Court Opinion

ID: 9577219
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:33:08.360979+00
Date Added: 2024-06-11T13:20:10.731358
License: Public Domain

Otis, Justice
(dissenting).
In granting a new trial the majority holds that there was evidence which would support these findings by the jury:
Defendant customarily backdated its health insurance policies.
Decedent had fully recovered from pneumonia on the day of her application.
The condition for which she was hospitalized did not manifest itself within 30 days of her application.
1. On cross-examination, defendant’s agent, Donald Jenkins, testified as follows:
“Q. In your experience with health and accident policies, you have seen policies dated when they come out, the date the application was signed, have you not?
“A. Yes.”
There is no other evidence that policies were “customarily backdated” other than the isolated statement that the agent had seen policies bear the application date when they were issued. It is inconceivable to me that we would have held this was sufficient testimony to prove by a fair preponderance of the evidence that backdating was a “custom” had the case gone to the jury. Indeed, plaintiff makes no such claim in her pleadings, nor did she at any time argue to the trial court that such a custom was an issue for determination. She insisted there was an oral contract of insurance and merely referred to a case in which the insurer “customarily” backdated workmen’s compensation insurance in citing what appears to be Glens Falls Ind. Co. v. D. A. Swanstrom Co. 203 Minn. 68, 279 N. W. 845 (1938).
*61The majority apparently shares these views when it recognizes “plaintiff’s obvious failure to submit additional evidence to support her arguable claim of backdating health insurance policies or to clearly urge this factual dispute in opposition to defendant’s motion for a directed verdict.”
I respectfully submit it is not our function to give litigants a second chance to try their lawsuits simply because they have failed to sustain their burden of proof at the first trial if they have had a full and fair opportunity to present all of the evidence available to them. There is no claim that the trial court excluded admissible evidence or erred in any other respect in preventing the plaintiff from introducing competent testimony on this key issue.
I respectfully suggest that the majority has overlooked the critical testimony of Dr. Strunk concerning Mrs. Gibson’s state of health on February 11,1971. The doctor’s statement that she was in good health on that date reflected only his office records as of that time. He did not examine her following her October illness until March 19, 1971, when she entered the hospital. An exploratory operation on March 23 disclosed an advanced mass of cancer in the right middle lobe of Mrs. Gibson’s lung from which she died on April 21, 1971.
Dr. Strunk testified that in his opinion Mrs. Gibson was suffering from lung cancer in October 1970, and he so stated in her death certificate. Although in fixing the onset at 6 months he first observed that he was making “a wild guess,” he then went on to support that opinion as follows:
“Q. Now, the chest x-ray in October of 1970 showed that she had a problem in the right middle lobe of her lung, is that correct?
“A. That’s right.
“Q. And that is a problem which the radiologist concluded was pneumonia, isn’t that correct?
“A. That’s right.
*62“Q. Now, the routine x-ray that was taken at North Memorial Hospital on March 19 when she entered, a routine chest x-ray, also showed a problem in the right middle lobe, did it not?
“A. That’s right.
“Q. And in the initial x-rays, the 'radiologist called it consolidation of the right middle lobe, is that correct?
“A. That’s right.
“Q. But the radiologist did not make a diagnosis of cancer at that time ?
“A. No.
“Q. All he saw was that there was this problem which had earlier been called, pneumonia, isn’t that right?
“A. That’s right.
“Q. Now, as the attending physician you were called upon to fill out the death certificate, isn’t that correct?
“A. That’s right.
“Q. And during the course of your professional career, Dr. Strunk, I assume that you have made out many of these death certificates?
“A. That’s right.
“Q. And one of the questions that you as the attending physician are asked to answer on a death certificate is the approximate interval between the onset and death of the disease that caused the death, isn’t that correct?
“A. That’s right.
“Q. And on the death certificate you filled in the approximate interval between the onset of the cancer and death as being six months, isn’t that correct?
“A. That’s right.
“Q. And that was your best estimate of the length of time that she must have had this cancer, isn’t that correct?
“A. That’s right.
“Q. And that was based on the size of the mass as it was discovered, isn’t that correct?
“A. Yes, that’s right.
*63“Q. And also based upon the fact of that earlier x-ray that had been taken in October, which showed a problem?
“A. Yes.
“Q. And that’s what you wrote down here on the certificate of death, where it says, ‘approximate interval between onset and death, six months. X-ray, October 11, 1970,’ isn’t that correct?
“A. That’s right.”
The inescapable inference from Dr. Strunk’s testimony is that Mrs. Gibson was not only suffering from pneumonia in October 1970, but that cancer of the lung also was present at that time notwithstanding the fact that the radiologist described her illness as a “consolidation” and did not make a diagnosis of cancer. Not having seen Mrs. Gibson since October, Dr. Strunk was hardly in a position to certify to her good health on February 11 when an examination would have disclosed her terminal illness. Dr. Strunk could not, and did not, respond to defendant’s inquiries concerning Mrs. Gibson’s health because he had no way of determining that fact without a thorough examination.
In my opinion, it is simply not correct to state that this record permits a finding that all of the conditions for issuing a policy had been satisfied at some unspecified date and “defendant would have issued a policy had it not learned of decedent’s hospitalization.” The evidence, as I see it, is to the contrary. In making its routine underwriting investigation of Mrs. Gibson’s application, defendant wrote to Dr. Strunk for a summary of her medical history but did not hear from him “despite several follow-ups.” Dr. Strunk admitted that he did not respond to defendant’s inquiries. On March 23, 1971, defendant was able to get through to the doctor’s office and then learned for the first time that Mrs. Gibson was hospitalized. The reason defendant then refused to issue the policy was because it was “unable to complete her underwriting review” and “her insurability was in doubt.”
The effect of the majority opinion is to foist coverage on *64a health insurer which, in attempting to confirm an applicant’s recovery from a prior illness, was unable to determine her insurability and consequently declined coverage. Disclosure of her terminal illness was made after a 43-day interval, prolonged by the failure of the applicant’s doctor to respond to the insurer’s legitimate inquiries.
This, in my opinion, is not only a manifestly unjust result but is bad law to boot. The majority cites no decision of this court or of any other jurisdiction in support of its conclusion. Our own cases clearly hold otherwise. In any event, I fail to see how the backdating of Mrs. Gibson’s policy is relevant since no policy was issued to her, and under our prior decisions the defendant was under no obligation to do so.
Although the majority cites LaFavor v. American National Ins. Co. 279 Minn. 5, 11, 155 N. W. 2d 286, 290 (1967), it does not distinguish that decision. In the instant case, defendant’s agent testified as follows:
“Q. Now, do you have authority from the Allstate Insurance Company to bind or to issue an oral contract of insurance for either life or health insurance?
“A. No, sir.
“Q. Have you ever had such authority?
“A. No, sir.”
In the LaFavor case, as here,
“Testimony on the part of defendant’s representative was that defendant does not give its agents authority to issue a binder or grant interim insurance coverage from the date of application, pending company approval, and that there is no interim insurance and no insurance unless it is ultimately issued by defendant based upon the application and such investigation as defendant may pursue. Under the circumstances there can be no back dating of such policy.” 279 Minn. 8, 155 N. W. 2d 288.
A unanimous court in reversing a judgment for the insured noted in LaFavor that health insurance in Minnesota is contrac*65tual only; that “the concept of legal relations between an applicant for insurance and the insurance company is essentially and fundamentally the same as. that between parties negotiating other contracts and, as such, is purely contractual”; that “there is no legal duty on the part of an insurance company to accept or reject an application for insurance”; that it is the general rule that without any statement in the application a contract of insurance is consummated by, and not until, the unconditional acceptance of the application or proposal for such insurance. 279 Minn. 11, 155 N. W. 2d 290. In concluding, we referred to our prior holdings in cases involving life and health insurance policies to the effect that “there is no legal duty on the part of an insurance company to accept or reject an application for insurance or submit a counterproposal.” 279 Minn. 12, 155 N. W. 2d 291.
I submit that the proposal of the majority to permit an agent without any express authority to create an implied contract for interim health and accident insurance is unsupported by either the record or by case law here or elsewhere and does violence to our prior decisions. Accordingly, I would affirm.