Quartararo v. Massachusetts Mutual Life Insurance Co.

199 So. 2d 20, 1967 La. App. LEXIS 5477
CourtLouisiana Court of Appeal
DecidedMay 1, 1967
DocketNo. 2588
StatusPublished

This text of 199 So. 2d 20 (Quartararo v. Massachusetts Mutual Life Insurance Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Quartararo v. Massachusetts Mutual Life Insurance Co., 199 So. 2d 20, 1967 La. App. LEXIS 5477 (La. Ct. App. 1967).

Opinion

HALL, Judge.

Plaintiff brought suit in the First City Court for the City of New Orleans on a group life, accident and health policy seeking to recover from the defendant insurer the sum of $332.86 for hospital and other medical services rendered to her dependent minor son, Philip Quartararo, Jr. She also prayed for statutory penalties and attorney’s fees. Defendant answered and reconvened for the sum of $124.81. Judgment was rendered in favor of plaintiff for $332.86 plus interest and costs. Further judgment was rendered dismissing defendant’s reconventional demand. Defendant appealed.

Plaintiff was insured under a group life, accident and health policy while in the employ of Kelly-Generes Construction Company. The master policy was issued by defendant to plaintiff’s employer on Septem[22]*22ber 1, 1961 and on the same date plaintiff signed an application for coverage thereunder and was issued a certificate of participation in the group insurance. The plan of coverage applied for by plaintiff was “with dependent insurance,” meaning major medical coverage for her dependents.

On February 3rd 1962 plaintiff’-s son, Philip Quartararo, Jr., was injured in an automobile accident and was taken to Hotel Dieu Hospital from which he was discharged on February 10, 1962. Although insisting that it was not liable therefor, for the reason hereinafter stated, defendant paid the hospital bill of $277.82 rendered February 14, 1962 by Hotel Dieu. Defendant however refused to pay the surgeon’s bill and subsequent hospital expense totalling $332.86 rendered necessary by the accident. This suit followed.

In its answer defendant alleged that plaintiff’s son was ineligible for benefits under the terms of the policy, being over 19 years of age when the policy was issued. Defendant further alleged that it paid the Hotel Dieu bill of $277.82 because it was obligated to do so under an agreement made'between a number of the major hospitals in New Orleans, including Hotel Dieu, and a number of insurance companies writing group insurance, including defendant, wherein it was agreed that if the employer of an employee covered under a group insurance policy of this type certified to a hospital that the.employee was insured for certain benefits under a particular group policy the hospital might rely upon such certification in extending credit to the insured employee or his dependent, and that notwithstanding any error which the employer might have made in such certification, the hospital could nevertheless expect ■ payment from the insurance company.

Defendant further alleged that it had no knowledge of the ineligibility of plaintiff’s son to receive dependent benefits until after it had received the bill of Hotel Dieu which revealed his age. Defendant acknowledged that it was indebted to plaintiff for $153.01 for premiums collected in error, and alleged that it was entitled to a judgment in reconvention against plaintiff for $124.81 being the difference between the sum of $277.82 by which plaintiff has been unjustly enriched by defendant’s payment of the Hotel Dieu bill and the sum of $153.01 return premium due by it to the plaintiff.

In her original petition plaintiff had alleged that prior to the date of issuance of the group policy defendant’s agents had interviewed all employees of Kelly-Generes Construction Company and had been fully advised of all facts, including the age of her dependent son, Philip Quartararo, Jr., and that said agents had represented to plaintiff that said minor son would be covered under said policy. Following the filing of defendant’s answer and reconven-_ tional demand plaintiff amended and supplemented her original petition by alleging that the policy issued by defendant failed and neglected, through mutual mistake and error of the parties, to express the true understanding and agreement of the parties and prayed that the policy be reformed so as to include coverage for Philip Quar-tararo, Jr. Plaintiff further alleged in the alternative that defendant is estopped from denying coverage to Philip Quartararo, Jr. as a result of its acceptance of premiums for such coverage with full knowledge of the age of said dependent prior to the issuance of the policy.

When the case was called for trial the parties stipulated to, and filed in evidence, a copy of the group policy and all the • documentary evidence necessary to the trial. Thereupon plaintiff was called to the wit-, ness stand to testify in her own behalf. When she was questioned about her alleged verbal assurance by the defendant’s agents that her over-age son would be covered under the policy as a dependent, defendant’s counsel objected to any and all evidence which might vary or contradict the terms of the policy. The Trial Judge re[23]*23ferred the objection to the merits and permitted her to testify about such alleged verbal assurance. Plaintiff’s testimony constituted all of the testimony adduced in her behalf.

It is undisputed that Philip Quartararo, Jr. was over 19 years of age on the date the policy was written, and under the plain and unambiguous terms of the policy a child over 19 years of age was ineligible for dependent benefits. It is clear therefore that in rendering judgment in plaintiff’s favor, the Trial Judge did so solely on the basis of the testimony which was admitted over defendant’s objection.

Defendant contends that the Trial Court erred in admitting, over his objection, pa-rol testimony to vary or contradict the terms of a contract of insurance, particularly when the contract (as it does in the instant case) contains the statutory provision that no agent has authority to change or waive any conditions and that no change shall be valid unless approved by an executive officer of the insurer and endorsed on the contract, citing LSA-C.C. Art. 2276; LSA-R.S. 22:213; LSA-R.S. 22:628 and Shuff v. Life and Casualty Ins. Co. of Tennessee, 164 La. 741, 114 So. 637.

Plaintiff contends that where there is mutual error between the insured and the insurance agent as to coverage the policy will be reformed and judgment rendered under the policy as so reformed, citing Brodie v. Atlas Assurance Co., Limited, 158 La. 695, 104 So. 620; Hardin Bag Co., Inc. v. Milwaukee Mechanics’ Ins. Co., 160 La. 439, 107 So. 298, both of which cases involved fire insurance'policies.

We shall not undertake to discuss plaintiff’s testimony regarding the alleged verbal assurance by defendant’s agents (which was categorically denied by the agents) that her over-age son would nevertheless be covered under the policy “as long as he was a student,” for the reason that in our opinion all such testimony was inadmissible and should have been excluded by the Trial Judge.

LSA-R.S. 22:213, regulating health and accident policies, provides in part as follows :

“A. Required provisions — Each such policy shall contain in substance the following provisions * * *:
“(1) Entire contract: Changes: This policy, including the endorsements and the attached papers, if any, and in case of industrial insurance, the written application, constitutes the entire contract of insurance. No agent has authority to change this policy or to waive any of its provisions. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto.”
LSA-R.S. 22:628 provides as follows:

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Related

Hardin Bag Co. v. Milwaukee Mechanics' Ins. Co.
107 So. 298 (Supreme Court of Louisiana, 1926)
Brodie v. Atlas Assur. Co.
104 So. 620 (Supreme Court of Louisiana, 1925)
Shuff v. Life Casualty Ins. Co.
114 So. 637 (Supreme Court of Louisiana, 1927)

Cite This Page — Counsel Stack

Bluebook (online)
199 So. 2d 20, 1967 La. App. LEXIS 5477, Counsel Stack Legal Research, https://law.counselstack.com/opinion/quartararo-v-massachusetts-mutual-life-insurance-co-lactapp-1967.