted the correctness of such diagnosis, as he had never suffered any pain, comparable to complaints of others who had ulcers. Sometime in April, 1961, before the certificate of insurance for Mr. Milligan was issued by appellant, Mrs. Milligan first learned of the doctor’s diagnosis that Mr. Milligan had an ulcer. She learned this from her husband, at a time when application was being made for a life insurance policy with another company which required a higher premium because of this diagnosis.

This condition diagnosed as an ulcer had no connection with Mr. Milligan’s confinement in the hospital on March 7, 1961, which the parties denominated as a syncope. Mrs. Milligan stated they were advised the condition was caused by a toxic reaction to a combination of medications and beverage consumed by Mr. Milligan. The Milligans were assured by their doctors that this was nothing serious and did not involve any organic or physical disorder. The ulcer likewise had no connection with Mr. Milligan’s later illness resulting in his hospitalization, for which this action was instituted.

Mr. Milligan suffered a heart attack on October 2, 1961, for which he was confined in two hospitals. He and his wife submitted a claim to the appellant insurance company for the hospital expenses and fees for medical services for this illness. The company denied this claim and this action was instituted to recover these sums. During the course of the trial before a jury, it was stipulated that if the respondents were entitled to be covered under the policy, that the sum of $568.87 was the amount of the expenses payable under the provisions of the policy.

Mrs. Milligan in her application to have her husband covered by the insurance as a dependent answered all the pertinent questions, as follows:

“1. Have dependents had any illness during the last three years? No. Except for colds.
“2. Have dependents ever been seriously ill? No.
“3. Do you know of any impairment in physical condition or health of dependents ? No.
“4. Do you know of any chronic ailment, disease or other condition of dependents now existing which is likely to lead to hospitalization or operation ? No.”
“5. Has any company or association ever declined to grant insurance on the. dependents ?” “N o.”

[194]*194In its answer to respondents’ complaint seeking- recovery under the policy, appellant company- admitted the marital status of the parties, that a certificate had been issued including Mr. Milligan as a dependent of Mrs. Milligan under the terms of the policy, that the respondents had presented a claim, which appellant denied. Appellant generally denied other allegations of the complaint and interposed as an affirmative defense that during investigation of the claim appellant learned that Mr. Milligan had suffered a syncope and was confined to the hospital at the time the application was submitted, that thereafter he was treated for a duodenal ulcer and that Mr. Milligan had been treated for a sinus condition for which he had surgery performed to correct an obstruction; it then alleged that had it been informed of such facts in the evidence of insurability fur-' nished, it would have determined the evidence of insurability not to be satisfactory and would have refused the dependent’s insurance with respect, to Mr. Milligan; that upon learning of such facts it denied the respondents’ claim. By counterclaim appellant sought .damages for false representation in the evidence of insurability and for attorney’s fees therefor.

' After the parties had completed presentation of their evidence the issue as to whether Mrs. Milligan gave "false answers to the questions' on the Health Statement” was- submitted to the jury by written interrogatories which the jury answered. The substance of the jury’s answers to the interrogatories were that Mrs. Milligan did not make a false answer-to the questions presented on the form she executed. The trial court entered its findings of fact incorporated in the jury’s special verdict together with other facts found by the court. Conclusions of law and judgment in favor of the respondents for $568.87, plus attorney’s fees of $750.00, were thereupon entered.

Appellant has taken this appeal from the judgment and from the order of the trial court denying its motion for judgment notwithstanding the verdict and its motion for new trial.

The principal contention made by appellant is that Mrs. Milligan was under an affirmative duty to notify the insurance company: (1) that her husband was confined in the hospital at the time she made the application for his insurance; and (2) that her husband had an ulcer, even though this was not discovered or known by her until after she had signed the form.

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Milligan v. Continental Life & Accident Company
418 P.2d 554 (Idaho Supreme Court, 1966)

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Bluebook (online)
418 P.2d 554, 91 Idaho 191, 1966 Ida. LEXIS 259, Counsel Stack Legal Research, https://law.counselstack.com/opinion/milligan-v-continental-life-accident-company-idaho-1966.