SOUTHERN LIFE AND HEALTH INS. v. Smith

518 So. 2d 77, 1987 WL 1414
CourtSupreme Court of Alabama
DecidedOctober 2, 1987
Docket86-71, 86-97
StatusPublished
Cited by19 cases

This text of 518 So. 2d 77 (SOUTHERN LIFE AND HEALTH INS. v. Smith) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SOUTHERN LIFE AND HEALTH INS. v. Smith, 518 So. 2d 77, 1987 WL 1414 (Ala. 1987).

Opinions

This is a fraud case. The jury awarded Robert C. Smith, Jr., $30,000 in compensatory damages, and $35,000 in punitive damages. The trial court remitted all but $86.51 of the compensatory damages award, and the remittitur was accepted by Smith. Southern Life and Health Insurance Company appeals. Smith cross-appeals from the order remitting the compensatory damages.

The case was tried around the factual disputes of whether Smith and his wife told the agents of Southern Life that Smith's wife was pregnant or suspected that she was pregnant at the time of the taking of the application for hospital, medical, and surgical expense coverage; and whether the Southern Life agents told Smith and his wife that the policy would cover expenses connected with the pregnancy even though she was pregnant at the time of the taking of the application.

Smith paid a total premium of $86.51; $52.45 on August 12, 1982, the date of the application for the policy, and $34.06 on September 9, 1982, the date of the delivery of the policy. The policy that was delivered to Smith contained the following provision regarding maternity benefits:

"4. MATERNITY BENEFITS — Upon receipt of due proof of hospital confinement of the Insured (or the Insured's wife, if she is covered) as a result of normal childbirth or pregnancy, the Company will pay to the Insured for the expenses of such confinement an amount determined from the following table:

"In event If confinement begins after the policy has been of hospital in force confinement resulting at least 280 days but two or more years, from less than two years, the benefit payable is the benefit payable is

"Normal 8 times the Daily 12 times the Daily childbirth Hospital Indemnity Hospital Indemnity

"Additionally, hospital confinement resulting from premature birth will, for benefit purposes, be treated in the same manner as a normal pregnancy provided pregnancy commenced at least 30 days after the policy date.

"This is the only provision in this policy which insures against the expenses resulting from normal childbirth or pregnancy."

In October, when an agent for Southern Life came to Smith to collect the second monthly premium, Smith informed the agent that Smith's wife was pregnant. At that time, the agent told Smith that the policy would not cover the expenses in connection with the pregnancy since the pregnancy had occurred before the application and issuance of the policy. No further premiums were paid on the policy, and the policy lapsed when the grace period expired. No claim for maternity benefits was made during the two months that the policy was in effect. A child was born to Smith and his wife approximately three months after the grace period expired. Smith never asked Southern Life to return the premium he had paid. The Smiths had coverage under the hospital, medical, and surgical expense policy for September and October 1982.

Smith was 20 years old at the time the application for the policy was taken. He had obtained his GED three years before this, and was employed as a roofer. Southern Life's agents were experienced insurance agents at the time the application was taken.

Southern Life first argues that reasonable or justifiable reliance, an essential element of actionable fraud, was not proven *Page 79 with the requisite sufficiency to justify submitting this action to a jury.1

In Webb v. Renfrow, 453 So.2d 724, 727 (Ala. 1984), this Court set out the basic requirements of a fraud action in Alabama:

"Actionable fraud in Alabama consists of (1) a false representation, (2) concerning a material existing fact, (3) reliance by plaintiff upon that false representation, and (4) damage to plaintiff as a proximate result."

Our decisions have held that the third element of actionable fraud, reliance, must be a reasonable reliance and that where a party has reason to doubt the truth of a representation before he acts, he has no right to act thereon. MJM, Inc. v.Casualty Indemnity Exchange, 481 So.2d 1136 (Ala. 1985).

Justice Beatty, writing for a division of this Court inHalbrooks v. Jackson, 495 So.2d 591, 592 (Ala. 1986) wrote:

"Our decisions clearly establish that a reliance upon a representation must be reasonable, and that when one has reason to doubt the truth of the representation made to him, or is informed of the truth before he acts, that party has no right to act upon the representation. Midstate Homes, Inc. v. Holt, 52 Ala. App. 415, 293 So.2d 476 (1974). Moreover, knowledge of facts which ought to excite inquiry and which, if pursued, would lead to knowledge of other facts, operates as notice of the other facts. Williams v. Dan River Mills, Inc., 286 Ala. 703, 246 So.2d 431 (1971). See also Bedwell Lumber Co. v. T T Corp., 386 So.2d 413 (Ala. 1980), and Mahoney v. Forsman, 437 So.2d 1030 (Ala. 1983)."

There have been many cases in which this Court has reached the conclusion that the alleged reliance of the plaintiff was not reasonable under the circumstances, or that the circumstances were such that the representation should have aroused suspicion as to its validity in the mind of a reasonable person. Under such circumstances, if a reasonably prudent person exercising ordinary care should have discovered the facts, the plaintiff was not allowed to recover, as a matter of law. First National Bank of Mobile v. Horner,494 So.2d 419 (Ala. 1986); Kilpatrick v. Citibanc ofAlabama/Andalusia, 494 So.2d 39 (Ala. 1986); Rich Crest Homesv. Vaughn Place, Inc., 485 So.2d 1123 (Ala. 1986); Holman v.Joe Steele Realty, Inc., 485 So.2d 1142 (Ala. 1986); Taylor v.Moorman Mfg. Co., 475 So.2d 1187 (Ala. 1985); Torres v. StateFarm Fire Cas. Co., 438 So.2d 757 (Ala. 1983). See also Cookv. Brown, 393 So.2d 1016 (Ala.Civ.App. 1981).

From Smith's testimony, it is obvious that he had a concern as to whether he could obtain hospital insurance that would cover the existing pregnancy of his wife. Smith says that he mentioned to the agents on the day the application was taken his suspicion that his wife was pregnant, and specifically asked them whether her pregnancy would be covered. Smith and his wife both testified that they saw the agents the day after the application was taken and asked whether the policy would cover her existing pregnancy. At that time, Smith had paid a $52.45 premium. No policy had been issued. There was no document that he could review to answer his question. Smith had previously obtained a disability policy from one of the same Southern Life agents with whom he was dealing. Smith was receiving disability payments under that policy at the time he applied for the hospital, medical, and surgical expense policy. There is evidence that Smith asked the person who should know, his insurance man (his "policy man"), if a certain risk was covered under a policy to be issued.

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SOUTHERN LIFE AND HEALTH INS. v. Smith
518 So. 2d 77 (Supreme Court of Alabama, 1987)

Cite This Page — Counsel Stack

Bluebook (online)
518 So. 2d 77, 1987 WL 1414, Counsel Stack Legal Research, https://law.counselstack.com/opinion/southern-life-and-health-ins-v-smith-ala-1987.