Portsmouth Ins. Agency v. Med. Mut. of Ohio

2012 Ohio 2046
CourtOhio Court of Appeals
DecidedMay 3, 2012
Docket10CA3405
StatusPublished
Cited by1 cases

This text of 2012 Ohio 2046 (Portsmouth Ins. Agency v. Med. Mut. of Ohio) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Portsmouth Ins. Agency v. Med. Mut. of Ohio, 2012 Ohio 2046 (Ohio Ct. App. 2012).

Opinion

[Cite as Portsmouth Ins. Agency v. Med. Mut. of Ohio, 2012-Ohio-2046.]

IN THE COURT OF APPEALS OF OHIO FOURTH APPELLATE DISTRICT SCIOTO COUNTY

PORTSMOUTH INSURANCE AGENCY, :

Plaintiff-Appellee/ : Case No. 10CA3405 Cross-Appellant, : vs. : MEDICAL MUTUAL OF OHIO, DECISION AND JUDGMENT ENTRY

: Defendant-Appellant/ Cross-Appellee. : ________________________________________________________________

APPEARANCES:

COUNSEL FOR APPELLANT/ CROSS-APPELLEE: David L. Day, 380 South Fifth Street, Suite 3, Columbus, Ohio 43215

COUNSEL FOR APPELLEE/CROSS-APPELLANT: David J. Wigham, John H. Schaeffer, and Andrew P. Lycans, Critchfield, Critchfield & Johnston, LTD, 225 North Market Street, P.O. Box 599, Wooster, Ohio 44691

CIVIL CASE FROM COMMON PLEAS COURT DATE JOURNALIZED: 5-3-12

ABELE, P.J.

{¶ 1} This is an appeal from a Scioto County Common Pleas Court judgment in favor of

Portsmouth Insurance Agency, plaintiff below and appellee herein, following a jury trial. The jury

determined that appellee did not breach an indemnity agreement that it entered into with Medical

Mutual of Ohio, defendant below and appellant herein. SCIOTO, 10CA3405 2

{¶ 2} Appellant assigns the following errors for review:

FIRST ASSIGNMENT OF ERROR:

“THE TRIAL COURT ERRED IN DENYING MEDICAL MUTUAL’S MOTION FOR JUDGMENT NOTWITHSTANDING THE VERDICT.”

SECOND ASSIGNMENT OF ERROR:

“THE TRIAL COURT ERRED IN DENYING MEDICAL MUTUAL’S MOTION FOR NEW TRIAL.”

THIRD ASSIGNMENT OF ERROR:

“THE JURY’S VERDICT IN FAVOR OF PORTSMOUTH AND AGAINST MEDICAL MUTUAL WAS AGAINST THE MANIFEST WEIGHT OF THE EVIDENCE.”

{¶ 3} Appellee/Cross-Appellant raises the following cross-assignment of error:

“THE TRIAL COURT ERRED IN OVERRULING [PLAINTIFF,] PORTSMOUTH INSURANCE AGENCY’S, MOTION FOR DIRECTED VERDICT MADE AT THE END OF THE [DEFENDANT], MEDICAL MUTUAL’S, PRESENTATION OF ITS CASE.”

I

OVERVIEW

{¶ 4} The present appeal involves appellee’s obligation under an indemnity agreement to

compensate appellant for attorney fees that appellant incurred when defending a separate lawsuit.

The separate lawsuit began after appellant allegedly wrongfully terminated Luther and Donna

Alley’s health insurance policy (the Alley litigation). The Alley litigation involved appellant’s,

appellee’s, and appellee’s agent’s (Todd Skaggs) liability to the Alleys. The parties eventually

settled the matter. The lawsuit that gives rise to the instant appeal arises out of (1) appellee’s SCIOTO, 10CA3405 3

declaratory judgment complaint that requested the court to declare the parties rights and obligations

under the indemnity agreement and (2) appellant’s counterclaim for breach of contract.

II

BACKGROUND

A

THE AGENCY AGREEMENT

{¶ 5} On November 9, 2000, appellee and appellant entered into an agency agreement.

Under the agreement, appellee warranted “that it will comply with [appellant]’s rules and

regulations relating to the completion and submission of applications by groups for coverage.”

Appellee further warranted “that it will diligently and to the best of its ability ensure that the

representations set forth by any applicant in the health statements solicited are true and correct.

Agent further warrants that it will fully inform the applicant that [appellant] will rely solely upon

these representations, conditionally accepting or contracting with applicant; that the subsequent

discovery by [appellant] of material facts known by applicant and either not disclosed or

misrepresented on the application can result in the rescission or cancellation by [appellant] of any

contract entered into in reliance thereon * * *.”

{¶ 6} The agreement also contained an indemnity provision that states: “The Agent agrees

to indemnify and save [appellant] harmless from all loss, expense, cost and liability resulting from

unauthorized acts or transactions by said Agent or any other persons engaged or acting on the

Agent’s behalf.”

B

THE ALLEYS’ HEALTH INSURANCE APPLICATION SCIOTO, 10CA3405 4

{¶ 7} On December 13, 2001, Luther and Donna Alley applied for health insurance

coverage with appellant through appellee’s agent, Todd Skaggs. The application that Skaggs

submitted on the Alleys’ behalf contained a medical health questionnaire (MHQ) that asked the

applicant whether the applicant, the applicant’s spouse, or any listed dependent has “at any time

been treated for or diagnosed as having any of the following [88 listed] conditions?” The Alleys’

application answered “yes” to two conditions: (1) high blood pressure; and (2) hysterectomy. As

further explanation of the conditions, the application stated that Mrs. Alley had an uncomplicated

hysterectomy approximately 12 years ago, and that Mr. Alley has high blood pressure and takes

Dyazide. The application additionally stated that Mr. Alley checks his blood pressure at home and

contained Mr. Alley’s three blood pressure readings from December, November, and October

2001.

{¶ 8} The application further recites certain terms and conditions, one of which states: “I

represent and warrant that I have read this Health and Life Insurance Application, and understand

each of the questions and the answers to each of the questions I have given are complete and true to

the best of my knowledge. I agree that any misrepresentation or concealment on this Application

will void my policy at the discretion of MMO and/or MLI. I further agree that if a policy is

issued, it will be issued by MMO and/or MLI (if applicable) in full reliance and in consideration of

the information, answers, and statements contained herein.” The Alleys’ signatures appear on the

same page as this paragraph.

{¶ 9} Appellant subsequently issued a policy. Appellant later observed more medical

claims on the Alleys’ behalf than it had expected, and decided to investigate.

C SCIOTO, 10CA3405 5

THE INVESTIGATION

{¶ 10} Appellant obtained the Alleys’ medical records and discovered that Mr. Alley had

medical conditions (high cholesterol, coronary artery disease, gout, high blood pressure, and

prostatitis) that existed before December 13, 2001 that were not disclosed on the application's

MHQ section.

{¶ 11} Appellant subsequently contacted the Alleys to inquire about the medical conditions

that had not been listed on the MHQ. On January 12, 2004, Medical Mutual Underwriting

Analyst Edward A. Stewart and Medical Mutual Supervisor of Financial Investigations Christopher

J. Ferrara spoke with Mr. Alley and first questioned him about some cardiac catheterization

procedures that he had undergone. Mr. Alley advised them that his most recent procedure had

been performed in 2002. Stewart then informed Mr. Alley that the medical records show that Dr.

Barry George had performed a cardiac catheterization in February 2001. Mr. Alley stated that

although Dr. George told him he had a 60% blockage, Dr. Bradley, who performed a cardiac

catheterization in 2002, informed Mr. Alley that Mr. Alley did not have a 60% blockage and that

the doctor “doubted if it was even 50% blockage.”

{¶ 12} Ferrara asked Mr. Alley why he answered “no” to the question on the MHQ

regarding coronary artery disease. Mr. Alley stated that he was “not really sure.” Mr. Alley

advised Ferrara and Stewart that he did not “think he had a heart problem, because Dr. George said

60% blockage, then Dr. Bradley said doubtful if even a 50% blockage, so he didn’t think there was

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2012 Ohio 2046, Counsel Stack Legal Research, https://law.counselstack.com/opinion/portsmouth-ins-agency-v-med-mut-of-ohio-ohioctapp-2012.