Morris v. Paul Revere Life Insurance Co.

135 Cal. Rptr. 2d 718, 109 Cal. App. 4th 966, 2003 Daily Journal DAR 6476, 2003 Cal. Daily Op. Serv. 5106, 2003 Cal. App. LEXIS 863
CourtCalifornia Court of Appeal
DecidedJune 12, 2003
DocketG030567
StatusPublished
Cited by55 cases

This text of 135 Cal. Rptr. 2d 718 (Morris v. Paul Revere Life Insurance Co.) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morris v. Paul Revere Life Insurance Co., 135 Cal. Rptr. 2d 718, 109 Cal. App. 4th 966, 2003 Daily Journal DAR 6476, 2003 Cal. Daily Op. Serv. 5106, 2003 Cal. App. LEXIS 863 (Cal. Ct. App. 2003).

Opinion

*969 Opinion

BEDSWORTH, Acting P. J.

Plaintiff Martin J. Morris appeals from a summary judgment entered in favor of The Paul Revere Life Insurance Company. Morris alleged that Revere acted in bad faith in denying his claim for benefits under his disability policy. The court granted summary judgment in favor of Revere, concluding that its interpretation of the policy language and the California statute governing incontestability clauses in disability insurance policies was reasonable in light of the evolving state of the law. We agree and affirm the judgment.

Revere issued disability policies to Morris in 1989 and 1990. Among the policies’ coverage limitations was one for disabilities caused by a “sickness or disease which first manifests itself after the Date of Issue and while Your Policy is in force.”

The policies also included an incontestability clause, as required by California Insurance Code section 10350.2, which provided: “a. After Your Policy has been in force for 2 years, excluding any time You are Disabled, We cannot contest the statements in the application, [f] b. No claim for loss incurred or Disability that starts after 2 years from the Date of Issue will be reduced or denied because a sickness or physical condition not excluded by name or specific description before the date of loss had existed before the Date of Issue.”

The policies also included a provision ensuring conformity with state laws: “Any provision of this Policy which, on its Date of Issue, conflicts with the laws of the state in which You reside on that date is amended to meet the minimum requirements of such laws.”

After the policies had been in effect for over two years, Morris filed a claim for benefits, because of a disability resulting from multiple sclerosis (MS). Although Revere initially paid benefits to Morris for about six months under the policies, it subsequently notified him that it was denying further benefits on the ground that his MS was not a covered disease because it had manifested itself before the effective dates of the policies.

Morris sued to obtain the benefits he claimed were owed to him. He also alleged that in light of the incontestability clause, Revere had acted in bad faith in denying the claim. The trial court granted summary judgment in favor of Revere on the coverage issue, concluding that the undisputed evidence demonstrated Morris’s MS had manifested itself prior to the date the policies had issued and was thus not a covered sickness. Having agreed *970 with Revere on the coverage issue, the trial court had no occasion to address the allegation of bad faith.

Morris appealed (Aprahamian v. Paul Revere Life Ins. Co., D036827), and while that appeal was pending, our Supreme Court considered and decided the identical coverage issue in Galanty v. Paul Revere Life Ins. Co. (2000) 23 Cal.4th 368 [97 Cal.Rptr.2d 67, 1 P.3d 658]. In Galanty, the court noted courts around the country had split on the issue. Decisions interpreting substantially identical policy and statutory provisions—as to whether a coverage provision excluding sicknesses which had manifested prior to the date of policy issuance was inconsistent with an incontestability clause that precluded an insurer from denying coverage on the ground the disease had preexisted—had gone both ways.

According to the Supreme Court, seven jurisdictions, led by the Fifth Circuit Court of Appeals in Massachusetts Casualty Insurance Co. v. Forman (5th Cir. 1975) 516 F.2d. 425, had found in favor of the insurer and concluded there was no conflict. (Galanty v. Paul Revere Life Ins. Co., supra, 23 Cal.4th at pp. 378, 384.) Those courts reasoned that the “manifestation” of a disease referred to the point when the insured has reason to know of or discover the condition, whereas the “existence” of the disease referred to the point when it first took hold, without regard to whether the insured had any reason to suspect, or even could have discovered, its existence. As exemplified in Forman, those courts held that distinguishing between those points gave the parties the benefit of their bargain and was consistent with the purposes of an incontestability clause: “The statutory [incontestability] clause protects both parties from uncertainty where coverage turns on when a disease first existed, occurred or arose. Under such polices coverage may be uncertain even long after the policy was procured because a disease may exist but not be discoverable by reasonable medical investigation. This clause resolves the uncertainty in favor of coverage beginning two years after the policy date. Where coverage turns upon manifestation rather than existence, the insurance policy itself eliminates this uncertainty because manifestation is normally discoverable by reasonable medical investigation.” (Massachusetts Casualty Insurance Co. v. Forman, supra, 516 F.2d at pp. 429-430.)

On the other hand, the Supreme Court noted nine other jurisdictions had ruled in favor of the insured, concluding the incontestability clause precluded the insurer from arguing a disease had premanifested once the incontestability period had commenced. (Galanty v. Paul Revere Life Ins. Co., supra, 23 Cal.4th at p. 378.)

Finally, the Supreme Court stated there was only one published opinion on point in this state, McMackin v. Great American Reserve Ins. Co. (1971) 22 *971 Cal.App.3d 428, 439-440 [99 Cal.Rptr. 227]. The McMackin court had decided the issue in the insured’s favor, albeit “without useful discussion.” On the other hand, two other California appellate courts had decided the issue in the insurer’s favor, including the lower court in Galanty, and the court in Callahan v. Mutual Life Ins. Co * (Cal.App.), in which review was granted and the case held pending the Galanty opinion. (Galanty v. Paul Revere Life Ins. Co., supra, 23 Cal.4th at p. 377.)

As part of a comprehensive review of the history and development of incontestability laws, the Supreme Court explained that the concept was first developed in the context of life insurance. As the incontestability law developed in that area, it was interpreted by some courts as wiping out the ability of insurers to place limits on the risks they undertook. In at least one case, the insurer had excluded death caused by air travel from coverage under the policy. When the insured later died in a plane crash, the court held that the exemption had been nullified when the policy became incontestable, and ordered the insurer to pay the benefits. (Jordon v. Western States Life Ins. Co. (1952) 78 N.D. 902 [53 N.W.2d 860].)

Other courts, recognizing the incongruity of such results, were careful to differentiate the concepts of coverage and incontestability. As explained by Chief Judge Cardozo in

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135 Cal. Rptr. 2d 718, 109 Cal. App. 4th 966, 2003 Daily Journal DAR 6476, 2003 Cal. Daily Op. Serv. 5106, 2003 Cal. App. LEXIS 863, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morris-v-paul-revere-life-insurance-co-calctapp-2003.