Monarch Life Insurance v. Brown

125 A.D.2d 75, 512 N.Y.S.2d 99, 1987 N.Y. App. Div. LEXIS 40743
CourtAppellate Division of the Supreme Court of the State of New York
DecidedFebruary 26, 1987
StatusPublished
Cited by18 cases

This text of 125 A.D.2d 75 (Monarch Life Insurance v. Brown) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Monarch Life Insurance v. Brown, 125 A.D.2d 75, 512 N.Y.S.2d 99, 1987 N.Y. App. Div. LEXIS 40743 (N.Y. Ct. App. 1987).

Opinion

OPINION OF THE COURT

Asch, J.

On September 9, 1981, Monarch Life Insurance Company (Monarch) issued a disability insurance policy to Alan R. Brown providing a monthly disability income benefit of $1,500. On June 24, 1984, more than two years after the inception of the policy, Brown submitted an application for benefits to Monarch. It stated that he had suffered a heart attack on April 30, 1984, and that he was thus rendered totally disabled from his then occupation, that of an accountant.

A letter from Brown’s doctor, John Morseman, M.D., stated that since Brown’s hospitalization in May of 1984, "he has been completely unable to work because of his underlying heart disease”.

Monarch later discovered that in 1976, Brown had been hospitalized as a result of an acute myocardial infarction. Because of this disability, in 1977 he had been found to be disabled from serving in his former position as Special Agent in the United States Treasury Department. He was subsequently hospitalized in July 1980 and October 1980 and diagnosed as suffering, inter alia, from coronary artery disease and cardiac arrhythmia.

In Brown’s 1981 application for the disability insurance, he had made no mention of the fact that he had suffered a previous heart attack or that he had been under treatment for heart disease. In that application, Brown stated that he had not been hospitalized within the preceding five years and that he did not have such symptoms as "hypertension, angina” and other heart symptoms from which he did, in fact, suffer.

Monarch commenced this action seeking a declaratory judgment that, under the terms of the disability income policy, it is not obligated to pay the claim made by defendant.

The policy, on its face page, states: "Subject to all provisions of this policy, we insure you against disability or other loss resulting from: sickness, which first makes itself known while this policy is in force”. (Emphasis added.)

[77]*77Under the policy amendment rider which, in conformance with New York State Insurance Law, changes the incontestability period from three years to two years, the following language appears:

“contesting this policy

“misstatements in the application

"We rely on the statements you make in your application. We will not contest those statements after this policy has been in effect for 2 years during your lifetime. Any length of time you are disabled is excluded in computing this 2 year period.

“pre-existing conditions limitations

"If disability starts or a loss is incurred more than 2 years after the Date of Issue, we won’t reduce or deny the claim on the ground that sickness or physical condition existed before this policy’s effective date. This does not apply to any sickness or physical condition excluded from coverage by name or specific description.”

It is Monarch’s position, as regards the meaning of the above policy provisions, that the policy requires it to pay benefits to Brown only for those physical illnesses which had not manifested themselves before the policy was issued. In other words, Monarch maintains that a fair reading of the incontestability clause bars it from disclaiming coverage for illnesses which may have been present before the issuance of the policy but the presence of which had not yet "manifested” themselves in symptoms which reasonably would have led to a diagnosis. Defendant acknowledges that he deliberately omitted to describe his previous cardiac history on his policy application form. However, he claims that, since he was not totally disabled until the two-year “incontestable” period had run, Monarch is obligated to pay the full $1,500 monthly disability benefits to him.

The leading case in New York concerning the application of an incontestability clause is Apter v Home Life Ins. Co. (266 NY 333), decided in 1935. There the policy provided that payments would be made for disability arising from disease commencing after the issuance of the policy. The policy also contained an incontestability clause providing simply that, after the policy had been in force for one year, it would be incontestable except for the nonpayment of premiums. The insurer sought to prove after a one-year period had elapsed that the insured had contracted the disabling disease before [78]*78the policy had been issued. The Court of Appeals held that it was not barred by the incontestability clause from so doing, finding that the insurer excluded such a preexisting disability from coverage.

Since the decision in Apter (supra), the Legislature amended the Insurance Law to mandate the inclusion of a clause, such as that inserted by plaintiff in its instant policy, which bars it from denying a claim on the ground that a disease or physical condition not excluded by name or specific description existed prior to the effective date of the policy. (Insurance Law § 164 [3] [A], now Insurance Law § 3216 [d].)

Insurance Law § 3216 (d) currently contains, inter alia, the incontestability clause which is mandated for use and does not differ in salient respects from the prior language used in Insurance Law former § 164:

"(d) Each policy of accident and health insurance * * * shall contain the provisions specified herein * * * except that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are not less favorable in any respect to the insured * * *

"(1) Each policy shall * * * contain the following provisions:

"(A) entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance * * *

"(B) TIME LIMIT ON CERTAIN DEFENSES:

"(i) After two years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such two year period * * *

"(A policy * * * may contain in lieu of the foregoing the following provision (from which the clause in parenthesis may be omitted at the insurer’s option) under the caption 'incontestable’:

"After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.)

"(ii) No claim for loss incurred or disability (as defined in the policy) commencing after two years from the date of issue [79]*79of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.” The insurer’s attempt to deny benefits for any disability arising from "sickness, which first makes itself known while [the] policy is in force” does not comply with the statute’s requirement that exclusion from coverage for disease or physical condition be "by name or specific description”.

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Cite This Page — Counsel Stack

Bluebook (online)
125 A.D.2d 75, 512 N.Y.S.2d 99, 1987 N.Y. App. Div. LEXIS 40743, Counsel Stack Legal Research, https://law.counselstack.com/opinion/monarch-life-insurance-v-brown-nyappdiv-1987.