Court Opinion

ID: 9628711
Source: CourtListenerOpinion
Date Created: 2023-08-22 09:30:07.502548+00
Date Added: 2024-06-11T18:07:10.253110
License: Public Domain

*138Fatzeb, J.
concurring and dissenting: While I agree with the court’s conclusion that the Uniform Policy Provisions for health and sickness insurance adopted by the legislature in 1951 (G. S. 1961 Supp., 40-2205 [C]), is the controlling statute under the facts and circumstances presented, I cannot agree that the district court’s findings of fact warrant or support its conclusion of law, “That the false answer did materially affect both the defendant company’s acceptance of the risk and the hazard it thereby assumed.” While the evidence was clear the plaintiff had diabetes, it was not clear at all that his condition had reached the stage where he thought he had diabetes, and the defendant company produced no evidence to establish he had been told he was a diabetic. Be that as it may, the district court’s findings of fact warrant the entry of judgment for the plaintiff.
In Finding of Fact No. 5, the district court stated, “. . . there is no evidence of any connection between diabetes or any of its related illnesses and cataracts.” Finding of Fact No. 9 reads:
“Had the answer to the question in the application about diabetes been ‘yes,’ the defendant company would not have issued the policy in the form it did issue it, but that it would have issued a policy identical with that which was issued except that there would have been a specific exclusion endorsement whereby there would be no benefits payable under the policy for diabetes and related illness.”
Under the district court’s Finding of Fact No. 9, the defendant company would have simply issued an identical policy with that which was issued except it would have excluded benefits payable under the policy for diabetes and related illnesses. It is clear to me such a finding would not materially affect the defendant company’s acceptance of the risk and hazard it assumed for cataracts.
As indicated, the district court’s conclusion of law as to the materiality of the plaintiff’s representation is not supported by its findings of fact. I would reverse the judgment and direct that the plaintiff recover the amount he incurred for doctor and hospital bills for the removal of cataracts from his eyes.