Ryman v. American National Insurance

488 P.2d 32, 5 Cal. 3d 620, 96 Cal. Rptr. 728, 1971 Cal. LEXIS 274
CourtCalifornia Supreme Court
DecidedAugust 30, 1971
DocketL.A. 29827
StatusPublished
Cited by13 cases

This text of 488 P.2d 32 (Ryman v. American National Insurance) is published on Counsel Stack Legal Research, covering California Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ryman v. American National Insurance, 488 P.2d 32, 5 Cal. 3d 620, 96 Cal. Rptr. 728, 1971 Cal. LEXIS 274 (Cal. 1971).

Opinions

[623]*623Opinion

TOBRINER, J.

Plaintiffs James and Joan Ryman, injured in an automobile accident on November 11, 1966, instituted this action against defendant American National Insurance Company to recover medical and hospital benefits under an insurance policy issued by the insurer. The company defended on the ground that the policy had lapsed for nonpayment of premium prior to the date on which the injuries had been incurred; plaintiffs claimed that the policy had been reinstated at the time of the accident, alleging that the insurance company had accepted a late-tendered premium more than a week before the accident occurred. The parties submitted the issue of coverage to the trial court on the basis of a written statement of stipulated facts, and on this record the court entered judgment for defendant insurer. Plaintiffs now appeal from that adverse judgment.

As discussed below, we have concluded, on two independent grounds, that under the stipulated facts the policy in question was in effect at the time of the accident. First, under the terms of the reinstatement provision included in the policy, a mandatory provision required by statute, the policy is automatically reinstated if the company accepts a payment of an overdue premium without issuing a conditional receipt and without requiring an application for reinstatement. In this case the company did initially accept a late payment tendered by plaintiffs, and not until several weeks later did the company notify plaintiffs that its initial acceptance was only a conditional one; under these circumstances, the policy was reinstated upon acceptance and was in force on the date of the accident.

Second, past decisions have established that in California, as in a majority of states, an insured enjoys a contractual right to reinstatement of an insurance contract, which accrues whenever the insured satisfies the reasonable preconditions to reinstatement; once the insured meets these requirements the insurance company cannot arbitrarily refuse reinstatement. In the instant case the stipulated facts- reveal that, at the time they applied for reinstatement by tendering payment of the single overdue premium, the insureds were fully insurable; under our case law the insureds were then entitled to reinstatement, and the insurer could not thereafter refuse reinstatement on the basis of their subsequent accident.

1. The facts.

The insurance policy in question, is a “Family Major Medical Expense Policy” issued by the defendant insurer to plaintiffs on June 17, 1965.1 The [624]*624policy called for a quarterly premium of $61.54 payable in advance, and provided for a 31-day grace period, following the premium due date. During the grace period the policy remained fully in force, and the insured could pay the premium without penalty. Plaintiffs had paid all . premiums either before the due date or within the grace period up to and including the premium due June 17, 1966. The premium due September 17, 1966, was not paid when due, however, and although defendant insurer mailed the insureds a premium due reminder between September 27 and October 2, giving September 17th as the due date, the insureds did not mail the premium check before the 31-day grace period expired on October 18, 1966. Plaintiffs concede that the policy initially lapsed after October 18, 1966, for nonpayment of premium.

Plaintiffs contend, however, that subsequent events reinstated their policy so that the policy was in force on the date of their accident; in this regard, the chronology of the parties’ actions takes on particular significance.

On October 31, 1966, less than two weeks after the expiration of the grace period, Mrs. Ryman mailed a check for $61.54 to defendant; the amount of the check constituted a full quarterly premium payment. The insurance company received this check on November 2, 1966, at its home office* 2 and immediately deposited the check in the company’s general commercial bank account, in the same manner as it had done with all of the insureds’ prior timely payments. Although defendant then credited the payment to its own “suspense file” rather than to plaintiffs’ regular account, the company at this time sent no notice to the Rymans indicating either that the tendered payment had only been accepted “conditionally,” or that some further action would be required by the insureds in order to have their policy reinstated.

Instead, on November 8, 1966, six days after the insurer had received and deposited plaintiffs’ check, the company mailed the insureds a “Notice of Lapse,” which read: “Our records show the past due premium has not been paid and your policy is lapsed.” (Italics added.) This notice also stated that the policy would be considered for reinstatement if the insureds [625]*625completed the application on the reverse side of the notice and returned it to the company “with payment for the amount of premium due.” The application for reinstatement included a provision in fine print which read: “I agree that any reinstatement of said policy shall be in accordance with and subject to the terms of the policy and that it shall not be considered or reinstated until this application for reinstatement shall be accepted and approved officially by American National.”

Plaintiffs received this communication on November 10 and Mrs. Ryman immediately mailed the following letter to the insurer: “Received ‘Notice of Lapse’ today. I mailed Sept. 17, 1966 payment for $61.54 Oct. 31, 1966, check no. 584. Have you received it? Or otherwise notified me immediately. [Par.] According to my records there will be another payment of $61.54 due Nov. 17, 1966.”3 The parties stipulated that “[a]t all times prior to and including November 10, 1966, the Rymans were in good health.”

The following day, November 11, 1966, both Mr. and Mrs. Ryman were seriously injured in an automobile accident and were incapacitated for several weeks thereafter. Medical expenses arising from the accident totalled $15,389.47, and the parties agreed that if the insurance policy was in effect, the total benefits due would be $12,431.58. The parties also stipulated that at the time of the accident plaintiffs did not carry any other health or accident insurance.

On November 17, 1966, while the Rymans were still hospitalized, Joan’s mother forwarded another check for $61.54 to defendant on behalf of the Rymans. Once again the company deposited this check in its. general account upon receipt, credited its suspense file, but did not mail any notice to the insureds indicating a “conditional acceptance.”

On November 22, 1966, nearly three weeks after receiving and depositing the Rymans’ October 31st check, the company wrote a letter to the insureds stating that the payment made on October 31 could not be accepted “at this time” as it was received after the grace period, but that plaintiffs might apply for reinstatement on a form on the back of the letter. Such application, the correspondence promised, would be considered promptly; if not approved, the. insureds’ premium payment, which the company continued to retain, would then be refunded.

On December 13, 1966, apparently more than three weeks after the [626]

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Ryman v. American National Insurance
488 P.2d 32 (California Supreme Court, 1971)

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Bluebook (online)
488 P.2d 32, 5 Cal. 3d 620, 96 Cal. Rptr. 728, 1971 Cal. LEXIS 274, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ryman-v-american-national-insurance-cal-1971.