Straub v. Mutual of Omaha Insurance

335 F. Supp. 892
CourtDistrict Court, Canal Zone
DecidedDecember 17, 1971
DocketCiv. No. 6901
StatusPublished

This text of 335 F. Supp. 892 (Straub v. Mutual of Omaha Insurance) is published on Counsel Stack Legal Research, covering District Court, Canal Zone primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Straub v. Mutual of Omaha Insurance, 335 F. Supp. 892 (canalzoned 1971).

Opinion

FINDINGS OF FACT AND CONCLUSIONS OF LAW

CROWE, District Judge.

1. The plaintiff, George Edward Straub, applied for a policy of health insurance with the defendant, Mutual of Omaha Insurance Company, on May 28, 1969 and in the application certain questions were proposed covering the physical condition of the applicant and his dependent wife, Rita Clifford Straub.

2. Pursuant to the application, the defendant issued Policy Number 70 FH 352289-68M, dated May 28, 1968, which was entitled “Medical and Hospitalization Insurance Policy” and the plaintiff paid to the defendant an initial premium of $54.90.

3. On September 20,1968 through October 3, 1968 and from May 12, 1969 through May 14, 1969 and from May 26, 1969 through May 31, 1969, Rita Clifford Straub became ill from cancer of the breasts which necessitated hospitalization, medical care, surgery, radiological therapy, and physiotherapy, the costs of which were in the amount of $2,782.61. It later developed in the pelvic area, but there is no showing that any of the claim and hospitalization was due to the cancer in any area except that of the breasts.

4. The plaintiff filed a claim with the defendant in April, 1969 and thereafter amended his claim on June 22, 1969, setting up the medical and hospitalization expenses, and the defendant replied by refusing to honor the claim on the ground that certain answers on the application for insurance, made by the plaintiff, were not true and were incomplete, and assumed the position that the insurance contract was therefore set aside and without force and effect, and remitted to the plaintiff a refund covering all premiums paid to that date, in the amount of $274.50.

5. The particular questions in the application for insurance which are the subject of this litigation are as follows:

“2. Have you or any dependents ever had, or been advised by a physician that you had, or received advice or treatment for: (Circle conditions answered ‘yes’ and give details in 5. below.)
(c) Any form of tuberculosis; kidney or bladder trouble, prostate trouble, female trouble, venereal disease?
(e) Cancer, tumor or any form of growth; any deformity; loss of hearing; loss of, or loss of use of, eye or limb ?”

and to each of these the plaintiff answered “no”.

“3. Have you or any dependents ever had, or been told you had, or received advice or treatment for: (a) any physical conditions or injuries not mentioned above, or
(b) any symptoms of ill health?”

and to this the plaintiff answered “no”. No details were given in 5., as directed, and in filling out 5. there was a place for the name of his wife, and after her name, in the column headed by the language “Condition, Injury, Symptom of 111 Health, or Findings of Examination (if operation performed, state type)”, the plaintiff placed the language “General Check”, 1968, by Dr. Maritano.

6. The plaintiff and Mrs. Straub were married in 1957 and prior to that time, she had had an ovarian tube (salpingectomy) and her appendix removed [894]*894in 1941, and, also, an operation was performed called a “uterine suspension”, which was to correct a condition caused by a fall.

7. After the marriage she suffered over a period of six years from anemia and was treated for vaginal bleeding in the years 1963, 1964, 1965, 1966, 1967 and 1968 and had had several blood transfusions, which were incident to the flooding and anemia. During this time she was working hard and was very active in teaching music and working as a newspaperwoman and both she and the plaintiff were convinced that her health was good. The vaginal bleeding was due to fibroid tumors of the uterus, which would, she believed, “dry up and go away” and the bleeding would cease after the “passage of menopause.”

8. On May 22, 1969, six days before the execution of the application on May 28, 1968, Rita Clifford Straub received treatment for “fibroids in uterus” and the medical history reflected in the report states, “she had Gyn exam on 4/27/64 at which time fibroids and anemia diagnosed.” This treatment was at Gorgas Hospital in the Canal Zone.

9. The plaintiff either knew of the condition of his wife’s health after their marriage or was charged with knowing them when making the application.

10. Mr. Joseph B. Lockman, Manager of Mutual of Omaha in Panama City, testified that if question 2(c) had been answered “yes” and if question 5. had been answered to embrace all of the personally known medical history of Mrs. Straub, as testified, the application would have been rejected.

11. The cancers that developed in the breasts of Rita Clifford Straub necessitated the removal of the breasts, but from the letter of Dr. Leslie S. Archer, who performed an examination of her breasts and pelvic area in 1968, shortly before he left the Isthmus in June of that year, it is found that there was no sign of cancer or pre-cancer. From further medical testimony, it is found by this Court that the fibroid tumors and excessive menstrual flow “in the past has absolutely no relationship to the present cancer, which she did, and still continues to suffer.”

12. The policy, although offered generally to the public, is not a “group type policy” but is the kind of policy issued on a selective basis and the company accepts or rejects on the application.

13. The parties did not contract for the payment by the defendant of any attorney’s fees of the plaintiff in any contemplated action by the plaintiff against the defendant on the contract of insurance.

CONCLUSIONS OF LAW

1. The court has jurisdiction of the action.

2. The rules governing avoidance of forfeiture of a life insurance policy for misrepresentations are in general applicable to policies of health insurance. Except as otherwise provided by statute, insuror may avoid a policy of health insurance if it is induced either by insured’s intentional concealment or misrepresentation of facts material to the risk. On the other hand, it is generally considered that the company cannot claim forfeiture of the policy for statements which, although untrue, were not made fraudulently or with intent to deceive or which were not material; but there is authority holding, by virtue either of statutory or contractual provisions, that falsity of representations materially affecting the risk defeats the insurance, although such representations were made in good faith and were without intentional deceit. A misrepresentation will be deemed material where it is reasonably calculated to affect the action and conduct of the company and a suppression of a series of facts as to conditions of health and recurrent illnesses may be material, although some of those facts singly may appear relatively unimportant. 45 C.J.S. Insurance § 663.

An insured’s failure to disclose facts that she had been treated for a thyroid condition and had an operation for the removal of the thyroid gland, in answering questions in the application for a hospitalization policy as to whether she [895]*895had had medical or surgical treatment within the past seven years, and ever had surgery, is material misrepresentation and the suppression or leaving out of such facts is a bar to recovery under a hospitalization policy. Kuritzky v. National Casualty Company, 261 A.D. 1083, 27 N.Y.S.2d 5.

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Related

Danaher v. United States
184 F.2d 673 (Eighth Circuit, 1950)
Robinson v. Occidental Life Insurance
281 P.2d 39 (California Court of Appeal, 1955)
Maggini v. West Coast Life Insurance
29 P.2d 263 (California Court of Appeal, 1934)
Kuritzky v. National Casualty Co.
261 A.D. 1083 (Appellate Division of the Supreme Court of New York, 1941)

Cite This Page — Counsel Stack

Bluebook (online)
335 F. Supp. 892, Counsel Stack Legal Research, https://law.counselstack.com/opinion/straub-v-mutual-of-omaha-insurance-canalzoned-1971.