Sherman v. Security Mutual Life Insurance

291 A.2d 304, 447 Pa. 442, 1972 Pa. LEXIS 549
CourtSupreme Court of Pennsylvania
DecidedMay 25, 1972
DocketAppeal, No. 529
StatusPublished
Cited by2 cases

This text of 291 A.2d 304 (Sherman v. Security Mutual Life Insurance) is published on Counsel Stack Legal Research, covering Supreme Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sherman v. Security Mutual Life Insurance, 291 A.2d 304, 447 Pa. 442, 1972 Pa. LEXIS 549 (Pa. 1972).

Opinion

Opinion by

Mr. Justice O’Brien,

On July 15, 1965, Irving Sherman applied for life insurance from the Security Mutual Life Insurance Company of New York, the appellee. He felt well and [444]*444believed that he was in good health. On July 19, 1965, a physician for the company examined Mr. Sherman and confirmed that he was in good health. On August 24, 1965, between nine and ten a.m., a policy in the amount of $15,000 was delivered to Mr. Sherman at the place of business operated by him and his brother.

The evening of that same day, Irving Sherman complained of feeling nauseated. Since it was his day off, he went to a family physician, Dr. Nemez, for relief. Upon examining Mr. Sherman, Dr. Nemez discovered a mass, said to be “the size of a lemon,” in his left mid-abdomen. Two days later x-rays established that Mr. Sherman had a tumor in his colon. The tumor was malignant. Surgery was performed on August 30,1965, which may have prolonged his life but could not save it. Mr. Sherman died nine months later, on May 17, 1966.

Under the terms of Mr. Sherman’s application for insurance: “. . . [A]ny policy issued on this application shall take effect on the date it is delivered to the Owner and the first premium is paid during the lifetime of each and every person proposed for insurance under such policy and then only if the health and other conditions affecting insurability remain as described in this application.”

The appellee insurance company, taking the position that there was a material change in Irving Sherman’s health between July 15, 1965, when he executed the application for the policy, and August 24, 1965, when the policy was delivered, denied coverage. His widow, the appellant, instituted an assumpsit action to recover the face amount of the policy.

Trial was held before a judge without a jury on August 1, 1968, and the court filed an opinion in which it found that the physical condition of Irving Sherman had changed from July 19, 1965, to August 24, 1965, [445]*445and, therefore, that the policy did not take effect on that day or thereafter. The appellant filed exceptions which were considered and argued before the court en banc, which entered an order dismissing the exceptions on April 13, 1970. This appeal followed the entry of judgment for appellee.

At trial, the insured’s physician, Dr. Nemez, testified that in his opinion, based on the size of the tumor when first discovered, the insured had been afflicted with the tumor for at least a year prior to August 24, 1965. Nevertheless, the trial court felt bound by what it considered a statutory presumption contained in the Act of May 17, 1921, as amended, P. L. 682, Art. IY, §411a, added 1935, July 19, P. L. 1319, §1, 40 P.S. §51 la, Avhich provides as follows:

“§ 5:11a. Effect of medical examination and waiver thereof.

“In any case where the medical examiner, or physician acting as such, or the agent of the insurer recording the answers of the applicant where a medical examination is waived, of any insurance company doing business in this State, shall issue a certificate of health, or declare the applicant a fit subject for insurance, or so report to the company or its agent under the rules and regulations of the company, it shall thereby be estopped from setting up in defense of the action on the policy or certificate issued to the insured, that the insured was not in the condition of health required by the policy or certificate or by the company issuing the same at the time of the medical examination, or the recording of the answers of the applicant where a medical examination is waived, unless the same was procured by or through the fraud, deceit, or misrepresentation of or on behalf of the insured.”

In the trial court’s opinion, the statute precluded him from going beyond the company’s examination, [446]*446which found no evidence of a malignant condition on July 19, 1965.

The court en banc, quite properly, chose not to consider any such statutory presumption.1 However, the court en banc,. believing it was only faced with the question of whether the evidence would support the verdict winner, affirmed the verdict of the trial court that the policy was not in effect. The court en banc based its opinion, on the fact that the insured’s cancer had reached the terminal stage before the delivery of the policy on August 24, 1965, and that this was hot the case on July 15, 1965, even though the cancer was probably also- in existence on the earlier date. However, under Pennsylvania law, the. continued growth of an already existent tumor from a. stage where it is not discovered to a stage where it is discovered is not the type of “material change” in the physical condition of the insured necessary for an insurer to avoid liability under “a good health clause” of a policy .issued after the insured has been examined by a medical representative of the insurer.

The reason behind this rule was explained in Prudential Ins. Co. v. Kudoba, 323 Pa. 30, 186 Atl. 793 (1936), at pp. 35-36, where we said: “If an applicant for such insurance is examined by a medical representative of the company, and is ‘passed,’ and a policy thereupon issues, he is certainly justified in assuming, in the absence of any fraud or misrepresentation on his part, that the company has satisfied itself as to his state of health, and that he can rest confident in the belief that he has obtained a valid policy of insurance upon his life. For the company later to be allowed successfully to contend that the policy never became [447]*447effective because the applicant breached the sound-health clause in that he suffered from disease or bodily-impairment when the policy was delivered to him, in a case where the same condition existed when the company examined him, would be to give countenance to a practice that, while perhaps not fairly to be characterized as fraudulent, would be unreasonably destructive of the protection which life insurance is aimed to secure. . . . We conclude, therefore, that the sound-health clause has no application to such diseases as the insured may have had at the time of the medical examination, but that its legal scope must be restricted to mean only that the applicant did not contract any new disease impairing his health nor suffer any material change in his physical condition between the time of such examination and the date of the policy.”

In Minzenberg v. Met. Life Ins. Co., 157 Pa. Superior Ct. 557, 43 A. 2d 377 (1945), the Superior Court applied the Kudoba, principle to facts closely paralleling those in the instant case. The insured “passed” the insurer’s medical examination on September 12, 1941. One day later, a routine examination by his family physician uncovered enlarged lymph glands and two days later one gland was removed. Laboratory examination of the removed gland indicated that the insured had Hodgkin’s disease. The policy was delivered after the gland was removed, but before the dreaded diagnosis was confirmed. The insurer’s attempt to avoid coverage under the policy was refused by the court.

A similar result was reached by the Superior Court in Davidson v. J. Hancock Mut. Life Ins. Co., 159 Pa. Superior Ct. 532, 49 A. 2d 185 (1946). In Davidson, the insured “passed” the insurer’s medical examination on March 12, 1940. Three days later the insured visited his physician, complaining of a slight cough. After examination, which disclosed that insured “had

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Bluebook (online)
291 A.2d 304, 447 Pa. 442, 1972 Pa. LEXIS 549, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sherman-v-security-mutual-life-insurance-pa-1972.