Tiner v. Aetna Life Insurance Company

285 So. 2d 813
CourtLouisiana Court of Appeal
DecidedNovember 21, 1973
Docket12075
StatusPublished
Cited by2 cases

This text of 285 So. 2d 813 (Tiner v. Aetna Life Insurance Company) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tiner v. Aetna Life Insurance Company, 285 So. 2d 813 (La. Ct. App. 1973).

Opinion

285 So.2d 813 (1973)

B. J. TINER et al., Plaintiffs-Appellees,
v.
AETNA LIFE INSURANCE COMPANY, Defendant-Appellant.

No. 12075.

Court of Appeal of Louisiana, Second Circuit.

May 1, 1973.
On Rehearing October 10, 1973.
Writ Granted November 21, 1973.

*814 Lunn, Irion, Switzer, Johnson & Salley by Charles W. Salley, Shreveport, for defendant-appellant.

Pugh & Nelson by Sydney B. Nelson, Shreveport, for plaintiffs-appellees.

Before AYRES, BOLIN and HEARD, JJ.

BOLIN, Judge.

Betty Jane Tiner, joined by her husband, brought this action to enforce the provisions of a health and accident policy issued by Aetna Life Insurance Company to plaintiff. Defendant company filed an answer, in which it denied coverage, and reconvened, affirmatively pleading that certain fraudulent and material misrepresentations were made in the application for its policy; that if the truth had been known to Aetna it would have refused to issue the policy. Defendant tendered $300.21 as return of premiums collected under the policy and also asked for judgment against plaintiffs, as defendants in reconvention, for a return of $157.95 which it had previously paid plaintiffs on an uncontested claim. After trial the district judge, without assigning written reasons, rendered judgment in favor of Betty Jane Tiner for $790.11, and defendant appeals. We affirm the judgment.

At the outset of the trial it was stipulated the various documents, including the policy, the application form, reports from doctors and from the Shreveport Mental Health Center would be admitted without dispute; further, that the amount due, should the court find for plaintiffs, would be $790.11. The remaining questions concerned coverage, i. e., whether there was a fraudulent statement or misrepresentation of the facts in the application, imputable to plaintiffs, which would render the policy void; or, if misrepresentations were made by the person who sold the policy, was such person the agent of the insured or the insurer?

The policy was purchased by E. R. Tiner for his daughter prior to her marriage. Appellant's position is that the policy was issued in error in reliance upon material misrepresentations of Mr. Tiner in answering questions relative to his daughter's medical history, previous psychiatric treatments and hospitalization for emotional disturbances. Appellant contends further that A. J. Abramson, who sold the policy, was a broker and not an Aetna agent; therefore, if truthful responses to questions in the application were given to Abramson and he falsely entered the answers, the insured is bound by such misstatements since Abramson was acting as agent for the insured and not as agent for Aetna. Alternatively, it is urged plaintiff, by accepting the policy with due notice that the application was attached and made a part of the policy, is charged with knowledge of and is bound by misrepresentations inserted therein.

Betty Jane, who was not present when the application was filled out, later signed the application and the Tiners paid premiums, which were received by Aetna without *815 complaint over a period of 21 months before the present controversy arose. Appellees contend the questions were answered truthfully; that the Tiners thought they were dealing with an agent of Aetna; and they relied upon him to fill out the application correctly.

Mr. Tiner testified he called Abramson and asked him to come to his home for the purpose of discussing the purchase of a health policy for his daughter; that he had been referred to Abramson whom he thought represented Aetna; that when Abramson arrived he had with him an Aetna application form and rate book and advised him he could write an individual health and accident policy on Tiner's daughter with Aetna; that Abramson asked certain questions which he, Tiner, answered truthfully and Abramson entered the answers on the application form. From the evidence it appears that in the normal course of business such completed application forms are taken by the broker or agent to the insurer which in turn submits the applications to the underwriting department. If the policy is to be issued it, together with the application form, is sent back to the person making the application to be signed. A request for payment of premium accompanies the policy.

Abramson testified he was and had been a licensed agent for Equitable Life Insurance Company for thirteen years; that he acted as broker for Aetna as well as a number of other companies; that on the day Tiner called his company office the cashier took the call and gave it to him. He went to the Tiner home that evening and when Tiner told him he wanted some health insurance for his daughter, Abramson advised him that Equitable did not write individual policies but that he could write or "broker" it with Aetna. When asked by Aetna's attorney what he meant by "broker" he stated he was representing Aetna but that his client was Tiner. Questioned if there was any difference in the way a policy application submitted by a full-time Aetna agent was processed and a policy application submitted by a broker, he replied there was none; that both were submitted through a local office to the company's underwriting department; that agents and brokers use identical rate books and receive the same rate of commission, i. e., 35% of the first year's premium.

The controversial question, answered in the application, was as follows:

"13. Has any person to be covered: Yes No

* * * * * *

(c) ever had any mental, nervous, physical, or functional disorder or impairment? X"

To the above question (13-c) Mr. and Mrs. Tiner testified they answered "yes". Further they testified they answered all questions asked them by Abramson truthfully and that they told him of the prior medical treatment received by their daughter. Abramson admitted that the Tiners answered "yes" to the question but that they minimized the severity of the emotional disturbance and he subsequently circled or marked through the "X" in the "yes" block and placed an "X" in the "no" block.

The record established that the insured, Betty Jane Tiner, had been treated on a weekly out-patient basis at the Shreveport Mental Health Center over a period of approximately one year prior to the issuance of the policy in March, 1970. However, there is no documentary record of hospital treatment for psychiatric disturbance before June 1, 1971, over a year after the policy was issued. It is true Mr. Tiner stated his daughter had been treated by a psychiatrist before issuance of the policy but, initially, on cross-examination he had stated he did not recall the time definitely. [The two claims for which this suit was brought were for illnesses unconnected with mental illness.]

From our review of the record, including the records from the Shreveport Mental *816 Health Center, Schumpert Hospital and Dr. Andrew J. Mullen, we are convinced that Betty Jane Tiner had been emotionally disturbed and had been treated by the psychiatrist at the Mental Health Center prior to March 3, 1970, the effective date of the policy. However, even though the testimony is somewhat conflicting, we believe there was no material misrepresentation made by the Tiners to Abramson and that if the answer to question 13-c was incorrect it was due to Abramson's actions in crossing out the "yes" answer to the question and inserting "no".

Appellant urges that Abramson was not an agent of Aetna and that insofar as Aetna is concerned he is a broker.

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Related

Tiner v. Aetna Life Insurance Company
291 So. 2d 774 (Supreme Court of Louisiana, 1974)
Tiner v. Aetna Life Insurance Co.
286 So. 2d 656 (Supreme Court of Louisiana, 1973)

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285 So. 2d 813, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tiner-v-aetna-life-insurance-company-lactapp-1973.