Court Opinion

ID: 9584708
Source: CourtListenerOpinion
Date Created: 2023-08-21 22:51:56.851669+00
Date Added: 2024-06-11T15:13:47.036366
License: Public Domain

McMurray, Presiding Judge.
Patricia Case gave JOA Marine (“JOA”) $500 toward the purchase of a ski boat during a January 1996 boat show in Atlanta, Georgia. When she went to JO As place of business to complete the transaction on January 17, 1997, a JOA employee persuaded her at closing to pay Hanover Insurance Company (“Hanover”) a $412 premium in exchange for insurance coverage for her new boat. Ms. Case signed a blank insurance application and a “bunch of” other papers at the closing and, later that day, orally completed this insurance application during a telephone interview with an employee of RGA Reinsurance Company (“RGA”) — apparently an independent insurance agency. Ms. Case later received a Hanover insurance policy covering her boat, but she did not receive a copy of her insurance application.
Ms. Case’s boat sank on Lake Lanier shortly after its maiden voyage. Upon investigating this loss, Hanover discovered that Ms. Case’s adult daughter, Andrea Case, was residing with her mother when Ms. Case applied for coverage and that Andrea Case had been involved in an automobile collision and had received several traffic citations within five years before Ms. Case applied for insurance. Hanover denied Ms. Case’s property damage claim based on these findings, alleging that she duped Hanover into insuring her boat by checking the “no” box next to the following question on her insurance application — “Has any member of the household had a motor vehicle *2or boating accident or loss or been convicted of a moving violation within the past 5 years?”
Ms. Case brought an action against Hanover to recover under her policy and sued RGA for negligent submission of her insurance application, alleging that RGA’s agent, Vicki Arnold, failed to record Ms. Case’s disclosure that Andrea Case would likely be operating her boat. This appeal followed the trial court’s order granting RGA’s and Hanover’s respective motions for summary judgment. Held:
1. Ms. Case contends that genuine issues of material fact remain as to the materiality of the inaccurate negative response on her insurance application. An incorrect statement in an insurance application will not prevent recovery under the policy unless the insurer, with knowledge of the true facts, would not in good faith have issued the policy, not have issued a policy in as large an amount or at the given rate, or would not have provided coverage with respect to the hazard resulting in the loss. Pa. Life Ins. Co. v. Tanner, 163 Ga. App. 330, 333-334 (293 SE2d 520). The only evidence in this regard, in the case sub judice, is Hanover’s expert underwriter’s affidavit that the company would not have issued Ms. Case an insurance policy “[h]ad Hanover been aware of the previous moving violations and automobile accident of Andrea Joyce Case. . . .” The problem with this statement is that such “opinion testimony is always a question of acceptance or nonacceptance on the part of the jury.” Pa. Life, 163 Ga. App. 330, 334, supra. We take issue with the dissent’s statement that we ignore “a long line of cases” (five panel decisions of the Court of Appeals of Georgia). The “opinion testimony” rule upon which we rely is not only based on this Court’s factually indistinguishable decision in Pa. Life, but is grounded upon venerable Supreme Court of Georgia authority providing that “summary judgment can never issue based upon opinion evidence alone.” Ginn v. Morgan, 225 Ga. 192 (2) (167 SE2d 393). In our view the dissent, without explanation, would ignore this rule and adopt a holding which provides that summary judgment must go to the insurer if the insurer’s employee provides his employer with a favorable opinion in the requisite affidavit.
The test for materiality of a representation in an insurance application should not be based upon such procedural gaming, but must be grounded upon a weighing of whether the representation varied from the truth so as to substantially change the nature, extent, or character of the risk. Preston v. Nat. Life &c. Ins. Co., 196 Ga. 217, 228-236 (26 SE2d 439). Although such factual scrutiny was avoided in Sanders v. Southern Farm &c. Ins. Co., 174 Ga. App. 888 (332 SE2d 33), when this Court disregarded the “opinion evidence” rule and mistakenly elevated the insurer’s employee’s prediction (as to what would have happened regarding coverage) into something other than opinion evidence, we have no power in the case sub judice to *3undo any resulting harm because, unlike Sanders and other decisions which may ignore the “opinion evidence” rule, there is proof in the case sub judice that Hanover placed no reliance on Ms. Case’s insurance application. To this extent, it is undisputed that Hanover agreed to cover Ms. Case even though several questions in the insurance application, which were relevant to the risk of coverage, were left blank and a response in the insurance application indicated that Ms. Case’s boat would be used for an unusually high risk activity. Specifically, the policy application’s “UNDERWRITING INFORMATION” section indicates that Ms. Case’s ski boat would be used for “racing” and the application’s “SUPPLEMENTAL QUESTIONNAIRE” section was left completely blank. This section’s inquiry concerns additional boat owners, the existence of a survey or statement as to the boat’s condition, any prior damage, needed repairs or deterioration, the boat’s last inspection date, the existence of kitchen or bathroom facilities on the craft, and the conditions under which the boat would be stored.
This Court affirmed a jury’s verdict for the insured in Pa. Life, 163 Ga. App. 330, 334, supra, holding that similar policy application omissions authorized the jury’s finding that any policy application misrepresentation was not material to the insurer’s acceptance of the risk under the policy. For the same reasons, we find genuine issues of material fact as to whether Hanover actually relied on Ms. Case’s insurance application before issuing her an insurance policy. The trial court therefore erred in granting Hanover’s motion for summary judgment. If the movant for summary judgment fails to show an entitlement to a judgment as a matter of law, with the evidence viewed in favor of the non-moving party, a prima facie case has not been shown. Dental One Assoc. v. JKR Realty Assoc., 269 Ga. 616, 617 (1) (501 SE2d 497).
2. Citing Jackson Nat. Life Ins. Co. v. Snead, 231 Ga. App. 406 (499 SE2d 173), cert, denied at 231 Ga. App. 908, Ms. Case contends that Hanover’s insurance application’s “yes” or “no” question regarding the boating and driving history of members “of the household” would authorize a jury’s finding that the negative response in her application did not constitute a misrepresentation.1
*4In Jackson Nat. Life, supra, this Court adopted the general rule that answers to questions on insurance applications that are ambiguous and call for “yes” or “no” answers cannot be false as a matter of law. Id. at 410, 411 (4), supra. This holding is based on a deceased insured’s negative responses to a life insurance application’s questions regarding her status as a smoker. Because these questions were subject to interpretation based, in large part, on the application’s requirement for nothing more than “yes” or “no” responses, this Court affirmed a jury’s finding that the insured’s negative responses regarding her prior use of cigarettes were not false or misleading — even though there was proof that the insured had possibly “slipped” a cigarette or two during the year preceding her insurance application. Id.
The insurance application question at issue in the case sub judice covers several matters regarding the boating and driving history of unspecified members “of the household.” While it may be assumed that the term — “the household” — refers to Ms. Case’s household (since she is charged with verifying the application), the question calls for a single “yes” or “no” response to a compound question and fails to identify the subjects of Hanover’s inquiry, e.g., past, present, expected, short-term, or long-term members “of the household.” Further, there is no question in the application which clarifies this ambiguity, nor is there proof that Hanover conducted an inquiry to straighten out this problem before it issued Ms. Case an insurance policy. Accordingly, any misunderstanding caused by the insurance application’s question regarding a prior boating or driving history of “any member of the household” must be construed in Ms. Case’s favor.
The same rule of construing an insurance policy or bond strongly against the insurer and favorably to the insured applies to an application, or matters contained therein, as to the policy itself, the instrument having been prepared by the insurer. The insurance company is also under a duty to frame questions in the application so that they will be free from misleading interpretations. When it has failed to do so, an ambiguity or doubt arises, questions and answers thereto will be construed most favorably to the insured. 13A Appleman, Ins. Law & Practice, § 7585, pp. 254-256.
Jackson Nat. Life, 231 Ga. App. 406, 410, 411 (4), supra.
The trial court erred in granting Hanover’s motion for summary judgment as summary judgment is authorized only when there is no remaining genuine issue of material fact and the movant is entitled to judgment as a matter of law. OCGA § 9-11-56 (c). See Dental One, *5269 Ga. 616, 617 (1), supra. This holding renders it unnecessary to address Ms. Case’s remaining arguments regarding the grant of Hanover’s motion for summary judgment.
3. Ms. Case testified in her deposition that she informed RGA’s agent, Vickie Arnold, during her telephone interview with Ms. Arnold, that her son and her daughter, Andrea Case, would also be operating the boat. Since there is no conclusive proof that RGA was Hanover’s duly authorized agent acting within the prosecution of Hanover’s business, Ms. Case’s testimony raises genuine issues of material fact as to RGA’s liability for negligently preparing and submitting Ms. Case’s insurance application. Where an independent insurance agent endeavors to procure insurance for another and is negligent in his undertaking, he is liable for loss or damage to the limit of the agreed policy. Beavers Ins. Agency v. Roland, 135 Ga. App. 263 (217 SE2d 484).
The dissent’s reliance on James, Hereford & McClelland v. Powell, 198 Ga. App. 604 (402 SE2d 348), is misplaced. As we view it, Powell holds that an insurance applicant cannot recover against the insurance agent for fraudulently inducing the insurer to cover the applicant because to do so would, in effect, provide the applicant with coverage that he would not have otherwise been able to acquire. Id. at 605 (1), supra. Ms. Case’s claim against RGA is not based on fraud, but is based on RGA’s alleged negligence in failing to complete and prepare her insurance application. The difference is that proper preparation of the policy application in the case sub judice would have, at the very least, alerted Ms. Case to the alleged significance of her daughter’s driving record and the need to negotiate coverage for this risk. The dissent’s view that the record evidence demands a finding that Ms. Case’s boat was not insurable is not only inaccurate, but is unrealistic.

Judgment reversed.

Johnson, C. J., Pope, P. J., Smith, Ruffin and Eldridge, JJ, concur. Andrews, P. J., concurs specially in part and dissents in part.

 While the dissent correctly points out that this Court cannot consider arguments raised for the first time on appeal, we are not being asked to do so here. This enumeration of error instead questions the impact of a recent whole court decision which is relevant to an issue that was before the trial court, i.e., whether a response in Ms. Case’s insurance application voided her policy of insurance. We address this enumeration of error because it is this Court’s function on appeals from the grant of summary judgment to examine the record de novo and determine whether the allegations of the pleadings have been pierced so that no genuine issue of material fact remains. Ga. Farm &c. Ins. Co. v. Shook, 215 Ga. App. 66, 67-68 (449 SE2d 658).