Smith v. North American Co. for Life & Health Insurance

775 F.2d 777
CourtCourt of Appeals for the Seventh Circuit
DecidedSeptember 30, 1985
DocketNo. 84-1872
StatusPublished
Cited by4 cases

This text of 775 F.2d 777 (Smith v. North American Co. for Life & Health Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. North American Co. for Life & Health Insurance, 775 F.2d 777 (7th Cir. 1985).

Opinion

POSNER, Circuit Judge.

This appeal in a diversity case governed by the common law of Wisconsin requires us to consider an interesting problem in the law of insurance contracts. On June 25, 1982, Lane Smith, a successful businessman who was 41 years old, signed an application for a $100,000 life insurance policy to be issued by the North American Company for Life and Health Insurance, and executed a form indicating that he was not a smoker. He gave the insurance agent (an independent agent named Jacobson) a check for $141, representing the first year’s premium due under the policy, and received in exchange a conditional receipt which stated that the insurance would be in effect from the date of the application, provided that Smith “on this date [was] acceptable to the Company under its rules and practices as standard risks on the plan and for the amount applied for.” In the space provided on the form for “plan,” Jacobson wrote “ART.” North American has no plan called “ART”; the acronym refers not to a specific plan but to a class of plans known as “annual renewable term” life insurance. En route to North American, intermediate insurance agencies altered Smith’s application to substitute “Graduate” for “ART” and then “Graduate Preferred” for “Graduate.” “Graduate Preferred” is the name of a North American annual renewable term life insurance plan which costs $141 a year (what Smith paid Jacobson) for a man of Smith’s age and requires that the insured not be a smoker. Apparently neither Smith nor Jacobson knew the name of the policy.

The application asked whether the applicant had ever had or been treated for high blood pressure, to which Smith answered “no.” He also answered “no” to the question whether he had consulted a doctor within the last five years. In processing Smith’s application North American discovered that Smith had in fact received medical treatment for high blood pressure within the previous three to five years. On July 22,1982, North American sought additional information about Smith’s blood pressure, and on August 4 it asked him to submit to a medical examination and provide a urine specimen. On August 1, however, Smith had drowned in a boating accident. After discovering that Smith had consulted a doctor at least nine times in the last five years for sciatic pain and high blood pressure and had been taking medication for high blood pressure throughout this period (he had refilled his prescription last on May 13, 1982, six weeks before he applied for the life insurance), North American informed Smith’s widow that it would not honor the conditional insurance contract. The district court found after a bench trial that Smith’s misrepresentations had been material, and therefore entered judgment for the insurance company.

The parties agree that Smith’s death during the processing of his application for life insurance did not make the contract lapse. North American was duty-bound to complete its investigation, and if the investigation had shown that Smith (if he had survived) would have been contractually entitled to the issuance of the insurance policy on which he paid the first pre[779]*779mium, the company owes his beneficiaries $100,000. See, e.g., Brown v. Equitable Life Ins. Co., 60 Wis.2d 620, 627-28, 211 N.W.2d 431, 435 (1973). Since, however, by definition the company would not have insured Smith if he made material misrepresentations in the application, it owes the beneficiaries nothing if his misrepresentations were material. See, e.g., Gibson v. Prudential Ins. Co., 274 Wis. 277, 289-90, 80 N.W.2d 233, 240 (1956).

The problem arises from Smith’s death before the insurance company completed its investigation. If the investigation had been completed and had revealed that Smith had only mildly elevated blood pressure well controlled by medication, the insurance company might have insured him anyway. But in deciding how likely this is, it becomes important just what insurance policy Smith was applying for. If as the district judge found it was the “Graduate Preferred” policy, the misrepresentations were material; the company would not have insured Smith under a plan designed for people in the very pink of health. But the application did not say “Graduate Preferred,” and the conditional receipt said that the applicant would be insured if he met the requirements for “standard risks” —not the below-average risks for which the “Graduate Preferred” plan is designed. Since nothing in the application, the conditional receipt, or Jacobson’s oral representations suggests that Smith was told he was applying for a policy for which he was ineligible if (as turned out to be the case) he had high blood pressure, rather than a policy with less demanding requirements that he might well have satisfied despite that condition, it seems that the company is trying to enforce a term to which Smith never agreed.

But asking whether Smith “agreed” to the underwriting standards of the “Graduate Preferred” policy is the wrong question. The right question is whether Smith applied for the “Graduate Preferred” policy or for some other policy. If the former, then he was stuck (at least in the absence of misrepresentations by the insurance company or its agents) with whatever happened to be the underwriting standards applicable to that policy. Normally a person does not know, when he applies for life insurance, what the underwriting standards are. No doubt he assumes that if he answers all the health questions “no” he will be insured, but he does not know what will happen if he answers some of them “yes.” He consents to whatever the standards are, provided they are not applied in a selective fashion to him, and there is no suggestion they were here. The point is perfectly general: you might buy a bicycle and find that you could not learn to use it and hence that it was worthless to you; but that would not change the fact that you had bought it pursuant to a valid contract of sale — unless, of course, the seller had made misrepresentations to induce the sale. Often when people buy things they are gambling about what they are actually getting, and that was the case here.

Smith filled out the nonsmoker form, which pertains only to the “Graduate Preferred” policy, and he paid the exact premium due under that policy for the first year. No other policy offered by North American carries the same premium. Jacobson obviously did not pull the figure $141 out of his hat. It was the premium for the “Graduate Preferred” policy, whether he knew the name or not. Any other North American “annual renewable term” policy would have carried a substantially higher annual premium (either $221 or $329). The problem of the written contract that does not unambiguously identify the subject matter of the transaction is not a new one in contract law. See Raffles v. Wichelhaus, 2 Hurl. & C. 906, 159 Eng. Rep. 375 (Ex.1864). In such a case the court must gather the meaning of the contract (if there was a contract, a meeting of the minds) from whatever evidence is presented. See, e.g., Kraemer Bros., Inc. v. United States Fire Ins. Co., 89 Wis.2d 555, 562, 278 N.W.2d 857, 860 (1979); Frigaliment Importing Co. v. B.N.S. Int’l Sales Corp., 190 F.Supp. 116 (S.D.N.Y.1960) (Friendly, J.). Although ambiguities in insurance policies are resolved in favor [780]*780of coverage, see, e.g., Katze v. Randolph & Scott Mutual Fire Ins. Co.,

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775 F.2d 777, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-north-american-co-for-life-health-insurance-ca7-1985.