Paul Revere Life Ins. Co. v. Haas

628 A.2d 772, 266 N.J. Super. 35, 1993 N.J. Super. LEXIS 709
CourtNew Jersey Superior Court Appellate Division
DecidedJuly 7, 1993
StatusPublished
Cited by4 cases

This text of 628 A.2d 772 (Paul Revere Life Ins. Co. v. Haas) is published on Counsel Stack Legal Research, covering New Jersey Superior Court Appellate Division primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paul Revere Life Ins. Co. v. Haas, 628 A.2d 772, 266 N.J. Super. 35, 1993 N.J. Super. LEXIS 709 (N.J. Ct. App. 1993).

Opinion

266 N.J. Super. 35 (1993)
628 A.2d 772

THE PAUL REVERE LIFE INSURANCE COMPANY, PLAINTIFF-APPELLANT,
v.
GILBERT K. HAAS, DEFENDANT-RESPONDENT.

Superior Court of New Jersey, Appellate Division.

Argued May 26, 1993.
Decided July 7, 1993.

*36 Before Judges GAULKIN, HAVEY and STERN.

Robert Wright argued the cause for appellant (Melli & Wright, attorneys; Mr. Wright and Cynthia Dokas on the brief).

Brian T. Campion argued the cause for respondent (Herten, Burstein, Sheridan & Cevasco, attorneys; Mr. Campion on the brief).

The opinion of the court was delivered by HAVEY, J.A.D.

Plaintiff Paul Revere Life Insurance Company appeals from a summary judgment dismissing its complaint against its insured, defendant Gilbert K. Haas. The gravamen of plaintiff's complaint is that its disability insurance policy issued to defendant should be rescinded because of material misrepresentations made by him in his application for insurance. Alternatively, plaintiff seeks a *37 declaration that the policy does not cover defendant's medical condition, retinitis pigmentosa. In dismissing plaintiff's complaint, the trial court concluded that the policy's incontestability clause barred plaintiff's action. The incontestability clause provides:

10.2 INCONTESTABLE
a. After Your Policy has been in force for two years, excluding any time You are disabled, We cannot contest the statements in the application.
b. No claim for loss incurred or disability beginning after two years from the Date of Issue will be reduced or denied because a disease or physical condition existed before the Date of Issue unless it is excluded by name or specific description.

We hold that the incontestability clause bars an action to rescind instituted after two years from the inception of the policy, even if the insured's representations are fraudulent. We also conclude that the clause precludes the carrier from denying coverage based on the policy's definition of "sickness" and on its preexisting condition exclusion. However, if defendant becomes disabled during the period of contestability, part (a) of the incontestability clause, by its terms, tolls the running of the two-year period, and part (b) has no application. We therefore affirm in part, but reverse in part for a determination as to when defendant became disabled.

On January 20, 1987, defendant applied for disability insurance with plaintiff. In response to questions in the application concerning his "medical history," he answered that he was not under observation or treatment, had not be examined by or consulted a physician in the last five years, and never had any known indication of, or been treated for, any disease or impairment of the eyes. Defendant also answered "no" to the question: "Has any person had any surgical operation, treatment, special diet, or any illness, ailment, abnormality, or injury, not mentioned above, within the past five years?" On March 5, 1987, plaintiff issued the disability policy to defendant.

On December 1, 1990, defendant notified plaintiff of his intention to file a disability claim. On January 7, 1991, he executed a proof of claim form, stating that on December 1, 1990, he became *38 totally disabled as a result of retinitis pigmentosa, a loss of central vision. Defendant also submitted a "disability attending physician statement," completed by Dr. Leo Masciulli, stating that defendant's symptoms first appeared on November 1, 1989. Dr. Masciulli responded "yes" to the question: "Has patient ever had same or similar condition?" and listed "Dr[s]. Sidarsky [sic] & Poole [New York City] 1985" as defendant's treating physicians. Dr. Masciulli also reported that when defendant came to him on November 1, 1990, he was seeking a "second opinion."

Plaintiff's investigation of the claim revealed that beginning on October 20, 1983, defendant had been evaluated in the New York University Retinal Clinic. Dr. Ronald E. Carr, one of defendant's physicians, stated in a letter to Dr. Sudarsky dated August 9, 1984, that defendant "had been told of retinitis pigmentosa in the past and indeed shows findings quite typical for this problem." It is also undisputed that defendant's medical records, dating back to 1985, disclosed that he has had a history of retinitis pigmentosa since at least that date. On or about October 17, 1991, plaintiff filed the present complaint.

For the purposes of defendant's summary judgment motion, he admitted that his misrepresentations in the application were fraudulent. The trial judge nevertheless granted the motion, concluding:

I don't find that there is any way that you can get around the fact that [defendant] fits right into the mold of the person who is [saved] by the incontestable clause, and I find that the clause applies and the insurance company has to go through on it.

I

Plaintiff acknowledges that it instituted its action beyond two years after issuance of the policy. Nevertheless, relying on Johnson v. Metropolitan Life Ins. Co., 53 N.J. 423, 251 A.2d 257 (1969), plaintiff argues that the clause pertains only to equitable fraud, and does not bar an action based, as here, on a claim of legal fraud.

*39 In Johnson, the disability policy contained the following incontestability clause:

Time Limit on Certain Defenses: (a) After two years from the date of policy no misstatements, except fraudulent misstatements, made by the applicant in the application for this Policy shall be used to void this Policy or to deny a claim for loss incurred or disability (as defined in this Policy) commencing after the expiration of such two year period.
[Id. at 436 (emphasis added).]

This clause essentially tracked the statutory language required to be inserted in policies under N.J.S.A. 17:38-13.2(A) (now repealed). The Court rejected the insurer's argument that the phrase "except fraudulent misrepresentations" preserves the concept of equitable fraud beyond the contestability period, reasoning that "the provision can have no significance" unless the phrase "requires an intent to deceive." 53 N.J. at 438, 251 A.2d 257. It noted that a contrary interpretation would frustrate the apparent intent of the clause "to improve the position of the insured." Ibid. Thus, it concluded "the statute... boils down to the proposition that after two years the policy may not be voided for a misstatement in the application unless the misstatement is `fraudulent' as we have defined the word...." Id. at 441, 251 A.2d 257 (emphasis added). Since the insured's misrepresentation on his application was not made with intent to deceive, the insurer's attempt to rescind was barred because it came after expiration of the two-year period. Id. at 443, 251 A.2d 257.

What is fatal to plaintiff's argument is that Johnson involved a different incontestability clause than the clause pertinent here. N.J.S.A. 17B:26-5 requires that all health insurance policies contain one of two incontestability clauses:

a. After 2 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 ...

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Related

Paul Revere Life Insurance v. Haas
644 A.2d 1098 (Supreme Court of New Jersey, 1994)

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Bluebook (online)
628 A.2d 772, 266 N.J. Super. 35, 1993 N.J. Super. LEXIS 709, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paul-revere-life-ins-co-v-haas-njsuperctappdiv-1993.