Suluai v. National Western Life Insurance

6 Am. Samoa 3d 203
CourtHigh Court of American Samoa
DecidedMay 10, 2002
DocketCA No. 134-00
StatusPublished

This text of 6 Am. Samoa 3d 203 (Suluai v. National Western Life Insurance) is published on Counsel Stack Legal Research, covering High Court of American Samoa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Suluai v. National Western Life Insurance, 6 Am. Samoa 3d 203 (amsamoa 2002).

Opinion

OPINION AND ORDER

Sipu Suluai (“Sipu” or “decedent”), deceased, and his wife Sefulutasi Suluai (“Sefulutasi” or “plaintiff’) applied for life insurance from the defendant National Western Life Insurance Co. (“NWL”), a corporation with headquarters in Texas. Sipu and Sefulutasi were initially interviewed on July 7, 1997, by NWL’s American Samoa agent Afa Roberts (“Roberts”). Based on answers given by Sipu and Sefulutasi at these interviews, Roberts filled out an application form, a NWL standard form document, which sought, among other things, certain information on each applicant’s medical history. This form required applicants to indicate whether they had been treated for any of a variety of illnesses over the previous five years. NWL delivered a policy on December 15, 1997, on Sipu’s life designating plaintiff as the primary beneficiary. Plaintiffs application, on the other hand, was denied. Sipu died nine months after, on September 26, 1998, within the policy’s “contestability clause” period of two years.

Testimony at trial and a series of letters and faxes exchanged between the parties illuminate how this case developed. On September 8, 1999, plaintiff filed a claim with NWL, enclosing copies of the decedent’s death certificate and insurance policy, demanding the face amount of the policy, $50,000. On September 16, 1999, NWL wrote back requesting additional documents to process the claim, including copies of all medical records from July 1992 until the date of death. NWL pointed out that death had occurred within the contestable period. On October 14, 1999, plaintiffs counsel responded and advised, among other things, that he was attempting to locate the decedent’s medical records, and that the documents would be forwarded immediately upon receipt. On October 26, 1999, NWL requested the decedent’s medical records directly from LBJ Medical Center. On December 3, 1999, plaintiffs counsel wrote NWL that he had tried unsuccessfully to verify that the medical records were sent, and asked NWL if it had yet received the records. He then raised the suggestion that the records were unnecessary for NWL to process the claim because in his opinion the medical [205]*205problems admitted on the insurance application were the same problems resulting in the death of the decedent.

NWL’s December 13, 1999, response indicates where the working relationship between the parties was clearly taking a turn for the worse. In this response, NWL mentioned that plaintiffs counsel had recently told one of NWL’s staff members that the medical records were either lost or destroyed, but that LBJ had not confirmed this. NWL also informed plaintiffs counsel that it was plaintiff, and not the decedent, who had indicated she had diabetes at the time of the application. Once again, NWL then stated it needed the decedent’s medical records before the claim could be further processed.

On March 29, 2000, NWL, citing a lack of communication from plaintiff, offered to refund the premiums paid on the policy. On April 10, plaintiffs counsel responded by citing Texas Insurance Code § 21.21 and asking for payment of the policy in full. No mention was made of the medical records. On April 12, NWL raised their position that the Texas Insurance Code requires an insurer to reject or accept a claim within fifteen business days after the date the insurer receives all forms and documents necessary to secure proof of loss — not simply within fifteen days of the filed claim. NWL also indicated that according to decedent’s employer, he had been treated at LBJ prior to the issue date of the policy. Again, NWL requested that the medical records be provided if located.

Discussion

It is NWL’s theory that the decedent committed a misrepresentation by failing to notify NWL, at the time of application, of what should have been recognized as a major medical condition. Such a misrepresentation would absolve NWL of liability under the insurance contract. See, e.g., Skinner v. Aetna Life and Cas., 804 F.2d 148, 149 (D.C. Cir. 1986).

A. Misrepresentation

A “misrepresentation” in insurance is 1) a statement or representation by omission, made by the insured, that is untrue; 2) that is either made with the intent to deceive or made without knowing it to be trae; 3) that misleads or has a tendency to mislead by causing reliance by the insurer; and 4) that is material to the risk insured. See Mut. Life Ins. Co. v. Hilton-Green, 241 U.S. 613, 621 (1916);Union Bankers Ins. Co. v. Shelton, 889 S.W.2d 278, 282 (Tex. 1994); Hollinger v. Mut. Ben. Life Ins. Co., 560 P.2d 824, 827 (Colo. 1977); 43 Am. Jur. 2d Insurance § 1011 (2000).

[206]*206Roberts, agent of NWL who took decedent’s and plaintiffs applications for life insurance and filled out their applications, testified before this court that he asked decedent whether he had any diseases or had been hospitalized in the five years preceding application. Roberts also testified that while he did not originally recall whether it was decedent or plaintiff who told him about having diabetes at that time, after reviewing the application it was his testimony that only the plaintiff admitted to having diabetes. This testimony is certainly more compelling than plaintiffs counsel’s personal intimation while cross-examining Roberts that the latter had at a later date admitted knowledge of decedent’s diabetes, a conversation Roberts did not recall. A review of the insurance application form itself shows that a box is checked indicating a history of illness, and in the “Details” section it is revealed that plaintiff had diabetes. Roberts’ explanation of how the “Details” section would necessarily include any indication of decedent’s condition, if mentioned, is obviously accurate and, accordingly, the form itself comports with Roberts’ testimony. Additionally, when plaintiffs own insurance was rejected because of her diabetes, neither she nor decedent made any mention of the latter’s diabetes to Roberts.

The insurance application itself was signed by decedent, and while the application clearly indicates that plaintiff suffered from diabetes it conspicuously makes no mention of decedent’s condition. From this signed answer to the application’s inquiries concerning health, we can conclude that decedent made the representation to NWL at the time of application that he did not knowingly suffer from any disease or illness at the time of application, and had not suffered from such for five years preceding application. See, e.g., Phoenix Mut. Life Ins. Co. v. Raddin, 120 U.S. 183, 189-90 (1886); Prudential Ins. Co. v. Barden, 424 F.2d 1006, 1010 (4th Cir. 1970); 43 AM. JUR. 2d Insurance § 1008 (2000) (where an answer of the applicant to a direct question purports to be a complete answer to the question, any substantial omission in the answer avoids a policy issued on the faith of the application).

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Related

Phoenix Life Ins. Co. v. Raddin
120 U.S. 183 (Supreme Court, 1887)
Allstate Insurance Company v. Albert Winnemore
413 F.2d 858 (Fifth Circuit, 1969)
Bruce Bagwell v. Canal Insurance Company
663 F.2d 710 (Sixth Circuit, 1981)
Hollinger v. Mutual Benefit Life Insurance
560 P.2d 824 (Supreme Court of Colorado, 1977)
Union Bankers Insurance Co. v. Shelton
889 S.W.2d 278 (Texas Supreme Court, 1994)

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Bluebook (online)
6 Am. Samoa 3d 203, Counsel Stack Legal Research, https://law.counselstack.com/opinion/suluai-v-national-western-life-insurance-amsamoa-2002.