Prudential Insurance Co. of America v. Carr

199 N.E.2d 412, 94 Ohio Law. Abs. 385, 30 Ohio Op. 2d 373, 1964 Ohio Misc. LEXIS 303
CourtMarion County Court of Common Pleas
DecidedJune 5, 1964
DocketNo. 36401
StatusPublished
Cited by7 cases

This text of 199 N.E.2d 412 (Prudential Insurance Co. of America v. Carr) is published on Counsel Stack Legal Research, covering Marion County Court of Common Pleas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Prudential Insurance Co. of America v. Carr, 199 N.E.2d 412, 94 Ohio Law. Abs. 385, 30 Ohio Op. 2d 373, 1964 Ohio Misc. LEXIS 303 (Ohio Super. Ct. 1964).

Opinion

Sanders, J.

The court finds:

On January 26, 1960, the defendant, Mr. Carr, went to the Frederick C. Smith Clinic as a result of low back pain following an industrial injury. He was seen by Dr. Vernon A. Nichols, an internist on the staff of the Clinic. He was given treatment and medication for the back condition and when he returned to the Clinic on February 2, 1960, his back had improved but on this occasion he complained of chest pains which he said he had had for several years. In view of this complaint Dr. Nichols on February 2, and February 8 did a complete physical examination, including a chest x-ray, electrocardiogram and blood tests. As a result of the examination Dr. Nichols found that Mr. Carr had a heart abnormality which was a variation of the Wolf-Parkinson-White syndrome and diagnosed the condition as angina secondary to pre-excitation syndrome; and leukocytosis or a high white cell blood count.

Dr. Nichols told both Mr. and Mrs. Carr of his findings and explained what he had found in laymen’s language so that they would understand it. Mr. Carr testified that Dr. Nichols told him the electrocardiogram was slightly abnormal and that his white count was off. Mrs. Carr denied any knowledge of the heart condition but did admit that Dr. Nichols had told her of the high white count.

Medication was given for the heart condition and blood tests were made over the next several months. Dr. Nichols saw Mr. Carr on February 13, February 27, March 26, May 14, May 28 and June 25. The medication helped the heart condition. The white count stayed up. Since the cause of the latter condition had not been discovered, Dr. Nichols recommended a lymph node biopsy or bone marrow aspiration but Mr. Carr refused to have either done. He was not discharged by Dr. Nichols but an appointment was made for him wben he was seen in June which he failed to keep. After seeing him over this period of five months Dr. Nichols’ diagnosis was the same as it had been in February.

On April 8, 1961, defendant made application through Mr. Jett, an agent for plaintiff, for a Hospital Expense Policy.

[387]*387The application contained the usual type of questions concerning abnormal physical conditions, known disease and medical examination, treatment and advice, and the pertinent questions and answers are referred to and set out in paragraphs 3 and 4 of the petition. The only disclosure made by defendant in answers to these questions was that he had been operated on for hemorrhoids in February, 1954, by Dr. Murphy at his office in Cardington. He did not reveal his attendance and treatment by Dr. Nichols which had extended over the period from February to June, 1960, that an electrocardiogram had been run and found to be abnormal and that a heart condition and an abnormal blood condition had been found. The application contains the representation over the signature of Mr. Carr set out in paragraph 4 of the petition that the statements and answers in the application are complete and true.

When the application was filled out, defendant said nothing about any of the conditions found by Dr. Nichols. He did, however, tell Mr. Jett that he had had a physical examination at a clinic, but did not say what clinic or when.

The application for the policy was processed and a policy, which has been admitted in evidence as Plaintiff’s Exhibit C, was issued in April, 1961. The plaintiff would not have approved the application and issued the policy had defendant Carr revealed therein the nature of the examination by Dr. Nichols and the conditions found by him.

Later in 1961 Mrs. Carr filed a claim under the policy and, in the course of investigating it, plaintiff learned of the examinations, findings, diagnosis and treatment of Mr. Carr by Dr. Nichols. Plaintiff elected to rescind the policy on the ground of fraudulent misrepresentations by Mr. Carr in the application and tendered the amount of the premiums which had been received together with interest to the date of tender. A letter which was sent to Mr. Carr concerning the recission and tender after he had earlier been seen by a representative of plaintiff was admitted in evidence as Plaintiff’s Exhibit D and the other facts in this regard were stipulated by the parties.

Consideration of a case such as this properly begins with general principles as to recission of a contract for fraud, proceeds to the particularized situation presented in insurance policies and then examines the Ohio statute that sets forth [388]*388tbe requirements for recission of a policy such as is here involved.

It is, of course, well-settled that a contract procured by fraud is voidable at the election of the defrauded party. (See 17 C. J. S., 929.) An insurance policy stands on the same basis as other contracts in this regard.

“Like all other contracts, a contract of insurance procured by fraud is voidable.” 44 C. J. S., 1011.

There is, however, one important distinction to be noticed between the ordinary contract and the insurance policy. The law has recognized that the practicalities of the situation place insured and insurer in a much different position than are most contracting parties. The insurer, at least under a policy such as that here involved where there is no medical examination, must look to the insured for all of the information on which it is to consider the issuance of the policy. Insured, in turn, is entering into a somewhat particularized type of contract and may justifiably expect treatment such as that circumstance dictates. With the utmost correctness the United States Supreme Court has accordingly called attention to the fact that:

“Insurance policies are traditionally contracts uberrimae fidei and a failure by the insured to disclose conditions affecting the risk, of which he is aware, makes the contract voidable at the insurer’s option. (Citing authorities.)” Stipoich v. Metropolitan Life Ins. Co., 277 U. S., 311 (1928).

The same Court in an earlier case, Mutual Life Insurance Co. v. Hilton-Green, 241 U. S., 613, 36 S. Ct., 676, 60 L. Ed., 1202, had announced the same principle as follows:

“Beyond doubt an applicant for insurance should exercise toward the company the same good faith which may be rightly demanded of it. The relationship demands fair dealing by both parties.”

Other courts and legal authorities have declared the relation of insured and insurer to be fiduciary and to require of the parties the utmost good faith in their dealings.

“Whenever a contract is in its essential nature intrinsically fiduciary, the utmost good faith and the fullest disclosure of material facts are required from the parties, * * *. Any concealment of a material fact known to a party would necessarily be fraudulent. The most familiar and illustrative example of [389]*389such contracts is that of insurance.” Pomeroy, Equity Jurisprudence, Yol. 2, Sec. 907.

The law requires the applicant for insurance to disclose fully, completely and truthfully all of the facts deemed material by the insurer, and if he violates the relation any policy issued is voidable at the election of the insurer.

The Ohio legislature has recognized that fraud in an insured’s application avoids the contract and in Section 3923.14, Revised Code, has set forth the essential elements that must be shown by the insurer in such a case:

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Bluebook (online)
199 N.E.2d 412, 94 Ohio Law. Abs. 385, 30 Ohio Op. 2d 373, 1964 Ohio Misc. LEXIS 303, Counsel Stack Legal Research, https://law.counselstack.com/opinion/prudential-insurance-co-of-america-v-carr-ohctcomplmarion-1964.