Court Opinion

ID: 9467899
Source: CourtListenerOpinion
Date Created: 2023-08-05 01:59:22.895517+00
Date Added: 2024-06-11T17:40:35.217302
License: Public Domain

RONEY, Circuit Judge,
concurring:
I concur in affirming the district court’s judgment largely for the reasons stated in the district court opinion, as well as for those set forth in Judge Gewin’s opinion.
Plaintiff's policy provides benefits for disability resulting from a sickness which first manifests itself while the policy is in force. Plaintiff’s heart condition first manifested itself before policy coverage commenced, but resulted in a disability within two years of the policy’s issuance.
Since Georgia law is similar to Florida law in these matters, this Court’s decision in Massachusetts Casualty Insurance Co. v. Forman, 516 F.2d 425 (5th Cir. 1975), cert. denied, 424 U.S. 914, 96 S.Ct. 1114, 47 L.Ed.2d 319 (1976), is persuasive. Plaintiff’s argument, similar to that in Forman, is that since the application did not reveal a prior manifestation of heart disease, the incontestability clause prevents the insurer from asserting that the heart disease did in fact first manifest itself prior to the date of the policy, and is therefore not covered by the policy. The incontestability clause, however, does not take effect until two years after the policy is issued. Plaintiff’s disability began within the two-year period, therefore the incontestability clause does not apply, even though the disability continued for more than two years after the date of the policy.
Under part (a) of the incontestability clause, after two years the policy cannot be attacked because of misstatements in the application. This part does not apply because the insurer does not attack the validity of the policy. Part (a) does not govern whether the application’s statements must be taken as true or false; it just says that after two years it makes no difference.
Under part (b), disability occurring more than two years after the issuance of the policy is covered even though it results from a pre-existing disease, if the disease did not first manifest itself prior to the policy date. Part (b) does not apply in this case because the disability resulting from a pre-existing condition began within two years of the date of the policy. In any event, the disease manifested itself before the policy date.
Without the application of the incontestability provision, plaintiff has no case at all. By the policy’s language, plaintiff cannot receive benefits for a disabling sickness if the sickness has manifested itself before the policy was issued. The incontestability clause could in no way expand that coverage. The district court properly granted the insurer’s motion for summary judgment.