Toups v. Equitable Life Assur.

657 So. 2d 142, 1995 WL 254783
CourtLouisiana Court of Appeal
DecidedJuly 19, 1995
Docket94-1232
StatusPublished
Cited by7 cases

This text of 657 So. 2d 142 (Toups v. Equitable Life Assur.) 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
Toups v. Equitable Life Assur., 657 So. 2d 142, 1995 WL 254783 (La. Ct. App. 1995).

Opinion

657 So.2d 142 (1995)

Thalia Ann TOUPS, Plaintiff-Appellant,
v.
EQUITABLE LIFE ASSURANCE, et al., Defendants-Appellees.

No. 94-1232.

Court of Appeal of Louisiana, Third Circuit.

May 3, 1995.
Order Granting Limited Rehearing and Amending Opinion July 19, 1995.

*143 Ronald J. Fiorenza, Alexandria, Ralph W. Kennedy, Alexandria, for Thalia Ann Toups.

Grove Stafford, Jr., Andrew Parker Texada, Alexandria, for Equitable Life Ins.

John Gutierrez McLure, Alexandria, for William Stephens.

Before PETERS, AMY, and SULLIVAN, JJ.

PETERS, Judge.

The plaintiff, Thalia Ann Toups, brought this action to recover benefits under two policies of disability income insurance issued by the defendant, The Equitable Life Assurance Society of the United States (Equitable). She also named as defendant, William E. Stephens, Sr., the Equitable agent who sold the policies to her. Equitable filed a reconventional demand seeking the return of $11,600.00 in benefits already paid and filed a third party claim against Stephens. After trial, the trial court rendered judgment dismissing plaintiff's demands against the defendants as well as the reconventional demand and third party claim of Equitable. Only the plaintiff has appealed.

DISCUSSION OF RECORD

The plaintiff is a clinical social worker who began an outpatient psychotherapy practice in Alexandria, Louisiana, in 1985. In 1987, she and Patricia Godfrey, another clinical social worker and close friend of twenty years, formed North River Company, Incorporated, a corporation through which they offered their professional services to the public. By mid-1989, the business had become very successful, in large part as a result of the work ethic of Ms. Toups, whom Ms. Godfrey described at that time as an "incredibly energetic, active person." As a result of the corporation's success, Ms. Godfrey concluded there was a need for financial protection for Ms. Toups because the corporation was heavily dependent on her ability to work. In seeking information concerning possible insurance coverage, Ms. Godfrey turned to William E. Stephens, Sr., a cousin of the plaintiff, who had just recently joined Equitable.

Stephens had only joined Equitable on July 17, 1989, and became licensed as an agent of the company on August 1, 1989. In early August of 1989, Stephens and another Equitable agent, Tom Petrus, met with Ms. Toups and made a sales presentation of a disability income policy. The presentation was actually made by Petrus, who was an experienced Equitable agent and was responsible for training Stephens. Although Stephens had completed an Equitable training program, his participation in this presentation was his first experience with Equitable's disability income policy.

The policy application was not completed the day of the presentation. A few days later, Stephens met with Ms. Toups alone and completed the application. Petrus had been scheduled to conduct the application interview but cancelled at the last moment, leaving Stephens with no instruction as to how to proceed. In fact, Stephens' first experience in interviewing a client and completing any type of application on behalf of Equitable was on this occasion. Stephens orally propounded the application questions to Ms. Toups and recorded his interpretation of her answers. According to Ms. Toups, she did not sign the application that day. She testified *144 that Stephens took it back to his office to inquire as to some questionable matters and later presented the application, which she signed.

After acceptance of the application, Equitable issued a policy which provided for monthly disability income benefits in the amount of $3,800.00. The policy had an effective date of August 9, 1989, and, among other terms, contained a guaranteed insurability rider giving the plaintiff the option to purchase up to $2,000.00 per month in additional income disability benefits regardless of her medical condition at the time of purchase. Approximately one year later, Ms. Toups exercised her guaranteed insurability rider and purchased a second policy thereby increasing her coverage by $2,000.00 per month effective August 9, 1990.

On September 11, 1991, Ms. Toups was diagnosed as suffering from chronic fatigue syndrome, a debilitating condition. Her claim for benefits under the policies was initially honored, and Equitable paid $11,600.00 for the months of September and October of 1991. Thereafter, the benefits were suspended, and after Equitable obtained copies of the plaintiff's medical records, it denied coverage on the basis of material misrepresentation.

Equitable rejected the claim based on the answers to the application as recorded by Stephens. The answers in question are found in Sections 1, 3, and 5 of the application. In Section 1, the plaintiff gave the name and address of Dr. Richard G. Gaynor of Baton Rouge, Louisiana, as her personal physician. She was also asked the following questions in Section 1:

d. Date and reason last consulted [her personal physician] if within the last 5 years.

To this question Stephens recorded "PMS— No treatment given."

In Section 3 of the application, Stephens recorded a negative response on behalf of plaintiff to the following questions:

Have you ever been treated for or had any known indication of:
. . . .
b. Emotional, psychological, mental or nervous system disease or disorder, convulsions or epilepsy?
. . . .
f. Any disease or disorder of the blood or lymphatic systems?

A negative response was also recorded by Stephens on behalf of the plaintiff to the following questions in Section 5:

Other than above, have you within the past 5 years:

a. Consulted or been examined or treated by any physician or practitioner, or visited a psychiatrist, psychologist, psychiatric social worker, psychotherapist or counselor for any reason?
b. Been a patient in a hospital, clinic, sanatorium, or other medical facility? Had any diagnostic test?
c. Been advised to have any diagnostic test, hospitalization, treatment or surgery which was not completed?
d. Had any illness, injury, or surgery? Have you any deformity, lameness or amputation?

A review of Ms. Toups' medical history reveals there are inaccuracies on the application. In 1985, she had undergone radial keratotomy; in 1986, she was diagnosed as having a cystic fibroma lump in the right breast; and in 1987, she was involved in an automobile accident for which she received medical treatment. These constitute consultation, diagnostic testing, injury, and treatment within five years prior to the insurance application.

Dr. Gaynor became the plaintiff's personal physician beginning January 15, 1987, and was still seeing her professionally as of the effective date of the policy. During that period, the plaintiff related numerous complaints to Dr. Gaynor, almost all of which he ultimately attributed to her premenstrual syndrome condition. Included in those complaints were insomnia, anxiety, irritability, depression, headaches, fever, diarrhea, menstrual spotting, irregular flow, excessive flow, weakness, and tiredness.

In February of 1988, because of Ms. Toups' complaints, Dr. Gaynor suspected a possible Epstein Barr virus and ordered laboratory *145 tests which produced normal results. Dr. Gaynor's medical care consisted of the treatment of the plaintiff's symptoms with various medications.

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657 So. 2d 142, 1995 WL 254783, Counsel Stack Legal Research, https://law.counselstack.com/opinion/toups-v-equitable-life-assur-lactapp-1995.