Piedmont Southern Life Insurance v. Gunter

132 S.E.2d 527, 108 Ga. App. 236, 1963 Ga. App. LEXIS 592
CourtCourt of Appeals of Georgia
DecidedJuly 8, 1963
Docket40189, 40190
StatusPublished
Cited by19 cases

This text of 132 S.E.2d 527 (Piedmont Southern Life Insurance v. Gunter) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Piedmont Southern Life Insurance v. Gunter, 132 S.E.2d 527, 108 Ga. App. 236, 1963 Ga. App. LEXIS 592 (Ga. Ct. App. 1963).

Opinion

Hall, Judge.

In support of its motion for judgment notwithstanding the verdict and the general grounds of its motion for new trial, the defendant contends that the evidence showed conclusively that the plaintiff wife in procuring coverage by the group policy knowingly concealed material facts of her husband’s medical history, which concealment amounted in law to actual fraud, that the other elements of defense of fraud were proved, and therefore a verdict for the defendant was demanded. The Georgia courts have held that an employer who obtains a group insurance policy covering its employees is the agent of the insurance company for every purpose necessary to make effective the group policy, and that the insurance company has imputed to it knowledge of facts which the employer knows. Cason v. Aetna Life Ins. Co., 91 Ga. App. 323 (85 SE2d 568); Pilot Life Ins. Co. v. McCrary, 103 Ga. App. 549 (120 SE2d 134); Washington Nat. Ins. Co. v. Burch, 293 F2d 365 (5th Cir.).

*238 In this case the master policyholder was the Georgia Association of Finance & Loan Companies of which the plaintiff wife’s employer, Habersham Discount Company, was a member. The employer’s comptroller testified that it was a part of his duties to approach new employees and recommend their coverage under the group policy, and to give advice in answering the questions on the evidence of insurability form; and that he did this in the case of the plaintiff employee. His testimony was sufficient to support a finding that he knew the employee’s husband had been treated for a gastric ulcer and that he advised her to fill out the form as she did without mentioning it.

The defendant argues that the cases cited above are not applicable because in them it was the knowledge of an employer who was the master policyholder that was imputed to the insurance company; whereas in the present case, the plaintiff’s employer not being a master policyholder, its knowledge should not be imputed to the insurer. We see no difference in principle and reason between this case, where the employer was a member company in the association which was the named insured in the master policy, and the cases in which the employer itself was the named insured in the master policy. The comptroller of the member company of the master policyholder should accordingly be regarded as the agent of the master policyholder in performing his duties with respect to extending coverage under the policy. See Clauson v. Prudential Ins. Co. of America, 195 F Supp. 72 (D.C.D. Mass.); Mutual Bank & Trust Co. v. Shaffner, (Mo.) 248 SW2d 585; Neider v. Continental Assurance Co., 213 La. 621 (35 S2d 237, 2 ALR2d 846). “Where the insurer seeks to defeat a policy by reason of its fraudulent procurement through false and fraudulent statements made in an unattached application for the insurance, and where the plaintiff suing on the policy shows that the agent of the insurer was aware of, or was informed by the insured as to, his true condition, . . . the insurer would be estopped from setting up as a defense that the insured was not in good health at the time the policy was issued, on account of the knowledge to the contrary then had by the agent; so in the instant case the company could not be permitted to set up that it was deceived on account of the false and fraudu *239 lent statements of the insured, when its agent was made fully aware of his true condition.” Metropolitan Life Ins. Co. v. Bugg, 48 Ga. App. 363, 364 (172 SE 829); Firemen’s Fund Ins. Co. v. Standridge, 103 Ga. App. 442, 448 (119 SE2d 585).

The defendant contends also that since the new Georgia Insurance Code became effective January 1, 1961, the master policyholder’s representative can no longer be held to be an agent of the insurer. This statute, Code Ann. § 56-801a, defines the term “agent” and provides, “. . . under a group insurance plan, a person who serves the master policyholder of group insurance in administering the details of such insurance for the employees or debtors of such person, or of a firm or corporation by which he is employed, and who does not receive insurance commissions for such services, shall not be deemed to be an agent: . . .” This Code section is a part of Ch. 56-8a of the new Georgia Insurance Code, which deals with the necessity for licensing of insurance agents. The effect of this provision is that a person who serves the master policyholder in administering the details of group insurance is exempted from the licensing requirements of the chapter. It does not effect a change in the law established by the cases discussed above.

The defendant’s contention, that the plaintiff’s failure to introduce the master policy in evidence was fatal to the verdict, is without merit, since in its answer the defendant admitted the group policy. The evidence did not demand a verdict for the defendant on its defense of fraud and was sufficient to support the verdict for the plaintiff. The trial court, therefore, did not err in overruling the defendant’s motion for judgment n.o.v. and the general grounds of the motion for new trial.

With respect to the award of attorney’s fees, the defendant relies on Occidental Life Ins. Co. v. Templeton, 107 Ga. App. 322, 326 (130 SE2d 168), which held: “The verdict which expressly stated that no penalty was found against the defendant nullified the award of attorney’s fees.” The verdict in the present case, however, was: “We the jury find in favor of the plaintiff in the amt. of $420.00 plus $250.00 attorney fees.” Continental Aid Assn. v. Hand, 22 Ga. App. 726 (97 SE 206), held that where the evidence was sufficient to authorize a finding of *240 bad faith, the fact that the jury did not award the 25 percent damages allowed by statute would not prevent the recovery of attorney’s fees. The Continental case rather than the Occidental case, supra, is controlling in the present case.

The defendant assigns error on the allowance of the intervention of Dr. Earl Lewis and the Macon Hospital as parties plaintiff. In support of their petition for intervention, the intervenors offered as evidence purported assignments attached to forms filled in and signed by the physician and the hospital, informing the insurer of services furnished to the plaintiff husband. They are signed by the plaintiff wife and read as follows: “Assignment of insurance benefits: I hereby authorize payment directly to the above named surgeon [or hospital] of the Group Surgical [or hospital] Benefits herein specified and otherwise payable to me but not to exceed the charge stated above [or the hospital’s regular charges], I understand I am financially responsible to the surgeon [or hospital] for charges not covered by this assignment.”

The defendant objected to the intervention at the trial on the ground that these writings gave the intervenors no right upon which an intervention could be based. This objection was valid. Though the word “assignment” is used, the writings “disclosed no intention on the part of the plaintiff to sell or assign the indebtedness, and none on the part of the alleged assignee to purchase the same; and, hence, the evidence failed to show any legal or equitable assignment of the claim in controversy.” Didschuneit v. Enochs Lumber &c. Co., 42 Ga. App.

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Bluebook (online)
132 S.E.2d 527, 108 Ga. App. 236, 1963 Ga. App. LEXIS 592, Counsel Stack Legal Research, https://law.counselstack.com/opinion/piedmont-southern-life-insurance-v-gunter-gactapp-1963.