Morgan v. Golden Rule Ins. Co.

568 So. 2d 184, 1990 La. App. LEXIS 2102, 1990 WL 140243
CourtLouisiana Court of Appeal
DecidedSeptember 26, 1990
Docket21751-CA
StatusPublished
Cited by6 cases

This text of 568 So. 2d 184 (Morgan v. Golden Rule 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
Morgan v. Golden Rule Ins. Co., 568 So. 2d 184, 1990 La. App. LEXIS 2102, 1990 WL 140243 (La. Ct. App. 1990).

Opinion

568 So.2d 184 (1990)

Joseph D. MORGAN, Plaintiff/Appellee,
v.
GOLDEN RULE INSURANCE COMPANY, Defendant/Appellant.

No. 21751-CA.

Court of Appeal of Louisiana, Second Circuit.

September 26, 1990.

*185 Lundy & Dwight by Clayton Davis, Lake Charles, for Joseph D. Morgan.

Hudson, Potts & Bernstein by Gordon L. James, Monroe, for Golden Rule Ins. Co.

Davenport, Files & Kelly by William G. Kelly, Jr., Monroe, for Steve Best & Steve Best Ins., Inc.

Before LINDSAY, HIGHTOWER, JJ., and JASPER E. JONES, Judge Ad Hoc.

LINDSAY, Judge.

The defendant, Golden Rule Insurance Company (GR), appeals a judgment in favor of the plaintiff, Joseph D. Morgan, finding that Morgan did not intentionally make material misrepresentations on his application for health insurance and therefore GR did not have just and reasonable grounds upon which to rescind the policy. Morgan was awarded the policy benefit of $15,000, plus $15,000 in penalties and $15,000 in attorney fees. GR does not contest that part of the judgment ordering it to pay $15,000 on the insurance policy. GR does appeal from that portion of the judgment ordering it to pay penalties and attorney fees.

The plaintiff, Joseph Morgan, has answered the appeal, claiming the trial court award for attorney fees was excessively low. The plaintiff also seeks attorney fees and costs incurred in connection with this appeal.

We amend and as amended, affirm the trial court judgment.

FACTS

On August 26, 1986, Joseph Morgan and his wife, Angela, completed an application for health insurance with GR. This application was completed with the aid of Steve Best of Steve Best Insurance Inc., a broker for GR. Best was personally acquainted with the plaintiff and approached him about securing health insurance with GR.

On the application, Joseph Morgan, then twenty-five years old, disclosed that he had suffered grand mal seizures in 1980 and in 1982. He indicated that he was hospitalized for this condition in 1980. Since that time, he has been taking phenobarbital and Dilantin. The application states, apparently in the context of the grand mal seizures, that Morgan had no problems with seizures since 1982. The application further noted that Mr. Morgan's previous health insurer, State Farm, had excluded the grand mal seizures from coverage on its policy. On the application, Mr. Morgan furnished the name, address and phone number for his treating physician, Dr. Michael Boykin. He also disclosed that he had last seen Dr. Boykin on August 19, 1986, just a few days prior to the date the insurance application was completed.

In August, 1986, the plaintiff was experiencing dizziness, slurred speech and numbness. His doctor ordered an EEG and EKG test in which the plaintiff wore a monitor for 24 hours. This test failed to reveal any medical problem. Steve Best, the insurance agent, saw the plaintiff wearing the monitor during this time. However, the fact that this test was conducted was not mentioned in the insurance application.

After the application was completed, it was forwarded to GR for approval, and the issuance of a health insurance policy. On September 12, 1986, Teresa Wall, an "underwriting communicator", telephoned the Morgan residence and talked with Angela *186 Morgan concerning the insurance application. Mrs. Morgan confirmed that her husband suffered from grand mal seizures and was taking medication. Mrs. Morgan also stated that her husband regularly consulted his physician to keep this condition under control. Mrs. Morgan confirmed that Mr. Morgan had undergone extensive testing in 1980 but that the test results were not conclusive and that Mr. Morgan did not have epilepsy. Mrs. Morgan testified that she informed Ms. Wall about the 24 hour EEG & EKG test undertaken in August, 1986. Mrs. Morgan testified that she informed GR that her husband had been having dizzy spells and was under the care of Dr. Boykin. These facts were disputed by GR. The record of information gathered in the telephone conversation is very brief and contains no reference to the plaintiff's dizzy spells or to the 24-hour EEG & EKG test. Nevertheless, Mrs. Morgan was quite positive that these facts were discussed with Ms. Wall during their conversation.

GR did not contact Dr. Boykin or request the plaintiff's medical records before issuing the health insurance policy which is the subject of this litigation. On October 3, 1986, GR issued the policy to Joseph and Angela Morgan with an epilepsy rider. The effective date of the policy was September 15, 1986.

In October, 1986, Joseph Morgan was diagnosed as having a brain tumor. He underwent surgery on October 30, 1986. On November 11, 1986, plaintiff filed a claim with GR to recover on his health insurance policy for the medical bills incurred in connection with his recent surgery and treatment.

Following receipt of Mr. Morgan's claim, GR then obtained his medical records. GR found that since his last seizure in 1982, the plaintiff had sought medical treatment numerous times in connection with dizziness, numbness and slurred speech. GR also learned about Mr. Morgan's 24-hour EEG and EKG tests which were undertaken in August, 1986 in an attempt to determine the cause of his worsening neurological symptoms. GR did not contact its agent, Steve Best, until several months after the claim was filed by the plaintiff. Prior to the decision to void the policy, GR never attempted to contact the plaintiff in order to determine if there was a reason for the possible inconsistencies.

Based upon its review of the application, GR determined that the plaintiff had obtained the policy based upon material misrepresentations and misstatements. GR contended that these misrepresentations were made intentionally, thus giving it the right to rescind the plaintiff's policy and deny plaintiff's claim. Further, on March 11, 1987, four months after his claim was submitted, Joseph Morgan was informed by GR that his health insurance policy had been voided.

Joseph Morgan then filed suit against GR to collect on the policy.[1] He also sought penalties, attorney fees and costs, arguing that there was no intent to deceive GR and that the insurance company had a duty to investigate prior to issuing the policy.

The case was tried before a jury. In response to interrogatories propounded to the jury, the jury made these findings:

1. Joseph and Angela Morgan did not make false statements to the insurer with the intent to deceive nor did those statements affect the risk assumed by the insurer;
2. Information received by GR was sufficient to put it on notice to make further inquiry before it issued the policy;
*187 3. The brain tumor was not a pre-existing condition as defined by the policy;
4. GR did not have just and reasonable grounds to refuse to pay the claim within 30 days;
5. Steve Best was not negligent in completion of the insurance application;
6. Steve Best did act beyond his authority and contrary to instructions by GR;
7. The unauthorized action by Steve Best was not the cause of the loss in question to GR.

Judgment was granted in favor of the plaintiff, awarding recovery on the policy, plus penalties, attorney fees, legal interest from the date of judicial demand and all costs of the proceedings.

GR appealed the judgment.

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568 So. 2d 184, 1990 La. App. LEXIS 2102, 1990 WL 140243, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morgan-v-golden-rule-ins-co-lactapp-1990.