Pedersen v. LIFE OF MID-AMERICA INSURANCE COMPANY

164 N.W.2d 337, 1969 Iowa Sup. LEXIS 734
CourtSupreme Court of Iowa
DecidedJanuary 14, 1969
Docket53119
StatusPublished
Cited by4 cases

This text of 164 N.W.2d 337 (Pedersen v. LIFE OF MID-AMERICA INSURANCE COMPANY) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pedersen v. LIFE OF MID-AMERICA INSURANCE COMPANY, 164 N.W.2d 337, 1969 Iowa Sup. LEXIS 734 (iowa 1969).

Opinion

STUART, Justice.

Plaintiff, the designated beneficiary, brought this action in equity for declaratory relief seeking to establish a binding insurance contract with defendant on the life of her husband who was killed while the application was being processed. The trial court held for plaintiff. The company appealed.

The deceased, a bank cashier and part time insurance agent for defendant company, made application for insurance on his own life, paid the quarterly premium and passed the required physical examination on March 14, 1967. Three days later, before the policy was issued, he was killed in a one car accident.

Plaintiff claims March 14, 1967 was the effective date of the policy under the terms of the conditional receipt delivered by applicant as agent to himself as the insured when he paid the premium. The receipt reads as follows:

“It is understood and agreed that this premium payment is made and accepted subject to the following conditions:

“1. That if the Company after investigation shall be satisfied that on the date hereof, or on the date of the medical examination * * *, whichever is later, the Proposed Insured was insurable and entitled under the Company’s rules and standards to insurance on the plan and for the amount applied for at the Company’s published rates corresponding to the age of the Proposed Insured and shall approve said Application, the insurance protection applied for shall by reason of such payment take effect on the date hereof * * or from the date of such medical examination * * * whichever is later.”

The company claims: (1) The defendant was uninsurable as a moral risk because of alleged shortages and discrepancies in some bank accounts to which he had access. (2) The representations deceased made as agent for defendant on the application for life insurance on his own life were false and fraudulent.

I. “Binders” on life and health and accident insurance applications have been a fertile source of litigation. Anno. 2 A.L.R.2d 943. The leading case of Reynolds v. Northwestern Mutual Life Insurance Company, 189 Iowa 76, 176 N.W. 207 early established the Iowa law in this field. In that case we considered a conditional receipt similar to that set out above. We held: “[T]he contract became binding, and the insurance effective, on the date of the medical examination, subject, however, to the provisions of the company’s regular form of policy for the plan applied for, and the insurability of the applicant on the date of such medical examination. The in-surability of the applicant on the date of the medical examination is, by the contract, made the test of the company’s liability.

“By the third clause of the contract, the company agrees, in case the application is rejected, to return the premium paid. Unless the application is, in the proper exercise of the company’s rights, under the law and the contract, rejected, and the insurance refused, the preliminary contract provides protection from the date of the medical examination; and, if death results from some cause arising after the date of such examination, the company is liable upon the contract, according to its terms; but, if the company, in the proper exercise of its legal rights under the law and the contract * * * rejects the application, upon the ground that the applicant is not insurable, and returns the premium paid, no liability can arise thereunder.” 189 Iowa at 81, 176 N.W. at 209.

*340 The legal interpretation given such receipt in the Reynolds case provides a sound basis from which to proceed to the issues before us. See New England Mutual Life Ins. Co. of Boston, Mass. v. Hinkle, 8 Cir., 248 F.2d 879; Simpson v. Prudential Insurance Co. of America, 227 Md. 393, 177 A.2d 417, 423; Anno. 2 A.L.R.2d 943, 986; Comment, 44 Yale L.J., 1223, 1227, 1232.

II. Our problem here is more difficult than the one confronting the court in the Reynolds’ case. There “insurability” was denied because of the applicant’s physical condition at the time of his application. At the time of death, the company was still investigating his health. The death certificate revealed he was suffering from a heart condition which made him uninsura-ble. We held applicant uninsurable as a matter of law. 189 Iowa at 83, 176 N.W. at 210.

Here the claimed uninsurability is based on a nonmedical factor designated as a “moral hazard”. An insurance company executive, as a witness, described moral hazard as follows:

“Generally, there are medical and non-medical considerations that must be taken into account before an application for life insurance can be approved. By non-medical is meant the purpose and need for the insurance; the total amount of insurance in force on a particular individual; his occupation, his residence; his participation in hazardous duties; sports, if any; his business and financial history; his marital history, to some degree; his personal habits, such as drinking habits, philandering and that type of thing. There are many others. The medical considerations are the applicant’s current physical condition and his medical history.

“ ‘Moral hazard’ means any personal habit or activity of the insured that would cause him to be something less than a standard risk for insurance. Both medical and non-medical considerations affect longevity. The existence of moral habits affect insurability. There are two basic sources of information used in appraising the non-medical aspects of an application, inspection service reports and the agent himself. There are other sources that can be referred to, if necessary.

“Generally speaking, a moral hazard case will be either rated up or deferred, declined or postponed. Witness was familiar with generally accepted underwriting standards and stated that an individual that is known to have shortages in his accounts at a bank where he was working would be rated as a moral hazard. This fact would affect his insurability in that it would cause his application to be deferred, declined or postponed.”

“The weight of authority, which includes all the better-reasoned cases, seems to be to the effect that the term ‘insurability’ is broader than ‘good health’, * * Anno., 162 A.L.R. 668, 669. New England Mutual Life Ins. Co. of Boston, Mass. v. Hinkle, 8 Cir., 248 F.2d 879, 885-886 and citations; Kirby v. Prudential Ins. Co., 239 Mo.App. 476, 191 S.W.2d 379, 162 A.L.R. 660, 664-665; Gressler v. New York Life Ins. Co., 108 Utah 173, 156 P.2d 212, 214, modified on other grounds, 108 Utah 182, 163 P.2d 324, 164 A.L.R. 1047. See Warren v. New York Life Ins. Co., 5 Cir., 128 F.2d 671; Vargas v. Pacific National Life Assurance Company, 79 N.M. 152, 441 P.2d 50, 53, 55. There are cases which hold otherwise. Anno., 162 A.L.R. 668, 675.

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Bluebook (online)
164 N.W.2d 337, 1969 Iowa Sup. LEXIS 734, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pedersen-v-life-of-mid-america-insurance-company-iowa-1969.