Knapp v. Independence Life and Accident Ins. Co.
Knapp v. Independence Life and Accident Ins. Co.
Opinion of the Court
In this action of assumpsit, instituted in the Circuit Court of Kanawha County in July 1959, the plaintiff, Dennis R. Knapp, seeks a recovery from the defendant, Independence Life and Accident Insurance Company, a corporation, in the sum of $2,698.30 for necessary surgical, medical and hospital expenses incurred by the plaintiff in an effort to effect the cure of his wife who had contracted the disease of cancer. The plaintiff alleged in his declaration that the defendant owes him that amount under the terms and provisions of a policy of insurance which it issued to him on March 22, 1956 and on which the plaintiff bases his right to a recovery against the defendant in this action.
On March 22, 1956, the defendant issued a policy of insurance to the plaintiff and the members of his family against loss by reason of surgical, medical and hospital expenses incurred in an effort to cure the members of his family of certain diseases, eight in number, and in particular the disease of poliomyelitis. The disease of cancer was not included in the original policy, the face amount of which was $5,000.00, with an annual increase of $1,000.00 per year until the maximum amount should be increased to $10,000.00 during the fifth policy year.
Sometime prior to the fall of 1957 the plaintiff received by mail from the home office of the defendant a letter informing him that his poliomyelitis and other dread diseases policy provided maximum benefits for poliomyelitis of $10,000.00 which increased in an amount of $1,000.00 each year until it shall be increased to the amount of $15,000.00 at no additional cost and
In October 1957, after the plaintiff had received the foregoing rider which he attached to his policy, he received by mail from the home office of the defendant a form letter which contained, among others, these statements: “Dear Policyholder: In Re: Policy No. FD You are a holder of an Independence family Polio and other Dread Diseases Policy. The Company has recently added Cancer Benefits to your policy, without any increase in premium. * * The letter then informed the plaintiff of a new family life insurance policy obtainable from the defendant which would insure for one guaranteed low premium the father, the mother and all the children between the ages of fifteen days and twenty one years, and requested the plaintiff, if interested in such policy, to complete and mail to the
After receiving the foregoing letter the plaintiff renewed the policy for at least two additional periods of one year, paid a $10.00 premium for each renewal, and obtained receipts for each renewal which stated that cancer was included in the diseases covered by the policy. These renewal premiums were paid to, and the receipts were given by Eay W. Ellis, doing business as Ellis Insurance Agency, the broker who solicited and negotiated with the plaintiff in his purchase of the original policy of insurance.
Before the defendant mailed the plaintiff the second letter in October 1957, which was not accompanied by any rider, the defendant issued and sent to Coal Eiver Insurance Agency, its local agent in the Charleston area which included Nitro where the plaintiff resided, a quantity of riders. Each of these riders specified that the amount of cancer coverage which had been added to the type of policy issued to the plaintiff was the sum of $250.00, and each of these riders contained the statement that it took effect July 1, 1957, or ninety days after the date of the policy, if the date of the policy was subsequent to June 30, 1957, directed the insured to attach the rider to his policy, and was signed by the president and the secretary of the insurer. In February or March, 1958, after the plaintiff had received the letter in October, 1957, the defendant issued and sent to its local agent a second quantity of riders. Each of those riders specified that the amount of cancer coverage had been increased from $250.00 to $500.00, contained the statement that it took effect May 1,1958, or ninety days after the date of the policy, if the date of the policy was subsequent to April 30, 1958, directed the insured to attach the rider to his policy, and was signed by the president and the secretary of the insurer.
By letter dated June 11, 1959, the defendant denied liability for any amount in excess of $500.00 and informed the plaintiff of the rider which limited its liability to the plaintiff for cancer benefits to that amount. On June 15, 1959, the defendant sent its draft to the plaintiff in the amount of $500.00. The plaintiff instituted this action on July 6, 1959, which was before the expiration of sixty days from the date the plaintiff filed his proof of loss, and on July 24, 1959, he returned the draft to the defendant and notified it that he refused to accept the amount of the draft in settlement of his claim.
The stipulation contains numerous contentions in behalf of each of the respective parties. Among the contentions of the plaintiff are the contentions that as the letter received by him from the defendant in October 1957 contained no restrictions or limitations, the amount of coverage for cancer benefits was the same as that contained in the policy for the other diseases covered by the policy; that, as he did not receive any subsequent amendments or riders, and as he relied upon the foregoing letter, he did not obtain other insurance protection against the disease of cancer ; and that for that reason the defendant is estopped from asserting any construction of the letter received by the plaintiff in October 1957 which would limit its liability to the plaintiff for insurance protection against the disease of cancer to any amount less than the amount of the coverage provided by the policy.
The contention of the defendant that the broker who solicited the insurance was the agent of the plaintiff and not the agent of the defendant is disposed of, adversely to the defendant, by Section 13, Article 7, Chapter 33, Code, 1931, now Section 23, Article 12, Chapter 33, Code, 1931, as amended by Article 12, Chapter 97, Acts of the Legislature, Regular Session, 1957. That section provides that any person who shall solicit within this State an application for insurance shall, in any controversy between the insured or his beneficiary and the insurer issuing any policy upon such application, be regarded as the agent of the insurer and not the agent of the insured. See Moore v. United Benefit Life Insurance Company, 145 W. Va. 549, 115 S. E. 2d 311; Meadows v. Peoples Life Insurance Company, 118 W. Va. 404, 191 S. E. 852. See also Coles v. Jefferson Insurance Company, 41 W. Va. 261, 23 S. E. 732. The position of the defendant is that although under the statute the person who solicits the application for insurance is regarded as the agent of the insurer he is such agent in any controversy between the insurer and the insured or his beneficiary only to the extent that the application is involved and that the statute does not apply to a controversy in which other questions or issues are in dispute. This position is clearly untenable and can not be given judicial sanction. It is obvious from the clear and unambiguous language of the statute that the solicitor of the application for insurance should be regarded for all purposes as the agent of the insurer in any controversy between it and the insured or his beneficiary.
The undisputed evidence is that before the plaintiff received the form letter in October 1957, advising him that the defendant had recently added cancer benefits to his policy without specifying the amount of such cover
It is evident that there was no common understanding or agreement between the plaintiff and the defendant as to the meaning and the effect of the form letter of October 1957. The plaintiff apparently entertained, without justification, the mistaken belief that
The principle is well established that a contract of insurance must be assented to by both parties either in person or by their agents. 29 Am. Jur., Insurance, Section 192. There must be a meeting of the minds of the parties as to the essential terms of the contract. Jones v. The Standard Fire Insurance Company of Hartford, Connecticut, 116 W. Va. 597, 182 S. E. 800; Johnson v. Dixie Fire Insurance Company, 108 W. Va. 512, 152 S. E. 11; Meadows v. American Eagle Fire Insurance Company, 104 W. Va. 580, 140 S. E. 552; Bell v. Peabody Insurance Company, 49 W. Va. 437, 38 S. E. 541; Croft v. Hanover Fire Insurance Company, 40 W. Va. 508, 21 S. E. 854, 52 Am. St. Rep. 902; McCully’s Adm’r v. Phoenix Mutual Life Insurance Company, 18 W. Va. 782. In general the essential elements of the contract are the subject matter of the insurance, the risk insured against, the eommence
The form letter of October 1957 was not a rider or other means of amendment of the policy of insurance issued to the plaintiff. Instead it was in effect an advertisement of the new family life insurance policy issuable by the defendant which solicited the purchase of such policy by the plaintiff. This is clear from its terms and the plaintiff should have recognized and treated it for what it was: an advertisement designed to induce the plaintiff to purchase a policy of life insurance from the defendant. As the plaintiff was or should have been acquainted with the method of changing his policy employed by the defendant which was by rider to be attached to the policy, he should have known, in the absence of any accompanying rider, that the letter did not constitute a change in or an amendment of the policy. The letter merely served to put him on inquiry as to how, when and in what amount the cancer coverage had been added to his policy. It is evident that it was the purpose of the defendant to make effective the added coverage by the rider in the amount of $250.00 and the subsequent rider in the amount of $500.00 which were never delivered to or received by the plaintiff and of which he was not aware until long after they had been sent by the defendant to its local agent.
It is well settled in the law of insurance that ordinarily an advertisement issued for the purpose of soliciting insurance does not constitute a part of the contract when not attached to the policy or referred to in it. 29 Am. Jur., Insurance, Section 270. This rule applies to the form letter of October 1957 and operates to prevent it from being regarded as a part or
The doctrine of estoppel is not applicable to the facts of this case. In the law of insurance the elements of an estoppel against an insurer are conduct or acts on the part of the insurer which are sufficient to justify a reasonable belief on the part of the insured that the insurer will not insist on a compliance with the provisions of the policy and that the insured in reliance upon such conduct or acts has changed his position to his detriment. See Globe Mutual Life Insurance Company of New York v. Wolff, 95 U. S. 326, 24 L. Ed. 387; Coleman Furniture Corporation v. Home Insurance Company, 4 F. Supp. 794, affirmed 67 F. 2d 347, certiorari denied, 291 U.S. 669, 54 S. Ct. 453, 78 L. Ed. 1059; Security Insurance Company v. Fay, 22 Mich. 467, 7 Am. Rep. 670; Everett v. Metropolitan Life Insurance Company, 129 Neb. 386, 261 N. W. 575; Continental Insurance Company of New York v. Portwood, 184 Okla. 22, 84 P. 2d 435; 16 Appleman, Insurance Law and Practice, Section 9088; 6 Couch on Insurance, Second Edition, Sections 32:270, 32:271, 32:272; Yance on Insurance, Third Edition, Chapter 9, Section 88; 45 C. J. S., Insurance, Section 704a. Before the defendant may be estopped to deny that the cancer coverage of the policy was increased to the basic amount provided by the policy or in an amount in excess of $500.00 it must have been guilty of some fraud or must have done something by which the plaintiff was misled to his prejudice. Morgan v. American Central Insurance Company, 80 W. Va. 1, 92 S. E. 84, 1917D L.R.A. 1049. Nothing of that kind appears in the record in this case. The form letter of October 1957 merely informed the plaintiff that cancer coverage, without specifying the amount, had been recently added to his policy. It did not state how or when such coverage had been added. At that time, by the rider in the amount of $250.00, such coverage had been added to the policy, although that fact was not known to the plaintiff until after he incurred the loss which he now
As the form letter of October 1957, on which the plaintiff bases his claim, did not effect, in the manner required by the policy, a change in its provisions or add cancer to the coverage provided by the policy and does not cover the claim of the plaintiff, and as the
Reversed and remanded.
Dissenting Opinion
dissenting:
Being of the view that the facts of this case, really not in dispute, do not bring it within the principles applied thereto, except as to Point 1 of the Syllabus, I am forced to dissent.
To properly appraise the problems involved, it must be kept in mind that the original insurance policy provided only “Indemnity for expenses for treatment” for certain so-called “dread diseases”, including poliomyelitis but not including cancer. Except in a single instance not here material, involving a different disease, covered by a different rider, the amount of indemnity as to “expenses for treatment” incurred as to each of the several diseases covered was exactly the same, all being covered by the one definite provision as to the extent of liability. Therefore, it is clear that the only real question to be decided is whether the so-called letter or rider received by the plaintiff in October, 1957, had the effect, either by agreement or estop-pel, of placing cancer within the coverage of the policy. Before dismissing or sloughing off the effects of that paper as an advertisement, it should receive a more careful analysis or appraisement as to its qualitative characteristics.
The so-called advertisement was signed by the vice president of the defendant company; it was addressed and mailed to plaintiff, as a “policyholder”; it stated emphatically, without reservation, that “The Company has recently added Cancer Benefits to your policy, without any increase in premium”; and that this was “in accord with our Company practice # # *”. That this statement, representation and assurance was
Neither is it questioned that plaintiff subsequently twice renewed the policy, paying the regular premiums demanded by the defendant, and the inference is clear, I think, that he did so only because of reliance on the statements of the defendant company. There is no denial of that fact. Each of the receipts which in form were also notices of renewal premium due dates, mailed by defendant to the insured, gave the policy number, and contained this emphatic statement, representation and assurance: “All these specified diseases are covered Cancer; Diphtheria; Encephalitis; Leukemia; Meningococcic; Meningitis; Polio; Rabies; Scarlet Fever; Smallpox; Tetanus”. Thus cancer was expressly and positively placed in the same category as the other covered diseases. It may be significant that the apparent generosity of the defendant in adding cancer to the coverage was occasioned by the appearance and effect of the Salk polio vaccine, which rendered the original policies of the class of that held by plaintiff of much less value, much less saleable. The action was for the purpose of avoiding the lapsing or cancellation of existing policies. It had that exact effect as to the policy owned by plaintiff.
It is true, of course, that the so-called letter contained certain other statements which could be properly referred to as advertising, mentioning the “Family Life” policy. I would deem it useless, though, to argue or attempt to cite authorities to the effect that any such references would not vitiate the effects of a
Of course, if the question here considered is to be measured by the necessary elements of an original insurance contract, there must have been a meeting of minds as to the essential elements of the contract. The only facts relied on by the majority, as establishing a failure of the meeting of minds as to the rider in question, are that it “did not mention the essential elements of the amount of the added cancer benefits or the time at which they would commence and become effective ’ \ The contention last recited may be considered as resulting from an oversight, for the paper clearly and unquestionably says that such “Cancer Benefits” have recently been “added”. As above pointed out, there was no necessity for mentioning any amount of cancer benefits, since the original policy covered “expenses for treatment” in the same manner and amount as to each of the diseases covered by the policy.
Considering the nature of the original policy, one for “expenses for treatment” only, applying alike to all diseases covered except the one disease covered by a different rider, it appears clear to me that the only
Though I should assume, for argument, there was no meeting of minds, I can not escape the conclusion that
Yet another principle, referred to and relied on by the circuit court, requires an affirmance of the judgment of that court. It is stated in 44 C.J.S., Insurance, Section 275(2) as follows: “* # * Even where there is a mistake and both parties act in good faith, yet where the mistake is that of the company or its agents and it reasonably induces the other party to believe that he is insured, the company is estopped to deny the existence of the insurance.”
Though the majority opinion dismisses the question of fraud as having no significance, I can not do so. It certainly should have significance if considered with,
I am authorized to say that Judge Browning joins in the views expressed herein. We would affirm the judgment of the Circuit Court of Kanawha County.
Reference
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