OADE v. JACKSON NATIONAL LIFE INSURANCE COMPANY
Docket No. 114786
Supreme Court of Michigan
Argued January 17, 2001. Decided July 30, 2001.
465 Mich. 244
In an opinion by Justice YOUNG, joined by Chief Justice CORRIGAN, and Justices WEAVER, TAYLOR, and MARKMAN, the Supreme Court held:
The decedent had an explicit, contractual continuing duty to ensure that the answers in his insurance application remained true until the effective date of the policy. His failure to supplement his medical history rendered his original answers false, making them misrepresentations within the meaning of
MCL 500.2218(2) defines a “misrepresentation” as a “false representation.” A “representation,” in turn, is statutorily defined as a statement about past or present fact, made to the insurer by or by the authority of the applicant for insurance or the prospective insured, at or before the making of the insurance contract as an inducement to making it. Under the facts of the case, the decedent engaged in a misrepresentation for purposes ofMCL 500.2218(2) .A fact or representation in an application is material where its communication would have had the effect of substantially increasing the chances of loss insured against, so as to bring about a rejection of the risk or the charging of an increased premium. Further, MCL 500.2218(1) defines materiality in terms of an insurer‘s refusal to make “the” contract, not “a” contract. In this case, the undisputed evidence presented to the trial court made clear that the correct information would have led the insurer to charge an increased premium, hence a different contract. It is altogether irrelevant that plaintiff‘s health did not change during the prepolicy period. The proper materiality question under the statute is whether “the” contract issued, at the specific premium rate agreed upon, would have been issued notwithstanding the misrepresented facts. Because there is no genuine issue of material fact on the issue of materiality, the defendant is entitled to summary disposition underMCR 2.116(C)(10) .
Reversed.
Justice KELLY, concurring in part and dissenting in part, stated that although the false statements made by the decedent by failing to update his medical history were misrepresentations within the meaning of
Justice CAVANAGH concurred only in the result reached by Justice KELLY.
Fraser, Trebilcock, Davis & Foster, P.C. (by C. Mark Hoover, Marcy R. Matson, and Graham K. Crabtree) for the plaintiffs-appellees.
Butzel Long (by Phillip C. Korovesis and David H. Oermann) for the defendant-appellant.
Amicus Curiae:
Mika, Meyers, Beckett & Jones, P.L.C. (by Michael A. Zagaroli) and Victoria E. Fimea, Senior Counsel, Litigation, for American Council of Life Insurers and Life Insurance Association of Michigan.
I. INTRODUCTION
In this life insurance dispute, plaintiffs, Jeffrey Lee Oade and Sheilah Chouinard, seek to recover benefits from a Jackson National Life insurance policy issued and delivered to Gary Oade. Plaintiffs, the son and friend of Mr. Oade, respectively, are the named beneficiaries of the insurance policy. Defendant claims that the policy never became effective because Mr. Oade failed, as required by the terms of the insurance application, to provide updated information about his health and medical treatment between the date he signed the application and the day the policy was issued. We granted leave to address the applicability of the statutory requirement under
Because Mr. Oade had an explicit, contractual continuing duty to ensure that the answers in his insurance application remained true until the effective date of the policy, we hold that Mr. Oade‘s failure to supplement his medical history rendered his original answers false, making them “misrepresentations” within the meaning of
On November 29, 1993, Mr. Oade, a fifty-three year-old store owner, contacted his insurance agent and completed a Jackson National Life Insurance Company of Michigan application for a “preferred” $100,000 life insurance policy.1 In order to evaluate the insurance risks posed by an applicant and consistent with standard underwriting procedures, the Jackson National application required answers to certain questions about an applicant‘s health status. That application further required that the applicant inform defendant in writing if the applicant‘s health or any of the answers or statements contained in the application changed between the time the original answers were given and the date the policy was issued and delivered.2
The application contained the following questions relevant to the resolution of this case:
2. Have you ever been treated for, or ever had any indication of:
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d. Chest pain, discomfort or tightness; palpitations, high blood pressure, rheumatic fever, heart murmur, heart attack or other disorder of the heart or blood vessels? 3. Have you, in the past five years:
a. Consulted or been treated by a physician or other medical practitioner?
b. Been a patient in a hospital, clinic, or medical facility?
In answering the application questions, Mr. Oade denied, in response to question 2(d), that he had been treated for chest pain, discomfort or tightness, palpitations, rheumatic fever, heart murmur, heart attack or other disorder of the heart or blood vessels. However, he disclosed that he had been treated for high blood pressure. In response to question 3(a) and (b), he denied that he had been hospitalized but disclosed that he had been treated by a physician or other medical practitioner during the preceding five years. Defendant did not contest the accuracy of the initial answers Mr. Oade made in response to the application.
On December 25, 1993, between the submission of Mr. Oade‘s application and defendant‘s approval and delivery of the policy, Mr. Oade went to a hospital emergency room, complaining of chest pains. He was admitted to the hospital and stayed overnight while tests were performed. As noted, the application for insurance required Mr. Oade to provide updated health information. In particular, Mr. Oade‘s initial answers that he had not been a patient in a hospital in the preceding five years, and had never been treated for chest pains thus became inaccurate information concerning his health status. Despite the requirement to provide updated health information, it is undisputed that Mr. Oade did not inform defendant of his December hospitalization for chest pains.
Mr. Oade died suddenly from a heart attack on September 1, 1994. Plaintiffs submitted a claim to defendant for payment of the death benefits provided in the life insurance policy. Defendant investigated, discovered the undisclosed hospitalization, and denied the claim on the ground that, although required to do so under the terms of the insurance application, Mr. Oade failed to report his change in medical history. Defendant declared that, because Mr. Oade had violated conditions precedent to create insurance coverage, the policy never became effective.
Following defendant‘s refusal to pay under the policy, plaintiffs brought this action in the circuit court where both parties filed cross-motions for summary disposition. The circuit court granted summary disposition in favor of defendant, holding that Mr. Oade‘s failure to communicate in writing the “material changes” to his answers in the application prevented the policy from taking effect.
The plaintiffs appealed, and the Court of Appeals reversed in an unpublished per curiam decision.3 The Court of Appeals recognized that parties may mutually agree that certain conditions be met before an insurance contract will become effective. However, the Court reasoned that such contract terms must not conflict with applicable statutes. The Court held that the case was governed by
In applying the statute, the Court of Appeals attempted to determine whether the undisclosed health information was material within the meaning of
Applying these principles to the facts of the case, the Court of Appeals concluded that, because plaintiffs had presented the deposition and affidavit of one of defendant‘s underwriters indicating that there was a possibility that Mr. Oade would have been offered a policy at a higher rate, plaintiffs had established a genuine issue of fact concerning the materiality of Mr. Oade‘s failure to disclose.
This Court granted defendant‘s application for leave to appeal.4
III. STANDARD OF REVIEW
Issues of statutory interpretation are questions of law and are therefore reviewed de novo. Cardinal Mooney High Sch v Michigan High Sch Athletic Ass‘n, 437 Mich 75, 80; 467 NW2d 21 (1991).
A motion for summary disposition under
IV. ANALYSIS
The Court of Appeals relied on the materiality requirement found in
No misrepresentation shall avoid any contract of insurance or defeat recovery thereunder unless the misrepresentation was material. No misrepresentation shall be deemed material unless knowledge by the insurer of the facts misrepresented would have led to a refusal by the insurer to make the contract.
Although we agree with the Court of Appeals that
A. APPLICABILITY OF MCL 500.2218
The touchstone of the statute‘s applicability is a “misrepresentation.”
When he submitted his insurance application, Mr. Oade indicated on the application that he had not been a patient in a hospital in the preceding five years and that he had never been treated for chest pains. However, between the submission of Mr. Oade‘s application and defendant‘s approval and
The question, then, is whether Mr. Oade engaged in a misrepresentation for purposes of
It is represented that the statements and answers given in this application are true, complete, and correctly recorded to the best of my . . . knowledge and belief.
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I understand that no policy based on this application will be effective unless all of my statements and answers continue to be true as of the date I receive the policy. I understand that if my health or any of my answers or statements change prior to delivery of the policy, I must so inform the company in writing.
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I understand that my statements and answers in this application must continue to be true as of the date I receive the policy. I understand that if my health or any of my answers or statements change prior to delivery of the policy, I must so inform the Company in writing.
Likewise, the interim insurance receipt provides as follows:
[N]o policy will go into force unless all my statements and answers in this application continue to be true as of the date I receive the policy:
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If my health or any of my answers or statements given in this or any other supplement to this application change prior to delivery of the policy, I must so inform the Company in writing . . . .
Despite contractually promising that his answers would “continue to be true” as of the effective date of the policy, Mr. Oade failed to do so. This failure rendered Mr. Oade‘s previous answers false, thereby making them misrepresentations under
Having determined that the statute applies, we turn to the Court of Appeals decision that Mr. Oade‘s misrepresentations were not material and that defendant therefore could not avoid the insurance contract.
B. MATERIALITY REQUIREMENT
No misrepresentation shall avoid any contract of insurance or defeat recovery thereunder unless the misrepresentation was material. No misrepresentation shall be deemed material unless knowledge by the insurer of the facts misrepresented would have led to a refusal by the insurer to make the contract.
The Court of Appeals relied on its prior decision in Zulcosky v Farm Bureau Life Ins Co, supra, for the proposition that a change in facts is “material” only where the correct information would cause the insurer to reject the applicant altogether. Zulcosky would not find materiality where the correct information would merely prompt the insurer to offer a policy at a higher premium. However, this is contrary to the binding precedent of this Court. Our decision in Keys v Pace, 358 Mich 74, 82; 99 NW2d 547 (1959), made clear that a fact or representation in an applica-
In this case, the undisputed evidence presented to the trial court made clear that the correct information would have led the insurer to charge an increased premium, hence a different contract. Indeed, defendant‘s underwriter stated in her affidavit that defendant “may have been willing to offer a more expensive ‘rated’ insurance contract at approximately double the premium cost that Mr. Oade had paid for the ‘standard’ insurance policy in this instance.” Thus, the Court of Appeals erred in focusing on whether defendant would have issued any contract of insurance to Mr. Oade. The proper materiality question under the statute is whether “the” contract issued, at the specific premium rate agreed upon, would have been issued notwithstanding the misrepresented facts. The Court of Appeals contrary decision in Zulcosky is overruled.
Because there is no genuine issue of material fact on the issue of materiality, defendant is entitled to summary disposition under
V. RESPONSE TO THE DISSENT
Contrary to the dissent, we conclude that it is altogether irrelevant that plaintiff‘s health did not change during the prepolicy period. The dissent, in concluding that the case presents a question of material fact, asserts that plaintiff offered evidence that he had not
However, the focus of inquiry under the statutory “materiality” test is whether a reasonable underwriter would have regarded Mr. Oade‘s updated answers regarding his hospitalization for chest pains as sufficient grounds for rejecting the risk or charging an increased premium, not whether the status of Mr. Oade‘s health had changed. Because there is no dispute that defendant would have, at minimum, issued an insurance policy at a higher premium rate, no reasonable jury could conclude that it would have issued the same contract.
To create an issue of fact on the materiality question, plaintiffs were free to bring forth evidence drawing into question the testimony of defendant‘s underwriter. Because plaintiffs did not do so, the trial court properly granted summary disposition to defendant under
VI. CONCLUSION
While we agree with the Court of Appeals that
KELLY, J. (concurring in part and dissenting in part). I concur in part IV(A) of the majority‘s opinion. Because the decedent violated his contractual duty by failing to update his medical history, true statements in his insurance application became false at the time the contract was made. The false statements were “misrepresentations” within the meaning of
However, I dissent from the majority‘s conclusion in its part IV(B) that there was no genuine issue of material fact concerning the materiality of the misrepresentations. Plaintiff introduced sufficient evidence to raise a fact question whether defendant would have issued the same policy at the same premium if timely notified of decedent‘s 1993 episode and hospitalization. Because the issue should be resolved by the trier of fact, I would affirm the Court of Appeals decision that summary disposition for defendant was improper.
I. MISREPRESENTATION AND § 2218(2)
A trial court‘s ruling on a motion for summary disposition under
As the majority points out, “representation” and “misrepresentation” are defined in the act:
A representation is a statement as to past or present fact, made to the insurer by or by the authority of the applicant for insurance or the prospective insured, at or before the making of the insurance contract as an inducement to the making thereof. A misrepresentation is a false representation, and the facts misrepresented are those facts which make the representation false. [
MCL 500.2218(2) .]
Unless defined in the statute, every word or phrase of a statute should be accorded its plain and ordinary meaning. See Western Mich Univ Bd of Control v Michigan, 455 Mich 531, 539; 565 NW2d 828 (1997). Where a statute does not define a word, courts may consult dictionary definitions to ascertain the word‘s plain meaning. See Popma v Auto Club Ins Ass‘n, 446 Mich 460, 470; 521 NW2d 831 (1994).
Although § 2218(2) defines a misrepresentation as, in essence, a “false statement as to past or present fact . . . at or before the making of the insurance contract . . . ,” it does not define “statement.” Resorting to a dictionary, one finds that “statement” is “something stated,” “a communication or declaration in speech or writing, setting forth facts, particulars, etc.,” or “a single sentence or assertion.”1
In the present case, it is undisputed that, at the time he completed the insurance application, decedent provided accurate answers to the questions relating to his health and medical treatments. The application required him to provide an update to defendant if any of his answers changed between the
Because of decedent‘s December 1993 hospitalization, his statements that he had not been hospitalized in the preceding five years and had never been treated for chest pains were rendered false. Given that he did not update the statements, decedent‘s application contained false statements regarding his health at the time defendant issued the policy.2 Because there were false statements or representations by decedent at the time the policy was delivered to him, there were misrepresentations within the meaning of § 2218(2).
The case of Guardian Life Ins Co of America v Aaron,3 is instructive. In Aaron, the defendant answered in his application for insurance with plaintiff Guardian Life Insurance Company that he had never been refused life insurance. That answer was true at the time. However, before Guardian accepted the policy, the defendant applied for and was refused life insurance by a second insurance company. He failed to give Guardian this information before it accepted the policy.
The New York court held that the defendant‘s failure to provide updated information constituted a mis-
Also instructive is Cosby v Transamerica Occidental Life Ins Co,5 describing an insurance applicant‘s change of health as rendering untrue his responses in an insurance policy application where the application provided that “[a]ll of the statements and answers given in this application to the best of my . . . knowledge and belief continue to be true and complete as of the date of delivery of the policy.”
Finally, there is Fjeseth v New York Life Ins Co, 20 Wis 2d 295; 122 NW2d 49 (1963). In that case, the decedent asserted on an insurance application that he
No oral or written statement, representation, or warranty made by the insured or in his behalf in the negotiation of a contract of insurance shall be deemed material or defeat or avoid the policy, unless such statement, representation, or warranty was false and made with intent to deceive, or unless the matter misrepresented or made a warranty increased the risk or contributed to the loss. [Fjeseth, supra at 305, n 1; § 209.06(1) has been revised and renumbered and is now
Wis Stat § 631.11 .]
Following the reasoning in Aaron, Cosby, and Fjeseth, I would conclude that decedent‘s December 1993 hospitalization rendered false his statements in the application regarding his hospitalization and chest pain history. As a consequence, his application contained false statements or representations at the time the policy was delivered to him. These constitute misrepresentations within the meaning of § 2218(2).
II. MATERIALITY
The next question is whether defendant may avoid the insurance policy, as a matter of law, on the basis
The Court of Appeals relied on Zulcosky v Farm Bureau Life Ins,6 for the proposition that a misrepresentation is “material” only where the insurer would have rejected the application altogether. See id. at 99, citing In re Certified Question, Wickersham v John Hancock Mut Life Ins Co, 413 Mich 57, 65; 318 NW2d 456 (1982); Clark v John Hancock Mut Life Ins Co, 180 Mich App 695, 699-700; 447 NW2d 783 (1989).7
As the majority observes, the Zulcosky test for materiality appears contrary to Keys v Pace, 358 Mich 74; 99 NW2d 547 (1959). In Keys, we articulated the proper test for materiality as follows:
“The generally accepted test for determining the materiality of a fact or matter as to which a representation is made to the insurer by an applicant for insurance is to be found in the answer to the question whether reasonably careful and intelligent underwriters would have regarded the fact or matter, communicated at the time of effecting the insurance, as substantially increasing the chances of loss insured against[,] so as to bring about a rejection of the risk or the charging of an increased premium.” [Id. at 82, quoting 29 Am Jur, Insurance, § 525.]
However, even under the seemingly more stringent Keys test, there exists a genuine factual dispute whether decedent‘s misrepresentations were “material.”
Plaintiff proffered evidence that one day after the 1993 hospital visit, medical tests ruled out a heart attack as the cause of the decedent‘s chest pain. Also, about two weeks later, decedent passed a cardiovascular stress test. It showed that his level of cardiovascular fitness was above average for someone his age.
Plaintiff also introduced an affidavit from Dr. John Hall, the decedent‘s personal physician. In it, Dr. Hall stated that decedent‘s health “did not change in anyway [sic]” between the date he applied for the insurance policy and when it was delivered.
A jury reasonably could conclude, on the basis of the record, that a reasonable underwriter would have issued the same policy to decedent even had he given it notice of his hospitalization. It reasonably could conclude, also, that a reasonable underwriter would not have charged an increased premium.
The majority notes that the underwriter‘s affidavit was “uncontradicted” in stating that defendant would have charged a higher premium had it known of decedent‘s hospitalization. It asserts, also, that plaintiff‘s evidence that the decedent‘s health did not change is “altogether irrelevant.” Ante at 254. This evidence leads it to conclude that a reasonable jury could only find that defendant would have charged an increased premium. Id. This conclusion impermissibly invades the province of the factfinder by resolving an unsettled question of fact.
Moreover, plaintiff introduced evidence questioning the veracity of the defendant‘s underwriter‘s asser-
In Meyer, the defendant‘s underwriter testified that the defendant would have denied coverage had it known of the insured‘s physical condition. The court found that a question of fact existed on the issue, nonetheless. It stated that “materiality is a fact question based on the objective facts of the particular case, and ‘[a] jury is not required to accept even uncontradicted testimony if improbable or if surrounding facts and circumstances afford reasonable grounds for doubting its credibility.’ ” Id. at 153, quoting Blazek v North Am Life & Casualty Co, 251 Minn 130, 137; 87 NW2d 36 (1957).
The same is true respecting defendant‘s self-serving affidavit in support of the motion for summary disposition. Surely the majority would not assert that any affidavit by its underwriters, if not directly refuted, would eliminate a fact question on materiality. By way of hypothetical example, assume that questions in the insurance application asked the applicant, “Do you use tobacco in any form other than cigarettes?” “Did you ever use tobacco in any other form?” Assume that the applicant answered “No” and that, between the date he submitted the application and received the policy, he smoked a cigar in celebration of a newborn child. Assume, also, that he did not
In Brown v Pointer,9 this Court expressed its agreement with the proposition that summary disposition is inappropriate where a factual assertion in a movant‘s affidavit depends on the affiant‘s credibility. In particular, it stated:
[W]here the truth of a material factual assertion of a movant‘s affidavit depends on the affiant‘s credibility, there inheres a genuine issue to be decided at a trial by the trier of fact and a motion for summary judgment cannot be granted. Arber v Stahlin, 382 Mich 300, 309; 170 NW2d 45 (1969); Durant v Stahlin, 375 Mich 628, 647-648; 135 NW2d 392 (1965). [Id. at 354.]
In this case, plaintiff‘s evidence of the state of decedent‘s health after the hospitalization afforded reasonable grounds to doubt the credibility of the underwriter‘s affidavit. Thus, plaintiff created a triable fact question whether defendant would have charged an increased premium had it known of the hospitalization that, decedent‘s physician said, showed no change in decedent‘s health. See Skinner v Square D Co, 445 Mich 153, 161; 516 NW2d 475 (1994), “[t]he court is not permitted to assess credibility, or to determine facts on a motion for summary judgment.”
In Volunteer State L Ins Co, the Tennessee Supreme Court articulated well the concerns associated with accepting as dispositive statements from insurance companies regarding the materiality of a misrepresentation:
It is not to be left to the insurance company to say after a death has occurred that it would or would not have issued the policy had the answer been truly given. It is true the practice of an insurance company with respect to particular information may be looked to in determining whether it would have naturally and reasonably influenced the judgment of the insurer, but no sound principle of law would permit a determination of this question merely upon the say so of the company after the death has occurred. [244 SW 49 (emphasis added).]
When reviewing the ruling on defendant‘s motion for summary disposition, we construe the facts in the light most favorable to plaintiff. That, coupled with the reasoning already set forth, leads me to conclude that the fact issue concerning the materiality of decedent‘s misrepresentations should be resolved by the trier of fact. Summary disposition in defendant‘s favor, therefore, was improper.
III. CONCLUSION
I would hold that, because decedent failed to update his health information, his application con-
CAVANAGH, J., concurred only in the result reached by KELLY, J.
Notes
See 6 Couch, Insurance, 3d, § 82:2, pp 82-6, 82-7, ns 8-9 (1998). Statements set forth in an application for insurance are “continuing representations” until the date the contract becomes binding; see generally Stipcich v Metropolitan Life Ins Co, 277 US 311, 316; 48 S Ct 512; 72 L Ed 895 (1928), explaining the “continuing representation” concept. This Court has recognized the concept of “continuing representations,” at least where an indorser of a note gives a financial statement to a bank to secure a line of credit. See First State Savings Bank v Dake, 250 Mich 525, 528; 231 NW 135 (1930). In Dake, this Court called the financial statement a “continuing representation” of defendant‘s responsibility. There, the indorser represented that the information within the financial statement was and continued to be true and correct unless notice of a change was given.I . . . understand and agree that:
1. no policy will go into force unless all my statements and answers in this application continue to be true as of the date I receive the policy:
2. if my health or any of my answers or statements given in this or any other supplement to this application change prior to delivery of the policy, I must so inform the Company in writing . . . .
(2) No misrepresentation shall avoid any contract of insurance or defeat recovery thereunder unless such misrepresentation was material. No misrepresentation shall be deemed material unless knowledge by the insurer of the facts misrepresented would have led to a refusal by the insurer to make such contract. [Greene v United Mut Life Ins Co, 38 Misc 2d 728, 730; 238 NYS 2d 809 (1963). NY Ins Law § 149, revised and renumbered and is now
McKinney‘s Insurance Law § 3105 (1985) .]
Hence, the affiant‘s reference to charging an increased premium was based on inaccurate or incomplete information. Also, it did not state that any hospitalization, regardless of the triviality of its cause, would have given rise to a different contract having been offered.