AMERICAN SUN LIFE INSURANCE COMPANY, APPELLANT,
v.
VIVIAN IRENE REMIG, ETC., APPELLEE

Fla. 5th DCA | 1985-12-26
No. 84-1442
COBB, C.J., and UPCHURCH, J., concur.
482 So. 2d 435 Florida District Court of Appeal, Fifth District (1985) Caution
Cited by 6 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

American Sun Life Insurance Company appealed a judgment awarding medical benefits to Vivian Remig for her deceased husband's colon cancer treatment, claiming the illness was a pre-existing condition excluded under the policy. The court affirmed, holding that a pre-existing condition only manifests when the insured knew or should have known of symptoms that would prompt a reasonable person to seek medical diagnosis.


Holding

The court held that a condition not otherwise diagnosed manifests when the insured knew or should have known of the illness's existence because he was experiencing symptoms that would lead a reasonable person to seek medical diagnosis. Since the jury found substantial evidence that Remig's illness had not manifested prior to the policy effective date, the judgment awarding benefits was affirmed.


Headnotes

[1] An insurance policy exclusion for pre-existing conditions is payable after a specified period from the policy effective date if the condition manifested itself prior to c…

[2] A medical condition is considered "manifest" for insurance purposes when the insured knew or should have known of the existence of the illness due to experiencing symptom…

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Key Quotes

“A condition, not otherwise diagnosed, is manifest when the insured knew or should have known of the existence of his illness because he was experiencing symptoms that would lead a reasonable person to seek a medical diagnosis.”

The court's adopted definition of 'manifest' for pre-existing conditions that have not been previously diagnosed by a physician.

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Facts & Procedural History

Donald Remig applied for an insurance policy on June 28, 1982, which was issued July 2, 1982. On August 19, 1982, he was admitted to the hospital and …

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Opinion of the Court
GOSHORN, G.S., Associate Judge,

GOSHORN, G.S., Associate Judge,

American Sun Life Insurance Company (“American”) appeals a final judgment awarding Vivian Remig, individually and as personal representative of the estate of her deceased husband, Donald Remig, medical benefits under an insurance policy issued by American. American argues that Rem-ig’s medical expenses were the result of a pre-existing condition which was excluded under the terms of the policy. We disagree and affirm.

On June 28, 1982, Donald Remig applied for an insurance policy from American. The policy was issued July 2, 1982. On August 19, 1982, Remig was admitted to the hospital and four days later was diagnosed as having cancer of the colon. Rem-ig filed a claim for medical expenses with American. The claim was denied. Remig then filed suit against American alleging that he was entitled to hospitalization and medical benefits under the policy. American defended on the basis that the medical expenses were the result of a pre-existing condition which had manifested itself prior to the effective date of the policy and thus were excluded from coverage. The insurance policy issued to Remig provides:

PRE-EXISTING CONDITIONS: Loss due to any condition that manifested itself prior to the effective date of coverage shall be payable after two years from the policy effective date.

Thus, the case turns upon the definition of “manifest.”

American contends that an illness “manifests itself” when it is diagnosable, relying on this court’s opinion in Preferred Risk Life Insurance Company v. Sandi, 421 So. 2d 566 (Fla. 5th DCA 1982). This reliance is misplaced. In Preferred Risk, as distinguished from the instant case, the symptoms were clearly present prior to the application for the insurance policy. We reject American’s contention and adopt the following definition of “manifest” in cases where the condition has not been diagnosed by a physician:

A condition, not otherwise diagnosed, is manifest when the insured knew or should have known of the existence of his illness because he was experiencing symptoms that would lead a reasonable person to seek a medical diagnosis.

Here, the jury found that Remig’s illness had not manifested itself prior to the effective date of the policy. The evidence at trial showed that prior to July 2, 1982, Remig weighed between 200 and 220 pounds. He had diabetes but kept it under control by eating properly and taking insulin. Remig had a tendency to fluctuate in weight between 10 and 12 pounds, which the Remigs attributed to the diabetic condition. Vivian Remig testified that her husband had not complained of any health problems nor had she noticed any of the symptoms associated with colon cancer.1 The business manager of the store where Remig was employed full time testified that he had not noticed any material weight loss in Remig prior to July 2, 1982 nor had he observed or heard Remig complain of any of the other warning signals of colon cancer. Remig’s treating physician testified that the history given by Remig in August of 1982 was consistent with colon cancer and any number of other illnesses, including diabetes.

Since there was substantial competent evidence to support the jury’s decision, the final judgment awarding the amount of the insurance policies to Vivian Remig is affirmed.

AFFIRMED.

COBB, C.J., and UPCHURCH, J., concur. . Symptoms of colon cancer include abdominal pain, bloody or dark stools,' vomiting, cramping, bleeding, palpable masses, change in bowel habits, severe loss of appetite or anorexia, anemia or extreme tiredness.


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Citator

Cited By

  • R.J. Reynolds Tobacco Co. v. Ciccone, 123 So. 3d 604 (Fla. 4th DCA 2013)
    …cessarily when the exact nature of sickness or disease is diagnosed by a physician after extensive testing. Id. at 568 (quoting McDaniel v. State Farm Mut. Ins. Co., 3 Kan.App.2d 174, 591 P. 2d 1094 (1979)); see also Am. Sun Life Ins. Co. v. Remig, 482 So. 2d 435, 436 (Fla. 5th DCA 1985) (“A condition, not otherwise diagnosed, is manifest when the insured knew or should have known of the existence of his illness because he was experiencing symptoms that would lead a reasonable person to seek a medical diagno…
  • Nw. Nat'l Life Ins. Co. v. Rutta, 599 So. 2d 684 (Fla. 4th DCA 1992)
    …for the traditional principle that insurance provides protection only against fortuitous events, not ones which are certain to happen. Lawrence, 716 F.Supp. at 885 (citations omitted). Appellant also cites American Sun Life Insurance Co. v. Remig, 482 So. 2d 435 (Fla. 5th DCA 1985) and Preferred Risk Life Insurance Co. v. Sande, 421 So. 2d 566 (Fla. 5th DCA 1982). We recognize that these cases may be distinguished because of the context in which they arose but note with interest that the definition approved…
  • Life Gen. Sec. Ins. Co. v. Cook, 648 So. 2d 237 (Fla. 4th DCA 1994)
    …uld require an accurate diagnosis. Nor has the insured cited any authority to support her argument. The two cases on which she relies, Daniel v. Orange State Life Ins. Co., 403 So. 2d 438 (Fla. 2d DCA 1981) and American Sun Life Ins. Co., v. Remig, 482 So. 2d 435 (Fla. 5th DCA 1986), are distinguishable. In Daniel, the insured had not seen a physician prior to the policy becoming effective, and there was an issue of fact as to whether a tumor discovered after the policy’s effective date had “manifested itsel…

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