Walston v. Monumental Life Insurance

923 P.2d 456, 129 Idaho 211, 1996 Ida. LEXIS 120
CourtIdaho Supreme Court
DecidedAugust 29, 1996
Docket22153
StatusPublished
Cited by42 cases

This text of 923 P.2d 456 (Walston v. Monumental Life Insurance) is published on Counsel Stack Legal Research, covering Idaho Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Walston v. Monumental Life Insurance, 923 P.2d 456, 129 Idaho 211, 1996 Ida. LEXIS 120 (Idaho 1996).

Opinion

SCHROEDER, Justice

Following trial a jury awarded James Walston, an insured in a cancer insurance policy, $3,800 for a breach of contract, $120,000 for damages arising from fraud and bad faith denial of benefits and $10,000,000 in punitive damages. The trial court sustained the verdict on all counts but reduced the punitive damages to $3,200,000 in response to an alternative motion for judgment notwithstanding the verdict, new trial, or remittitur. Monumental Life Insurance Company appeals.

I.

BACKGROUND AND PRIOR PROCEEDINGS

Monumental Life Insurance Company (Monumental) sent James Walston (Walston) a solicitation to purchase a cancer expense insurance policy. The solicitation was under the auspices of a Masonic organization and consisted of a two-page promotional pamphlet and a letter composed by Monumental with the signature of the Sovereign Grand Commander of the Supreme Council of the Scottish Rite Brotherhood. The Masonic organization received a payment of $100,000 for use of its name. The brochure contained samplings of policy benefits which indicated limited coverage.

Walston did not read the part of the brochure describing the specific benefits payable. He read and relied upon two parts of the brochure: (1) a headline saying the policy provided “lifetime benefits of up to $250,000” and describing it as a “high-limit” policy, and (2) a set of questions and answers stating, among other things, that benefits were payable regardless of whether other policies or plans provided benefits for the same services. Walston testified that the “lifetime benefits of up to $250,000” caught his eye because the print was in “big black letters.”

Walston completed an application for the Monumental policy and signed a statement indicating that, “to the best of [his] knowledge and belief, no person to be insured under this coverage has been treated for any type of cancer for the past five years.” The application was dated January 25, 1991. Walston’s wife had undergone a second mastectomy for breast cancer on January 10, 1986, just fifteen days outside the five-year period. She then made two follow-up visits to her surgeon on January 31,1986, and May 25, 1986, both within the five-year period. Walston submitted the application with a $36 quarterly premium. Monumental then issued a certificate of insurance.

In February of 1991, approximately one month after Walston applied for the policy, his wife was diagnosed with lung cancer from which she died on July 11, 1991. Her medical expenses totaled approximately $41,000. *214 All but $8,000 — $4,000 was paid by Medicare and another insurer’s Medicare supplemental policy.

Mr. Walston submitted a claim to Monumental for medical services rendered from February 19, 1991, through June, 1991. Mrs. Walston’s treatment called for $3,800 in benefits under the terms of the policy. Due to the short time between the application and the diagnosis, a Monumental adjuster checked on whether the cancer involved a pre-existing condition. There was not a preexisting condition, but the investigation did reveal that Mrs. Walston had follow-up visits within the five-year period before the application. Monumental determined that the post-operative visits constituted treatment and, therefore, considered Mrs. Walston to have been under treatment for cancer from January 6, 1985, to May 25, 1986. Monumental concluded that the representation made by Walston on the application had been false and rescinded the policy.

Walston challenged the characterization of these post-operative visits as “treatment.” Monumental persisted in its position that the visits were properly characterized as treatment despite information that they were only check-ups on her condition. Walston sued Monumental, alleging breach of contract, bad faith denial of benefits and rescission of contract, and fraud.

James L. Wadhams, a former Nevada insurance official, was permitted to testify that the mailing sent to Walston violated Idaho insurance department advertising regulations and was designed to deceive. Wadhams testified that advertising the policy as a “high-limit” policy and referencing the $250,000 aggregate limit was misleading because of the internal limits on individual benefits contained within the policy which in fact made it a low-limits policy. It was virtually impossible to reach the overall limit advertised in the policy. In his view the $250,000 limit advertised bore “no relationship to the benefits that will be paid” and violated a regulation limiting use of words or phrases such as “all,” “full,” “complete,” “comprehensive,” “unlimited,” “up to,” and “as high as.” Wad-hams was also critical of advertising information which implied that this was a special offer that must be acted on in a limited time and the implication in the advertising literature that the policy would pay the cost of simple stage one cancer at a cost of more than $22,000. Additionally, he testified that describing policy limitations in a positive manner so as to imply that they were benefits violated insurance department regulations.

Wadhams testified that the denial of benefits on the basis that Mrs. Walston had undergone treatment within five years was improper, because Monumental imposed an unusual and strained interpretation on the term treatment. He described the way the policy was advertised and adjusted as an extreme deviation of reasonable standards of conduct.

Evidence at trial indicated that Monumental’s practices in this case were consistent with its usual way of doing business. The advertisements were mass mailed. The denial of benefits was approved by upper management. Management of Monumental did not see any problem with its conduct and intended to continue doing business in the same manner.

The jury rendered a verdict in favor of Walston, answering the questions propounded as follows:

1. Did defendant breach its contract of insurance with plaintiff? Answer: Yes.
2. If you answered “yes” to question No. 1, what is the amount of damages owed to plaintiff as a result of defendant’s breach of contract? Answer: $3,800.00.
3. Did the promotional material provided by defendant to plaintiff relating to a Scottish Rite Group Cancer Expense Protection Plan contain intentional fraudulent misrepresentations? Answer: Yes.
4. Did plaintiff reasonably rely on the misrepresentations in electing to purchase the insurance? Answer: Yes.
5. If you answered “yes” to question Nos. 3 and 4, did the plaintiff suffer damages as a proximate result of the fraudulent conduct? Answer: Yes.
6. Did defendant breach its duty of good faith and fair dealing in its handling of plaintiffs claim? Answer: Yes.
*215 7. If you answered “yes” to question Nos. 5 or 6, what is the additional damage suffered by plaintiff on account of defendant’s intentional breach of the duty of good faith and fair dealing and/or fraud? Answer: $120,000.00.
8. Was the conduct of defendant an extreme deviation from the standards of reasonable conduct warranting the imposition of punitive damages? Answer: For fraud? Yes. For breach of duty of good faith and fair dealing? Yes.

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Cite This Page — Counsel Stack

Bluebook (online)
923 P.2d 456, 129 Idaho 211, 1996 Ida. LEXIS 120, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walston-v-monumental-life-insurance-idaho-1996.