DocketNumber: 2006
Citation Numbers: 65 P.2d 399, 51 Wyo. 195
Judges: Blume, Riner, Kimball
Filed Date: 2/23/1937
Status: Precedential
Modified Date: 10/19/2024
On March 11, 1932, Clarence Rosenblum, of Cheyenne, Wyoming, made a so-called non-medical application for a policy of $2000 on his life, to the Sun Life Assurance Company, hereafter referred to as the insurance company or as the defendant. The applicant was then 18 years of age; his beneficiary was his father, Jacob Rosenblum, plaintiff herein. The applicant, answering certain inquiries, stated that he was in good health, and agreed — a clause also substantially contained in the policy, that "said policy shall not take effect until the first premium has been paid during my life and good health." He paid the first premium at the time of the application to defendant's agent, C.H. Hoffhine. The defendant issued a policy, dated March 25, 1932, in suit herein, pursuant to the application. It contains a clause of incontestability, etc., as follows:
"The policy is issued in consideration of the representations and agreements contained in the written application therefor and together with such application, a copy of which is attached hereto and made a part hereof, shall constitute the entire contract between the parties hereto and shall be incontestable after the policy has been in force during the life time of the assured for a period of two years from the date of issue except for non-payment of premiums and except as to provisions and conditions relating to disability and double indemnity benefits if any. All statements made by assured shall, in the absence of fraud, be deemed representations and not warranties, and no statement shall void the policy unless it is contained in the said application and a copy of the application is attached to this policy when issued."
The insured died on March 3, 1934, a few days prior to the expiration of the two years mentioned in the *Page 201 policy, and the insurance company refused to make payment thereon. Thereupon, the beneficiary under the policy brought an action in the district court of Laramie County to recover the amount of $2000 claimed to be due on the policy. The petition alleges that the insurance company is a corporation authorized to do business in the state of Wyoming; that it issued its policy on the life of the assured as above mentioned; that the assured died on March 3, 1934, while the policy was in full force and effect, and before any default in the payment of any premium due thereunder; that due notice of the death of the assured was given to the insurance company, and that "the plaintiff has done and performed each and every act and thing required of him to be performed under the terms of the policy and has demanded payment of the amount due thereunder." Judgment is asked for the sum of $2000. The defendant answered, admitted its corporate existence and the issuance of the insurance policy in suit. It pleaded that the application for the policy, and the policy, contain the statement that "said policy shall not take effect until the first premium has been paid during my life and good health," and that this provision had not been complied with, for the reason that at the time when the first premium was paid, Clarence Rosenblum was not in good health. Repayment of the premiums paid was tendered. Five separate affirmative defenses were interposed, all based on the ground that certain answers and statements of the insured in the application for the insurance policy were fraudulent. It is not necessary to mention the facts in reference thereto in detail, for the reason that no testimony in regard to them was introduced in the evidence. Plaintiff demurred to the answer. The demurrer was overruled. Plaintiff thereupon filed his reply, setting forth section 57-232 of the Revised Statutes of Wyoming, 1931, and alleging that defendant had waived its right of attacking *Page 202 the policy of insurance on the ground of fraud, for the reason that it failed to attack it within two years as required by the statute just cited.
The case was tried to the court. The plaintiff introduced the policy in question in evidence. He testified that he lived, and had for many years lived, at Cheyenne, Wyoming; that the insured was his son; that the latter died on March 3, 1934. It was stipulated between the parties that the insured obtained the policy of insurance in question, and that premiums due thereon up to the time of the death of the insured were duly paid, the receipts, duly issued by the insurance company, reciting payment by the insured. It was further stipulated that payment on the policy was duly demanded and refused. Plaintiff thereupon rested. The defendant company then moved for judgment on the ground that the petition fails to state a cause of action, and that the evidence in the case is insufficient as a matter of law to sustain any liability on the part of the defendant company. The court overruled the motion; the insurance company elected to stand thereon, and judgment was thereupon rendered in favor of the plaintiff, from which the defendant company has appealed.
The controversy on this appeal is concerning the effect of the clause, contained in the application and the policy, which reads: "This policy will not take effect until the first premium shall have been actually paid during the life and good health of the assured." This clause will be mentioned hereafter as the "health clause." The defendant contends that this clause constitutes, or creates, a condition precedent, and that fulfillment thereof must be pleaded and proved by the party suing on the policy; that in view of the fact that this has not been done, the petition is fatally defective, and the plaintiff has not shown himself entitled to recover herein. It may be noted that while it was pleaded *Page 203 that plaintiff performed all conditions precedent, it lacks an allegation in that respect on the part of the insured.
Speaking of the subject of conditions, it is stated in Corbin's Anson on Contracts (1924), page 434, that there is no doubt "that the law on this subject needs entire reconstruction and restatement, that there is no existing test capable of logical definition, and that the rules are largely arbitrary as well as conflicting. Such rules as now exist will frequently be found to be based on false logic and on more or less ill-defined notions of public policy."
In section 250 of the Restatement of the Law of Contracts, a condition precedent is defined as a fact which "must exist or occur before a duty of immediate performance of a promise arises." Under that definition, a contract containing such condition comes into existence, but need not be performed until the condition is fulfilled. Some authorities, however, recognize two kinds, namely, a condition precedent which must be performed before the agreement of the parties becomes a binding contract, or a condition which must be fulfilled before the duty to perform arises. Hurt v. Life Insurance Co.,
In view of the fact that plaintiff who seeks to subject a defendant to liability should show the reasons and the facts which create the liability, it has always been accepted as true, unless, perchance, there were countervailing reasons, that "in a case of a condition precedent the plaintiff must set out the condition as well as the promise, and must allege and prove the happening of the condition in order to establish the defendant's breach of contract." Williston, supra (2nd Ed.), Sec. 667 A; Moody v. Ins. Co., 52 Ohio St. 12, 38 N.E. 1011; Corbin's Anson on Contracts, supra, p. 433, and note on that and succeeding page; Clark on Code Pleading, p. 191; Couch, Cyc. of Insurance Law, Vol. 8, p. 6829; Redman v. Aetna Ins. Co.,
In Volunteer State L. Ins. Co. v. McGinnis,
If the authorities so far cited state the correct rule — and we should go at least that far — then the plaintiff in this case made out a prima facie case. Counsel for the insurance company, however, maintains that under these authorities the plaintiff was aided by a presumption; that a presumption arises in a case only in connection with the proof therein, and does not arise at any prior stage of the proceeding, and that hence, even though the plaintiff in this case was not compelled to prove the specific fact of good health of the insured at the time of the payment of the first premium, still the petition is fatally defective for failure to allege it. It is apparent, of course, that when a specific fact need not be proved by plaintiff, an allegation in that connection is rather an empty formality. And it would seem reasonable, in order to avoid such empty formality, that when facts are pleaded from which the presumption arises, these facts might well be provisionally accepted as true, until denied, so as to give rise to the presumption at that stage. And so it is held, for it is stated in 49 C.J. 39 that "there need be no direct allegation of fact which is necessarily implied from other averments, and presumptions of law need not be pleaded, even, it has been held, although they are prima facie only." See also Hartford F. Ins. Co. v. Kahn,
Pursuing the subject further, it is stated in 37 C.J. 616 that "by the weight of authority where plaintiff proves enough to establish a prima facie case (as stated in 37 C.J. 635), he is not required to produce affirmative proof that insured was in good health at the time of the payment of the first premium and delivery of the policy, as provided by the terms of the policy, as there is no presumption that he was not in good health, but the burden is on the defendant, if he asserts that insured was not in good health at that time." Authorities from nine different states are cited, and these bear out the text. Other courts, namely, in Indiana, Kansas, Oklahoma, Illinois, and Texas, have announced the same rule. Western Southern L. Ins. Co. v. Spencer,
These cases apparently, though that is not altogether certain in some instances, proceed on the theory that the true burden of proof on the point in question is on the insurance company — not merely that it has the burden to go forward in order to overcome a prima facie case made by the plaintiff; in other words, they consider the matter an affirmative defense. Hence plaintiff need not plead the presence of good health. If we are not mistaken, the rule in Vermont, Louisiana, and Florida is the same. Guiltinan v. Metropolitan Life Insurance Co.,
"There are provisions in the policy making the application a part of the policy, and declaring that the policy and application constitute a contract between the parties. The application contained the following provision: "No contract of insurance shall be deemed made and no liability upon the part of the company shall arise, until a policy shall be issued and be delivered, *Page 213 and be personally and manually received by me, and the first premium thereon actually paid, all during my lifetime and while I am in good health.' The appellant contends that the above provision, because of its peculiar language, constitutes a warranty and is in the nature of a condition precedent to any effective contract of insurance. We believe that such a construction is contrary to our own cases and the law generally upon the subject. To be sure, the application is signed by the applicant for insurance, and, in that sense, he adopts its contents or provisions as his own; but in reality the form of the application is prepared by the insurance company and its language, except the blanks to be filled out in response to questions, is the language of the company. Similar provisions are usually found in all standard applications for policies of insurance and are inserted for the benefit of the insurer. The provision above quoted was wholly for the benefit of the appellant. There is nothing in the language used to constitute a warranty on the part of the assured, or a condition precedent to a binding contract of insurance."
Explicit and unequivocal as this language is, doubt is thrown on the case by Atlas Life Ins. Co. v. Bolling,
It seems reasonably clear from the foregoing, that whether we call the health clause in controversy a condition precedent or not, the great majority of courts cast, in face of a clause reading like a condition precedent, the burden of pleading and proving want of good health on the insurance company. See also 24 Columbia L.R. 1515. Nor are sound reasons lacking for such a rule, when applied to cases like that before us here. Life insurance has become a great business and a beneficial one. It is in the interest of the individuals concerned, and in the interest of society as a whole, that every man, or nearly every man, should carry one or more policies of life insurance. The companies are interested in procuring as much business as possible. In furthering that purpose, it is for their interests, as well as the interests of the persons concerned, that *Page 214
their policies, once written, should be as free from attack as possible. That has been recognized by insurance companies generally by ordinarily embodying in its policies a clause of incontestability. To go a little further, and assume the burden above mentioned, will not, we think, operate against their interests, but will still further stabilize their business, and will be in the interest of policy holders and the beneficiaries thereunder. It is, of course, true that parties have a right to embody in their contracts whatever terms they wish, and that courts should not attempt to make a contract for them. But as a practical matter, we know that insurance is ordinarily written at the request and solicitation of the agents of life insurance companies. These companies dictate their own terms, which are usually numerous and many of which are often complicated. The ordinary man knows little of the meaning of a condition precedent. Moreover, health is a relative term. The ordinary man is hardly qualified to determine whether he is a good insurance risk; life insurance companies are. The ordinary man may know whether he is feeling well, or reasonably well, at a particular time; but he is hardly qualified to determine whether or not that has a particular bearing upon the state of health which would injuriously or otherwise affect the question of his insurance risk. Much more is that true in the case of a beneficiary under a policy. We think that the Supreme Court of Massachusetts was correct when it stated in Lee v. Insurance Company, supra, that it is a matter of common knowledge that life insurance companies do not issue policies until they have received satisfactory knowledge of the health of the insured. Nor is that confined to cases where a medical examination has been had. The policy in this case states that the answers of the insured to the questions submitted to him should be in lieu of a medical examination, but that such examination might be required. *Page 215
It seems, accordingly, that the company concluded, after examining the answers, that no medical examination was necessary and that it satisfied itself that the insured was in good health. And in view of the superior ability of life insurance companies and their qualification to determine when a man is, or is not, a proper risk, the rule stated in some of the cases to the effect that it is their duty, in the ordinary case at least, to determine that fact when they enter into a contract, and not demand proof thereof after the insured is dead, does not seem to be an unreasonable one. Mumaw v. Ins. Co., supra; James v. Life
Acc. Ins. Co.,
The force of what we have said applies particularly in the case at bar when we come to consider the contract as a whole. The policy provides that "if application for re-instatement be made within two years from the date of default in premium payments and while the policy is automatically continued in force, no evidence of insurability shall be required." The policy also contains, as has been noted, a clause of incontestability, effective after two years. Thus the defendant was willing to grant a reinstatement, without proof of health, though the policy might have become incontestable the next day. In other words, defendant required no proof of good health during the life-time of the insured. It is hardly likely, that it was intended that such proof should be required from a third party after the death of the insured. And there is an additional fact. We have already stated that it is held in Oklahoma that the health clause will not be considered a condition precedent where the policy (or the statute) provides that all statements shall be considered representations and not warranties, and that other courts hold the contrary. The latter consider the two clauses — the good health clause, and that relating to statements — to be entirely distinct. It is, perhaps, not unreasonable to so hold where, as appears in Cont. Ill. Nat. Bank v. Ins. Company,
It is clear, accordingly, that no matter what view we take in the case at bar, plaintiff's petition herein stated a cause of action, and he proved all the facts essential to be proved by him. The judgment herein is, accordingly, affirmed.
Affirmed.
RINER and KIMBALL, JJ., concur.
Commonwealth v. Deni , 317 Pa. 289 ( 1934 )
Benzinger v. Prudential Insurance Co. of America , 317 Pa. 561 ( 1935 )
Borough of Freeland v. Poltrok , 108 Pa. Super. 565 ( 1933 )
Lusk Lumber Co. v. Independent Producers Consolidated , 35 Wyo. 381 ( 1926 )
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Mohr v. Prudential Insurance Co. of America , 32 R.I. 177 ( 1911 )
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National Life Accident Ins. Co. v. Wicker , 171 Okla. 241 ( 1935 )
Mid-Continent Life Ins. Co. v. Trumbly , 170 Okla. 639 ( 1935 )
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Borgon v. John Hancock M. Life Ins. , 99 Pa. Super. 377 ( 1930 )
National Life & Accident Ins. Co. v. Doman , 31 S.W.2d 865 ( 1930 )
Western & Southern Life Insurance v. Spencer , 95 Ind. App. 281 ( 1932 )
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McNulty v. New Richmond Land Co. , 44 Cal. App. 744 ( 1919 )
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Tadday v. National Aviation Underwriters , 660 P.2d 1148 ( 1983 )
Aetna Insurance Co. v. Lythgoe , 618 P.2d 1057 ( 1980 )
Commercial Union Insurance Co. v. Stamper , 732 P.2d 534 ( 1987 )
Alm v. Hartford Fire Insurance Company , 369 P.2d 216 ( 1962 )