Mutual Benefit Life Insurance v. Gruette

529 A.2d 870, 129 N.H. 317, 1987 N.H. LEXIS 189
CourtSupreme Court of New Hampshire
DecidedMay 28, 1987
DocketNo. 85-529
StatusPublished
Cited by7 cases

This text of 529 A.2d 870 (Mutual Benefit Life Insurance v. Gruette) is published on Counsel Stack Legal Research, covering Supreme Court of New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mutual Benefit Life Insurance v. Gruette, 529 A.2d 870, 129 N.H. 317, 1987 N.H. LEXIS 189 (N.H. 1987).

Opinion

Thayer, J.

The defendant appeals from an order of the Superior Court {O’Neil, J.) approving the report of a Master {Mayland H. Morse, Jr., Esq.) which granted the plaintiffs petition for rescission of a disability insurance contract. We affirm.

On February 20, 1980, the defendant, David Gruette, and Gerald Gagne, a licensed agent of the New York Life Insurance Company, met to fill out an application for disability insurance from the plain[319]*319tiff, Mutual Benefit Life Insurance Company (Mutual Benefit). Although Gagne was not an agent of Mutual Benefit, his investigations into the matter lead him to believe that Mutual Benefit would provide the most satisfactory coverage for Gruette. The meeting progressed, with Gagne asking questions of the defendant and then recording the answers on the application form. Question 12(b) of the Mutual Benefit form requests information on the applicant’s current disability insurance. The significance of this question is that Mutual Benefit has internal guidelines that limit the amount of disability insurance that may be provided to a certain percentage of the prospective insured’s income.

When Gagne questioned Gruette on the subject of Gruette’s disability insurance, Gruette informed Gagne that he had a policy with the Insurance Company of North America (INA). Gagne then told Gruette that he would only be able to obtain a certain level of coverage in proportion to his income, and that disclosure of the INA policy might jeopardize issuance of the Mutual Benefit policy. Gagne then entered a response of “none” to question 12(b) (pertaining to existing disability coverage) on the application. Gruette knew that the answer to question 12(b) was false, and yet acquiesced in the deception because he knew, or at least suspected, that disclosure would disqualify him from receiving the additional coverage he desired from Mutual Benefit. Gruette’s participation in the filing of the deceptive application was compounded by the existence of cautionary language above the applicant’s signature that “the foregoing statements are true and complete.” Gruette also had in effect a policy with the Commercial Insurance Company (CIC), but was honestly unaware that the CIC policy afforded disability income protection, and thus did not tell Gagne of that policy. Gagne then submitted the deficient application to Mutual Benefit through the brokerage services of the Jules Meyer Agency of Boston. Mutual Benefit proceeded to issue a disability policy to the defendant.

On February 21, 1981, Gruette became disabled from psoriatic arthritis. Gruette applied for disability benefits from Mutual Benefit on March 5, 1981. At that time, Gruette disclosed the existence of his policies with INA and CIC. Mutual Benefit issued claims checks to Gruette while the company conducted an investigation. When Mutual Benefit verified the falsity of Gruette’s application, it terminated the payment of benefits and brought this action for rescission.

The master found that, because Gruette already had in effect the maximum level of disability coverage, the failure to disclose the existence of either or both policies materially affected the risk accepted by Mutual Benefit. The master concluded that “if given [320]*320this knowledge or information at the time of application it is manifestly clear that the plaintiff would never have issued this policy for which rescission is now sought.” The master also found that Gruette’s participation in submitting the false application constituted an actual intent to deceive. Thus, two conditions of RSA 415:9, preventing recovery on policies containing false information that either was furnished with actual intent to deceive or materially affected acceptance of the risk, had been satisfied. Consequently, the master granted the plaintiff’s petition for rescission. This appeal ensued.

The defendant presents the following contentions on appeal: (1) that Mutual Benefit’s internal guidelines limiting provision of disability insurance coverage to a certain percentage- of the insured’s income are unreasonable and, consequently, that the master erred in allegedly finding as a matter of law that the failure to disclose the existence of the disability policies materially affected acceptance of the risk; (2) that the doctrine stating that an agent’s fraudulent conduct is beyond the scope of the agent’s authority and not imputable to the company is a harsh maxim and should not have been applied in this case; (3) that Mutual Benefit’s acceptance, without investigation, of an application submitted by an independent broker unlicensed by Mutual Benefit constituted both a waiver of any defects in the application and an estoppel of the company’s raising potential defenses; and (4) that RSA 415:6, 11(4) and (5) prevent Mutual Benefit from limiting coverage based on other insurance policies.

The first issue we address is the reasonableness of Mutual Benefit’s internal policy of limiting the provision of disability insurance coverage to a certain percentage of the insured’s income. The relevant statutory provision reads as follows:

“Falsity in Application. The falsity of any statement in the application for any policy covered by this chapter shall not bar the right to recovery thereunder, unless such false statement was made with actual intent to deceive, or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer.”

RSA 415:9.

The defendant correctly states that “[t]he test under RSA 415:9 of the materiality of a false statement made without actual intent to deceive is whether the statement could reasonably be considered material in affecting the insurer’s decision to enter into the contract, in estimating the degree or character of the risk, or in fixing the premium rate thereon.” Taylor v. Metropolitan Life Ins. Co., [321]*321106 N.H. 455, 458, 214 A.2d 109, 112 (1965). If Mutual Benefit’s policy of providing disability coverage only up to a certain proportion of the applicant’s income is unreasonable, then Gruette’s omission of information regarding existing disability insurance could not “reasonably be considered material in affecting the insurer’s decision to enter into the contract. ...” Id.

The evidence, however, suggests that Mutual Benefit’s guidelines were indeed reasonable. Robert Remondelli, a Mutual Benefit officer, testified on the basis of statistical information that the more one is paid in disability benefits, the less one is inclined to make a speedy return to employment. Even the defendant’s own expert did not criticize the premise of preventing overinsurance. Indeed, the defendant's expert testified that no company would have issued Gruette a policy had it known of the defendant’s existing disability coverage. More than sufficient evidence exists in the record from which a reasonable trier of fact could conclude that Mutual Benefit’s disability coverage criteria were reasonable. See Belknap Textiles, Inc. v. Belknap Industries, Inc., 121 N.H. 28, 30, 424 A.2d 1141, 1142 (1981).

The defendant’s second contention rests on principles of agency law. In formulating this argument, the defendant refers us to several cases from the embryonic period of agency law in New Hampshire. Domocaris v. Metropolitan Life Ins. Co., 81 N.H. 177, 123 A. 220 (1923) (citing Delouche v.

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Bluebook (online)
529 A.2d 870, 129 N.H. 317, 1987 N.H. LEXIS 189, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mutual-benefit-life-insurance-v-gruette-nh-1987.