Court Opinion

ID: 9670810
Source: CourtListenerOpinion
Date Created: 2023-08-24 03:26:29.932454+00
Date Added: 2024-06-11T18:13:36.129311
License: Public Domain

Michael J. Kelly, J.
(dissenting). I respectfully dissent. It seems to me that there are factual issues that should be determined by a trier of fact. The trial court did not address these contested claims:
1. The application referred to in the majority opinion is a form prepared by defendant Jackson National Life Insurance Company containing two *569parts. Part i is entitled "Application for Insurance on Life of Proposed Insured named below.” Part n is entitled "Declarations (in lieu of medical examination).” Plaintiff contends that the application was signed by Guffrey and Plummer on February 26, 1988, in blank. The principals had a relationship with agent Adams, going back at least to 1986, when the agent had placed insurance on each principal for $150,000 to fund a buy/sell agreement and that the $150,000 policy on Guffrey had been placed with defendant Jackson National Life. (That policy of course is not at issue here; as far as we know there was no contest over that policy and it presumably has been paid in accordance with its terms.) The point is that plaintiff contends that the transaction at issue was delegated to agent Adams entirely. Guffrey signed the application in blank, Adams left plaintiff’s office with the application and later filled in all the blanks, including those in Part ii, answering all the medical questions. Plaintiff, though listed as owner and beneficiary of the policy, was not furnished a copy of the application, it was given only the "interim insurance receipt,” which did not contain the language relied upon by the trial court and the majority.
2. The actual policy bears the date of March 8, 1988, as the policy date, which of course relates back to the date of the medical examination. Neither the trial court nor the majority assessed the intent of the parties with regard to that critical date.
3. Neither the trial court nor the majority assessed the intent of the parties with respect to the prepayment of the premium for the first year by G. P. Enterprises check No. 1493 in the amount of $200 dated February 26, 1988.
4. Neither the trial court nor the majority as*570sessed the significance of the $25 earned premium unilaterally computed by defendant Jackson National Life when it rejected plaintiffs claim in its letter of November 2, 1988, and returned the "unearned premium” check of $175.35.
There is no question but that the insured passed a medical examination on March 8, 1988, by an examiner chosen by the insurance company. It seems to me that a trier of fact could find that that was the condition precedent to triggering coverage. The policy could have been issued that day or as soon thereafter as reasonably contemplated by the parties. When it was issued—considerably later—it related back to March 8, 1988. Had Guffrey been the victim of an instantaneous fatal accident there would be no coverage question. Because he was the victim of a fatal illness (pneumonia), the interpretation of the documents prepared by the company, which documents must be construed against the company, presents issues for the jury.
A jury should decide what the parties intended by prepayment. Bearing upon that issue is the agent’s interpretation, communicated to the plaintiff, that coverage was in effect. A jury could conclude that, because coverage was provided by the interim insurance receipt from the date of the completion of the medical exam, approval of the policy was automatic. Alternatively, the jury could conclude that the policy should reasonably have been effected before March 21, 1988, either in accordance with industry standards or in fulfillment of the intent of the parties. Certainly, the admission by agent Adams is entitled to be weighed in the balance. The agent thought approval was automatic. The trier of fact should decide if the delay in policy approval and policy delivery were reasonably contemplated by the par*571ties. The delay could only benefit the party that controlled it, and any delay permitted the company to have the benefit of plaintiffs premium risk-free. I doubt that was the intent of the parties.
I would reverse.