Prentiss v. Mutual Ben. Health & Accident Ass'n

109 F.2d 1, 1940 U.S. App. LEXIS 3836
CourtCourt of Appeals for the Seventh Circuit
DecidedJanuary 15, 1940
DocketNo. 7014
StatusPublished
Cited by6 cases

This text of 109 F.2d 1 (Prentiss v. Mutual Ben. Health & Accident Ass'n) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Prentiss v. Mutual Ben. Health & Accident Ass'n, 109 F.2d 1, 1940 U.S. App. LEXIS 3836 (7th Cir. 1940).

Opinion

EVANS, Circuit Judge.

On February 27, 1937, William E. Pren-tiss applied to the defendant for a policy of accident and sick benefit insurance. The application was approved, and, on March 5, 1937, the policy was issued. It called for the payment of $5,000 in the event of the death of the insured from accidental causes. On April 11, 1937, the insured, while driving an automobile on a highway in Indiana, was injured as the result of a collision with a truck, and two days later he died from said injuries. His wife, the plaintiff, who had accompanied him, was also seriously injured. On April 28, 1937,-plaintiff sent the proofs of loss to defendant’s Indianapolis office. In the “affidavit of attending physician,” appeared the following paragraph styled “supplementary statement”:

[3]*3“Mr. Prentiss came to me last August with a .rash on the foot around the base of the toes and I think a small patch of a dry rash on the tibia or lower leg. Some Doctor in the Southwest had made a tentative diagnosis of syphilis and had suggested treatment. He came to me and I have been giving him some treatment Neo Sal-varsan and Bismuth. I have never made a Wassermann or other blood test but expected to take one in about one month; following his death. Mr. Prentiss had no other clinical symptoms of lues and I feel quite sure he would have shown a negative Wassermann test. This in no way contributed to his death.”

At the trial it appeared that Prentiss went to Dr. Graves sometime in August, 1936, after a doctor in Oklahoma had previously looked at a rash on Prentiss’ leg and had taken a blood test, as a result of which he had recommended treatment for syphilis. This information was written on a card which contained Prentiss’ name, the name of the doctor who had taken the test, and, in addition, the words “4 plus Wassermann.” The typewritten word “negative,” also on the card, had been partially erased, but apparently was still visible.

Mrs. Prentiss testified that, in August, 1936, several months after she and Mr. Prentiss were married, she had gone back to Oklahoma for a visit. While there she took a Wassermann in connection with the renewal of her license as a beautician. The test showed “two-plus,” positive, indicative of syphilis. Thereupon, her husband also had his test taken as stated above.

On the strength of this case history, Dr. Graves began, in August, 1936, to treat Prentiss. At first neosalvarsan was injected intra-venously, and later, bismuth. At this time, Dr. Graves testified that he termed Prentiss’ case as syphilis in the secondary stage. The bismuth treatment, starting October 23, 1936, was continued until January 8, 1937. Then, after several weeks, another series of treatments with neosalvarsan was given. This lasted until late in February, 1937, when the bismuth treatments were again started. . These treatments continued until they were terminated by Prentiss’ death, in April. Dr. Graves further testified that he never gave Prentiss a Wassermann test, although he was planning to do so when the death occurred. He expressed the opinion that the test would have shown negative. When asked the significance of such a showing, he explained, “Well, it indicates, if you had a 4 plus, your treatment is doing good, but it doesn’t mean you are ready to turn the case loose.”

In the application for insurance which the defendant required the applicant to fill out, he was asked whether he had ever had any of certain diseases, among which syphilis was one. The applicant answered in the negative. Another question was framed thus:

“13. Have you received medical or surgical treatment or had any local or constitutional disease not mentioned above, within the last five years?”

His answer was “No.” A provision of the policy read:

“This policy does' not cover death, disability, or- other loss sustained * * * while the Insured is suffering from syphilis or venereal disease.”

Defendant’s position, based on Dr. Graves’ testimony, is that the insured made materially false representations concerning his medical treatment during the preceding five years, the existence of a syphilitic state, and it was therefore entitled to rescind the insurance contract and thereby avoid liability. It also contends that, upon learning of the false statements, it promptly rescinded the contract and offered to return the premium paid. Plaintiff denied this contention, and it is out of the instructions to the jury on these issues that defendant’s assignments of error chiefly arise.

Defendant’s first contention is that the lower court erred in submitting to the jury the materiality of the insured’s false statement that he had no syphilis and had received no medical treatment in the last five years. It is urged that as a matter of law the questions and statements were material.

We look to the Indiana decisions for the applicable law and find Metropolitan Life Ins. Co. v. Becraft, 213 Ind. 378, 12 N.E.2d 952, 955, 115 A.L.R. 93, where it is said: “Where facts are misrepresented, the measure of materiality is whether knowledge of the true facts might have led the company to decline the risk, or accept it only for a higher premium. * * * But it [the question of materiality] is clearly a question of fact, and no reason is seen why it should not be determined in the same manner as other questions of fact. The jury may not arbitrarily decide the question contrary to the preponderance of [4]*4the evidence. Where the evidence is such that there can be no reasonable difference of opinion, the court will control the determination of the jury, but where the evidence is such that reasonable men might differ in their conclusions, the matter will be left to the jury.”

The instruction was limited to the materiality of the representation concerning medical attendance. No mention is made of the statement that insured had not suffered from syphilis.

Defendant also complains because the court failed to instruct the jury that the fact that the insured died from a cause other than the concealed facts in his application was not material on this question. The law of Indiana is settled by the decision of the court in this same case of Metropolitan Life Ins. Co. v. Becraft, supra. There it was said: “But the court refused to instruct ‘that the fact that the deceased may have died from a disease or cause other than from the disease which may have been concealed is immaterial and if you find that the concealed facts were material and relied upon by the insurance company at the time of the issuance of the policy, this would void the policy even though the insured may have died from causes other than the concealed facts.’ ”

To the same effect, see Couch, Cyclopedia of Insurance Law, Vol. 4, p. 2694.

The materiality of the interrogatories, as well as the answers given by the insured, is asserted and disputed by opposing counsel. They raise a question not entirely free from doubt. It is, we think, quite obvious that questions and answers which would be material in an ordinary life insurance policy may nevertheless be viewed as immaterial in an accident insurance policy. Business Men’s Assur. Co. v. Campbell, 8 Cir., 32 F.2d 995; Standard Life and Acc. Ins. Co. v. Martin, 133 Ind. 376, 33 N.E. 105. Moreover, the debatability of the existence of the syphilitic condition adds to the doubt.

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Bluebook (online)
109 F.2d 1, 1940 U.S. App. LEXIS 3836, Counsel Stack Legal Research, https://law.counselstack.com/opinion/prentiss-v-mutual-ben-health-accident-assn-ca7-1940.