Opinion
No. CV03 08 26 52S
January 11, 2005
MEMORANDUM OF DECISION
The plaintiff, Karin Harmon, brings this action on behalf of Jacob Harmon, who is the named beneficiary of a life insurance policy issued by the defendant, All American Life Insurance Company, covering the decedent, Cheryl L. Harmon (insured).
The plaintiff's complaint filed on August 4, 2003, alleges the following. On June 11, 2000, the insured signed an application for term life insurance with the defendant in the amount of $50,000 payable to the plaintiff as beneficiary. The application was approved and the defendant issued a life insurance policy (policy), effective August 1, 2000. From August 14, 2000 to December 27, 2001, the insured paid the required premium. On December 27, 2001, the insured died. The executor of the insured's estate made a demand for payment of the policy benefits but the defendant refused to pay the plaintiff. The plaintiff alleges, therefore, that the defendant has breached its contractual duty to the plaintiff.
On September 29, 2003, the defendant filed an answer and five special defenses to the plaintiff's complaint. The plaintiff denied each and every allegation of the defendant's special defenses. On October 15, 2004, the defendant filed the present motion for summary judgment on the plaintiff's entire complaint, with a memorandum of law, a statement of undisputed facts and supporting evidence, on the grounds that no genuine issue of material fact is in dispute and that it is entitled to judgment as a matter of law. On October 29, 2004, the plaintiff filed a memorandum of law in opposition to the motion for summary judgment, along with supporting evidence.
Practice Book § 17-49 "provides that summary judgment shall be rendered forthwith if the pleadings, affidavits and any other proof submitted show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. In deciding a motion for summary judgment, the trial court must view the evidence in the light most favorable to the nonmoving party. The party seeking summary judgment has the burden of showing the absence of any genuine issue [of] material facts which, under applicable principles of substantive law, entitle him to a judgment as a matter of law . . . and the party opposing such a motion must provide an evidentiary foundation to demonstrate the existence of a genuine issue of material fact." (Citations omitted; internal quotation marks omitted.) Barrett v. Montesano, 269 Conn. 767, 791-92, 849 A.2d 839 (2004).
The defendant moves for summary judgment on the ground that no genuine issue of fact exists as to the change in the insured's health from the time of the application until the policy became effective. According to the defendant, the plaintiff's complaint fails as a matter of law for two reasons: (1) based on the express terms, the policy never became effective; and (2) if the policy became effective, the defendant had the right to rescind it because the insured's change in health was material and not disclosed to the defendant. In support of its motion, the defendant submits copies of the following documents: (1) the application for the policy; (2) a letter of approval of the policy; (3) the policy; (4) medical reports from Griffin Hospital; (5) the insured's certificate of death; (6) a letter dated April 12, 2002, regarding receipt of the claim; and (7) a letter dated June 6, 2002, denying benefits.
For evidentiary purposes, the court notes that defense counsel, Patricia R. Rich, has submitted an affidavit attesting that "all the documents attached to the statement of undisputed facts are true and accurate copies of the documents indicated therein."
The plaintiff counters that because the insured's policy was a mail-in insurance, it should be treated differently by the court. The plaintiff asserts that the insured did not know the application contained language that required good health at the time the premium was paid or alternatively, if she did know, the insured could not understand it. The plaintiff also argues that the language of the application is ambiguous and should be construed against the defendant. Further, although the defendant argues that the insured had a duty to inform the defendant of a change in health, the plaintiff contends that: (1) the insured made a truthful application; and (2) the defendant had a signed authorization to obtain medical reports but failed to update the insured's medical record. In support of her contention, the plaintiff submits the following evidence: (1) a copy of the application for the policy; (2) a copy of a letter of approval of the policy; and (3) an affidavit by Karin Harmon.
The statement of undisputed facts discloses the following. On or about June 11, 2000, the insured filled out an application for $50,000 in group term life insurance with the defendant. The insured completed the application herself, including the health questionnaire and signed the application. On or about June 21, 2000, the defendant received the application. On or about July 25, 2004, the insured received a notice from the nursing insurance plans confirming that her application had been approved and her insurance coverage would begin on August 1, 2000. The insured's application was approved to take effect on August 1, 2000, and she was issued certificate number 007219195 under Group Policy No. G-639. Between June 11, 2000 and August 1, 2000, when the policy was to take effect, neither the insured nor anyone acting on her behalf provided any additional information concerning the application, including but not limited to the insured's diagnosis of metastis adenocarcinoma. On or about June 27, 2000, the insured underwent a biopsy of her liver which resulted in a suggested diagnosis of metastis adenocarcinoma. The insured underwent additional testing, and on July 5, 2000, the insured was informed that she had been diagnosed with metastis adenocarcinoma. As treatment for her cancer, the insured underwent chemotherapy but died as a result of the cancer on December 27, 2001. On or about February 11, 2002, the insured's representatives filed a claim for life insurance benefits under the policy. The claim disclosed that the insured had been diagnosed with cancer in June 2000, and had been informed of this diagnosis on July 5, 2000. The claim was the first disclosure to the defendant of the insured's diagnosis of cancer. The defendant acknowledged receipt of the claim on April 12, 2002. By letter dated June 6, 2002, the defendant denied the claim for benefits.
The court notes that the defendant properly exercised its right to contest coverage within two years from the issuance of the policy. According to the amended General Provision 18, entitled "Incontestability," the insured's policy "shall be incontestable after two years from its date of issue except for nonpayment of premium." (Amendment, Exhibit C.)
The issue before this court is whether the policy issued by the defendant for the life of the insured in the amount of $50,000 is enforceable. "[C]onstruction of a contract of insurance presents a question of law for the court . . . [T]he terms of an insurance policy are to be construed according to the general rules of contract construction . . . The determinative question is the intent of the parties . . . as disclosed by the provisions of the policy . . . If the terms of the policy are clear and unambiguous, then the language, from which the intention of the parties is to be deduced, must be accorded its natural and ordinary meaning." (Citation omitted; internal quotation marks omitted.) Galgano v. Metropolitan Property Casualty Ins. Co., CT Page 338 267 Conn. 512, 519, 838 A.2d 993 (2004).
It is undisputed that on June 11, 2000, the insured signed a document marked "Application for Term Life Insurance to All American Life Insurance Company," which was made a part of the policy. (Application, Exhibit A; Policy, Exhibit C.) Above her signature appeared a clause containing a "condition precedent," which now forms the basis of contention between the parties. The clause reads: "I understand that my application for group insurance will be accepted or declined on the basis of these statements. Insurance shall take effect only if a certificate is issued based on this application and the first premium is paid in full (a) during the lifetime of the proposed insured and (b) while there is no change in the insurability and health of such person from that stated in this application." (Application, Exhibit A.)
The court finds that the language of the "good health" clause is clear and unambiguous. "[C]ourts cannot indulge in a forced construction ignoring provisions or so distorting them as to accord a meaning other than that evidently intended by the parties." (Internal quotation marks omitted.) Galgano v. Metropolitan Property and Casualty Ins. Co., supra, 267 Conn. 519. A literal and plain reading of the clause reveals that insurance coverage would fail and liability would not incur if the insured's health changed from that stated in the application. See Popowicz v. Metropolitan Life Ins. Co., 114 Conn. 333, 158 A. 885 (1932). Here, it is undisputed that between the time the insured signed the application indicating she did not have cancer and the effective date of the policy, the insured had been diagnosed with cancer. It is also true that when the insured paid her first premium, there had been a change in her health.
In Popowicz v. Metropolitan Life Ins. Co., 114 Conn. 333, 334, 158 A. 885 (1932), a life insurance policy provided that if the insured was not in good health at the date of issuance or, if before that date, had pulmonary disease then the company could void the policy. Before and at the time of issuance of the policy, the insured was not in good health. Id., 335. The Supreme Court held that the company had established a good defense to the action on the policy and the fact that the insured did not know she had the disease was immaterial. Id.
Additionally, the plaintiff's argument that the insured did not know the application contained language that required good health at the time the premium was paid lacks merit. "The general rule is that when a person of mature years who can read and write signs or accepts a formal written contract . . . it is his duty to read it, and notice of its contents will be imputed to him if he negligently fails to do so." (Internal quotation marks omitted.) LLP Mortgage v. Gurski, Superior Court, judicial district of Litchfield, Docket No. CV 02 0087002 (January 10, 2003, Pickard, J.); see also Kelly v. John Hancock Mutual Life Ins. Co., 131 Conn. 106, 110, 38 A.2d 176 (1944) (insured was under duty to know contents of insurance application signed by her, and failure to do so was inexcusable negligence). Further, if the insured did not understand the application after reading it, "it was her duty to inquire before signing [the application]." LLP Mortgage v. Gurski, supra, Superior Court, Docket No. CV 02 0087002.
Based on the unambiguous language of the application, including the condition precedent, the court finds that the policy never came into effect. The liability of the insurer is limited by the terms of the contract and the parties are bound by the "condition precedent" agreed to in the application. Because the condition precedent was not met, the insurance contract never became effective. Accordingly, the plaintiff has no cause of action.
For the foregoing reasons, the defendant's motion for summary judgment on the plaintiff's complaint is granted.
MORAN, J.