Puerto Rico v. Pan American Life Insurance

307 F. Supp. 1065
CourtDistrict Court, D. Puerto Rico
DecidedDecember 30, 1969
DocketCiv. No. 92-65
StatusPublished

This text of 307 F. Supp. 1065 (Puerto Rico v. Pan American Life Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Puerto Rico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Puerto Rico v. Pan American Life Insurance, 307 F. Supp. 1065 (prd 1969).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW

CANCIO, Chief Judge.

The plaintiff, the Commonwealth of Puerto Rico’s Employees Retirement System (hereinafter called the Retirement System), instituted this action against the defendant, the Pan American Life Insurance Company (hereinafter called Pan American or the Company) to recover on a credit life insurance policy issued by said defendant upon the life of one of the borrowers of the Retirement System. Admitting many of the facts stated in the complaint, the defendant answered by alleging that this borrower was not an insurable risk and that the plaintiff had failed to comply with the terms of the insurance policy inasmuch as it should have known when it attempted to extend coverage under the policy that the borrower was not an insurable risk. Pan American also contends that the borrower concealed material facts as to his physical condition and previous medical history, which were material to the acceptance of the risk, which the Company would not have assumed had it known the true facts involved.

Having thus the parties set the main issues of the case, the Court, after considering the documents submitted by stipulation and after hearing the testimony of the witnesses presented by both parties, makes the following

FINDINGS OF FACT

During the years 1961-1962 and 1962-1963, the Retirement System contracted with Pan American whereby, in consideration of the payment of premiums, the Company insured the lives of the borrowers of the Retirement System in an amount equal to the Retirement System’s debit balance of the loan, including interest and special charges.

From July 1, 1961 to June 30, 1962, the Company charged Forty Five (45) cents for each One Thousand ($1,000) dollars in the debit balance as premium, [1067]*1067and from July 1, 1962 to June 30, 1963, Twenty Nine (29') cents for each One Thousand ($1,000) dollars. These premiums were discounted on a monthly basis from the borrowers’ wages by the governmental agency for which they worked and were forwarded to the Treasury Department of the Commonwealth of Puerto Rico. A proof of payment was then issued by the Retirement System and sent to the Treasury Department, which in turn drew out a single check made to the order of Pan American, covering all premiums.

Under the terms of the policy, the retirement System administered the insurance plan mainly by processing the applications. Although this was the first occasion in which the Retirement System had adopted- an insurance plan, no instructions, either verbally or written, were provided by the Company to the Retirement System concerning the management of the insurance plan or relating to the issuance of the insurance. Neither were instructions given to require medical examination, statements of health or written information from the applicants, and, consequently, the Retirement System did not require them from the applicants.

On several occasions, the Company payed insurance on the deaths of the insured without questioning their insurability. Never did the Company reject any of the premiums, nor did it inquire as to the identity of the persons who were covered by its policy. Only by in•ference, that is, when the Company cashed the checks of the Treasury Department, was the Retirement System able to learn that the Company had accepted the applicants.

In arriving at a final determination as to whether plaintiff acted in good faith or not, an element of importance for the disposition of this case, the Court notes that the Retirement System, after the termination of the contract with Pan American in 1963, became, its own insurer and, up until the present, has followed the same procedure established under the aforementioned contract.

On August 31, 1960, the deceased, Rafael Rivera Cartagena, applied for a mortgage loan at the Retirement System. The loan was granted and Rivera Cartagena signed the mortgage deed on June 27, 1961. At Rivera Cartagena’s request, the Retirement System issued him a certificate of insurance dated April 1, 1962. Thereafter, the premiums of his insurance were promptly payed during the months of April, May, June, July and August. Then, after eighteen (18) days of illness, Rivera Cartagena died on August 24, 1962. The Retirement System filed the usual death claim form with the Company, which refused to pay the $13,986.99 of the loan’s debit balance.

Pan American’s refusal to pay stems mainly from the fact that Rivera Cartagena’s leave record shows many absences from his work due to sickness.1 The [1068]*1068Company contends that the Retirement System failed to fulfill its obligation under the policy when it did not investigate Rivera Cartagena’s insurability by inquiring at the Department of Labor, employer of the borrower, as to his absences from work.

CONCLUSIONS OF LAW

Defendant’s defense rests mainly on plaintiff’s admission of the fact that he did not investigate the insurability of Rafael Rivera Cartagena. It contends that this omission voids the insurance coverage plaintiff intended to extend to the applicant, since the policy’s provisions supposedly imposed on the plaintiff the duty to investigate the borrower’s insurability. With regard to this contention, the only applicable clause of the policy, Clause No. 1, reads as follows:

All borrowers between the ages of 18 and 69 of the Creditor, whom the Creditor believes to be in good health 2 are eligible for insurance. (Emphasis supplied.)

Reading the policy as a whole, the phrase “whom the Creditor believes to be in good health” does not require the plaintiff to conduct an investigation relative to the applicant’s health. Had the contracting parties intended otherwise, they would have so stated, as was done in the case of borrowers aged sixty, and in relation to which the policy states:

On borrowers aged 60 and over evidence of insurability satisfactory to the Company will have to be submitted before this insurance shall go into effect. (Emphasis supplied.)

The word “believes” in the clause in issue does not require the Retirement System to initiate an investigation nor to submit to the Company “evidence of the insurability before the insurance shall go into effect.” To infer the contrary would be to inject into the insurance contract elements of uncertainty and subtlety never thought of by the contracting parties. The London Assurance v. Tribunal Superior, 95 D.P.R. 305 (1967).

Actually, under the terms of the policy, the one responsible for determining the insurability of the applicant was the Company. The first paragraph in the second page of the policy clearly states that the Company had to accept, grant and approve the applications and had the right to require medical examinations when in doubt as to the insurability of an applicant.

[1069]*1069Defendant has tried to belittle the contents of this paragraph by saying that the usual practice in the field of insurance is to hand the creditor a set of instructions, thereby transferring these obligations to the creditor. The Court will not consider this argument since, under paragraph seven, it was provided that the policy, together with the application, constituted the entire contract between the parties.3

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Bluebook (online)
307 F. Supp. 1065, Counsel Stack Legal Research, https://law.counselstack.com/opinion/puerto-rico-v-pan-american-life-insurance-prd-1969.