Sweatman v. Department of Veterans Affairs

92 Cal. Rptr. 2d 560, 77 Cal. App. 4th 1371
CourtCalifornia Court of Appeal
DecidedMay 10, 2000
DocketE022817
StatusPublished

This text of 92 Cal. Rptr. 2d 560 (Sweatman v. Department of Veterans Affairs) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sweatman v. Department of Veterans Affairs, 92 Cal. Rptr. 2d 560, 77 Cal. App. 4th 1371 (Cal. Ct. App. 2000).

Opinion

92 Cal.Rptr.2d 560 (2000)
77 Cal.App.4th 1371

Bruce SWEATMAN III, Plaintiff and Appellant,
v.
DEPARTMENT OF VETERANS AFFAIRS, Defendant and Respondent.

No. E022817.

Court of Appeal, Fourth District, Division Two.

February 4, 2000.
Review Granted May 10, 2000.

*561 Law Offices of Robert K. Scott and D. Scott Mohney, Newport Beach, for Plaintiff and Appellant.

Arnulfo Hernandez, Jr., Elizabeth C. Wied, Frank Perez Tays, Bruce A. Crane, Sacramento, and Patrick Ramirez S. Bupara, San Francisco, for Defendant and Respondent.

OPINION

RICHLI, J.

The state Department of Veterans Affairs (the Department) made a home mortgage loan to Bruce Sweatman III (Sweatman), a veteran. For an additional payment, it also provided Sweatman with life and disability coverage. This meant that, if Sweatman died or became disabled, he would not have to make payments on the loan; an insurance company, which the Department had hired to administer its life and disability coverage program, would take the amount of the payments out of a bank account funded by the Department and would repay that amount to the Department.

When Sweatman in fact became disabled, however, the Department purported to rescind his disability coverage, claiming he had made material misrepresentations regarding his health history. A jury, finding no breach of contract, returned a verdict for the Department.

Sweatman appeals. He contends the disability coverage was insurance which, under the Insurance Code, the Department was not entitled to rescind. We disagree, and we will affirm.

I

FACTUAL BACKGROUND

A. The Plan.

Pursuant to the Veterans' Farm and Home Purchase Act of 1974 (Mil. & Vet. Code, § 987.50 et seq.), the Department makes home and farm mortgage loans to veterans.[1] As part of the loan contract, the borrower must "agree[], as required by Department, to maintain accident, *562 health, life or disability insurance payable to the Department.... Said insurance shall be in such form and administered or provided by such companies as Department may determine...."

The Department requires all borrowers to apply for its "Home Protection Plan of Life and Disability Coverage for Cal-Vet Purchasers" (the Plan). The Plan includes both "life coverage," generally defined as payment of the unpaid balance of the loan in the event the veteran dies, and "disability benefits," generally defined as monthly payments on the loan in the event the veteran becomes totally disabled. To obtain life coverage, a borrower must "submit satisfactory evidence of insurability" and pay a monthly premium. To obtain disability coverage, the borrower must qualify for life coverage; the borrower also must be employed and must pay an additional monthly premium. The disability coverage excludes any disability resulting from a preexisting condition.

B. The Administration of the Plan.

The Department is statutorily authorized to "enter[] into a master agreement with one or more insurance companies to provide life or disability insurance coverage" for veterans to whom it has made loans. (Mil. & Vet.Code, § 987.88, subd. (a).)

The Department has entered into a "Master Agreement" with Pacific Mutual Life Insurance Company (Pacific Mutual). Under the Master Agreement, Pacific Mutual acts as administrator of the Plan. Pacific Mutual calculates annually, using actuarial methods, the contribution necessary to fund the Plan. The Department then deposits this amount into a bank account. Borrowers' premiums are also deposited into this bank account.

Pacific Mutual is responsible for reviewing and approving applications for coverage. It is also responsible for reviewing, investigating, and approving claims. Once it approves a claim, it pays the amount of the claim, out of the bank account, to the Department. If the bank account proves insufficient, the Department may make an additional contribution; under no circumstances is Pacific Mutual to be liable for any shortfall. The Master Agreement provides: "The coverages provided under the Plan will be a form of self-funded benefits as between the Department and each Participant."

C. Sweatman's Dealings With the Department.

In February 1988, Sweatman applied to the Department for a home loan. In April 1988, he submitted an application for life and disability coverage under the Plan. According to Sweatman's application, he had not been in a hospital within the preceding ten years; the only doctor he had seen in the preceding five years was a Dr. Pepitone; the only medical treatment he had received in the preceding five years consisted of premarital HIV testing and treatment for a sore left shoulder; and he had never been treated for any nervous or mental disorder.

Actually, in September 1986, a counselor had told him he might have bipolar disorder. He was referred to Dr. Whiteley, a psychiatrist. Dr. Whiteley had him admitted to a hospital with a diagnosis of "major depression." Dr. Whiteley also prescribed antidepressant medication. Dr. Whiteley thought Sweatman might have bipolar disorder; he wanted to prescribe lithium, but Sweatman refused to try it. Two days after Sweatman was released from the hospital, he was readmitted, again with a diagnosis of "major depression." After his release, Dr. Whiteley continued to treat him for depression, until April 1987.

In or about July 1988, the Department's loan to Sweatman closed. Because he had reported a previous problem with his left shoulder, the Department added a rider to his disability coverage which excluded any disability resulting from "injury to or disease of [his] left shoulder."

*563 In 1992, Sweatman became totally disabled due to what was then diagnosed as bipolar disorder. In April 1993, he sent Pacific Mutual a claim for disability benefits. In it, he indicated the first time he had consulted a doctor regarding his disability had been in July 1986. On August 23, 1993, Pacific Mutual notified Sweatman it was rescinding his disability coverage on the ground that he had made material misrepresentations about his medical history.

II

PROCEDURAL BACKGROUND

The operative complaint stated a single cause of action, for breach of contract. The Department's answer has not been included in the record.

On February 24, 1998, the case was called for trial. The Department filed a written motion in limine for a ruling that the Plan was not insurance. The trial court denied the motion.

On February 25, 1998, a jury trial began. On March 5, 1998, Sweatman filed a motion for a directed verdict in which he argued the Plan was insurance. The trial court denied the motion. Accordingly, the case went to the jury.

On March 10, 1998, the jury, by special verdict, found that the Department did not breach the contract by rescinding Sweatman's disability benefits.

On March 20, 1998, Sweatman filed a motion for judgment notwithstanding the verdict (JNOV) in which he argued again that the Plan was insurance. On April 6, 1998, the trial court entered judgment in favor of the Department and against Sweatman. On April 24, 1998, the trial court denied Sweatman's motion for JNOV. On June 4, 1998, Sweatman filed a notice of appeal from the order denying his motion for JNOV.

III

DISABILITY COVERAGE UNDER THE PLAN AS "INSURANCE"

A. Standard of Review.

Sweatman appealed exclusively from the order denying his motion for JNOV.[2]

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Metropolitan Life Insurance v. State Board of Equalization
652 P.2d 426 (California Supreme Court, 1982)
Hauter v. Zogarts
534 P.2d 377 (California Supreme Court, 1975)
Title Insurance. Co. v. State Board of Equalization
842 P.2d 121 (California Supreme Court, 1992)
Clemmer v. Hartford Insurance Co.
587 P.2d 1098 (California Supreme Court, 1978)
Transportation Guarantee Co. v. Jellins
174 P.2d 625 (California Supreme Court, 1946)
Truta v. Avis Rent a Car System, Inc.
193 Cal. App. 3d 802 (California Court of Appeal, 1987)
Norman I. Krug Real Estate Investments, Inc. v. Praszker
220 Cal. App. 3d 35 (California Court of Appeal, 1990)
Nathanson v. Hertz Corp.
183 Cal. App. 3d 78 (California Court of Appeal, 1986)
Unilogic, Inc. v. Burroughs Corp.
10 Cal. App. 4th 612 (California Court of Appeal, 1992)
Hertz Corp. v. Home Insurance
14 Cal. App. 4th 1071 (California Court of Appeal, 1993)
Grand Rent a Car Corp. v. 20th Century Insurance
25 Cal. App. 4th 1242 (California Court of Appeal, 1994)
Osborn v. Irwin Memorial Blood Bank
5 Cal. App. 4th 234 (California Court of Appeal, 1992)
Fountain Valley Chateau Blanc Homeowner's Ass'n v. Department of Veterans Affairs
79 Cal. Rptr. 2d 248 (California Court of Appeal, 1998)
Brandenburg v. Pacific Gas & Electric Co.
169 P.2d 909 (California Supreme Court, 1946)
Metzinger v. Manhattan Life Insurance
455 P.2d 391 (California Supreme Court, 1969)

Cite This Page — Counsel Stack

Bluebook (online)
92 Cal. Rptr. 2d 560, 77 Cal. App. 4th 1371, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sweatman-v-department-of-veterans-affairs-calctapp-2000.