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FRANKLIN LIFE INS. CO. v. BIENIEK

November 29, 1961

FRANKLIN LIFE INSURANCE COMPANY, Plaintiff,
v.
Mary E. BIENIEK, and Sewickley Savings & Loan Association, Defendants



The opinion of the court was delivered by: DUMBAULD

Here, however, we find, the insured was told by his physician the nature of his heart condition, given medicine to take, and advised to find a job involving lighter work (which he did). This appears indisputably from the testimony of Dr. John Hibbs, a highly reputable heart specialist of Fayette County. (Tr. 5-11). Defendants' evidence goes merely to the fact that the insured did continue to work, and never complained or had to stop or slow down, so far as the witness noticed.

 The statements of the insured in the application were plainly (1) false (2) material and (3) made with knowledge of their falsity on the part of the insured.

 The insured was referred to the care of Dr. Hibbs in 1954, at which time the insured was in the Uniontown Hospital for over ten days. Dr. Hibbs continued to treat him until the end of June, 1957.

 In part II of the application, under date of March 13, 1958, the insured certified that his answers were correctly recorded to twenty-four (24) questions concerning his health. No. 7 ('When did you last consult a physician or surgeon and for what?') was answered that in 1956 he consulted Dr. J. R. Carothers of Smock for a cold. Nothing was said about the treatments by Dr. Hibbs as late as 1957.

 Question 9 as to pain in the chest, or other forms of heart disease, was answered 'No.' This is in conflict with the testimony of Dr. Hibbs.

 The insured's negative answer to Question 16 as to electrocardiograms likewise conflicts with the medical records.

 His denial in answer to Question 18 of ever having been 'under observation or treatment in any hospital' is clearly false.

 Question 19 as to absence from work is also possibly answered falsely, though it is possible that his hospitalization may have coincided with a miners' holiday or period of unemployment.

 The answer to Question 20 ('Have you now any disease, ailment * * *') may also be viewed with skepticism.

 Question 22 was 'Have you within 5 years consulted any physician not included in any of above answered?' Here the answer is 'Yes', overwritten over a first answer 'No'. This answer is elaborated in item No. 24, showing consultation of 'Dr. Robinson, Uniontown, Pa.' in 1946 for 'Amputating distal joint Right Index Finger.' This answer is also clearly false, in that it omitted mention of Dr. Hibbs.

 Indeed, the erroneous nature of the answer to Questions 22 and 24 is so clear that we believe it put the company on notice so that it should have made further inquiry, which would doubtless have disclosed the data on which it now relies to cancel the policy.

 The question called for the names of physicians consulted 'within 5 years'. The answer was dated March 13, 1958. It referred to an amputation in 1946. The question called for information concerning the period March 13, 1953 -- March 13, 1958. The answer was patently unresponsive. This showed either that the insured misunderstood the question or was answering evasively. In either case we think the company was put on notice of irregularity. When it failed to make appropriate inquiry, but chose instead to rely on the medical examination made by Dr. P. M. Haver on March 13, 1958, and the agent's confidential report, and proceeded to issue the policy, it waived the matter of misrepresentations in the application. Continental American Life Ins. Co. of Wilmington, Del. v. Fritsche, 37 F.Supp. 1, 2 (E.D.Pa.1941).

 It is possible, but we do not pause to investigate the matter, which is somewhat unclear on the present record, that the insurance company may have been somewhat lax in its investigation by reason of the fact that this policy was issued to insure a mortgage due to the Sewickley Savings & Loan Association which has one hundred seventy-four (174) such policies outstanding in its favor, involving premiums of about $ 14,000 yearly. The Association paid the first premium of $ 130.60 on April 4, 1958, and when the insured died it had paid premiums amounting to $ 261.20, some of which ...


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