DOROTHY T. LAMM, APPELLANT,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, A NEW JERSEY CORPORATION, APPELLEE

Fla. 3d DCA | 1965-10-26
No. 65-52
Before HENDRY, C. J., and CARROLL and SWANN, JJ.
179 So. 2d 238 Florida District Court of Appeal, Third District (1965) Negative Treatment
Cited by 22 cases

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Synopsis

Dorothy Lamm appeals a summary judgment dismissing her claim against Prudential Insurance for failure to pay benefits under hospitalization policies covering her and her children. The court reversed, holding that disputed factual questions about alleged misrepresentation regarding a child's heart condition must be resolved by a jury rather than on summary judgment.


Holding

Summary judgment was improper because the evidence was not so substantial as to eliminate any genuine issue of material fact. The questions of whether the insurance agent asked sufficient questions, whether the plaintiff's answers were correct, and whether the plaintiff knew of or misrepresented the seriousness of the heart murmur were factual disputes that must be resolved by a jury.


Key Quotes

“While it appears that there was considerable evidence to induce the trial court to enter a summary final judgment for the defendant, the evidence cannot be said to be so substantial as to show that there was 'no genuine issue as to any material fact.'”

Establishes the standard for summary judgment and why it was improper here—disputed material facts existed.

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Facts & Procedural History

Lamm, a widow, applied for medical insurance covering herself and her two young children, Robert and Dorothy. Prudential issued two policies when Robe…

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Opinion of the Court
PER CURIAM.

PER CURIAM.

Dorothy T. Lamm, plaintiff below, appeals a summary final judgment in favor *239of the defendant, The Prudential Insurance Company of America, in a suit for failure to honor provisions of a hospitalization policy.

The plaintiff, a widow, applied for medical insurance which covered herself and her young children, Robert and Dorothy. The defendant insurance company issued two policies, one when Robert was seven, and another when he was eight years old. At the time of the issuance of both policies, Robert participated in all school activities, as would any normal child his age. Subsequently, the plaintiff incurred continuing and substantial hospital, medical and surgical expenses of the nature insured against by the defendant.

The plaintiff notified the defendant of her claims under the policies and submitted formal claims and proof of loss. Although substantial premiums had been previously paid and accepted, the defendant denied liability and sought to cancel the policies in •question.

The defendant claims that at the time plaintiff applied for the policies, she had ■knowledge of the fact that Robert had a heart murmur and that her failure to put the defendant on notice constituted material misrepresentations, omissions, and/or concealment of material facts which were material to the risk and hazard assumed by defendant.

Plaintiff claims that she had no knowl•edge of any "abnormal” heart condition; that she made no material misrepresentations, omissions, and/or concealments of fact, and if any statements.were incorrect, they were not made in bad faith; and that in fact, the defendant’s agent filled out the Applications. As a result of- defendant’s refusal to pay the claims, the plaintiff filed ■suit. Subsequently, the trial court entered a summary final judgment for the defendant, which is the subject matter of this appeal.

While it appears that there was considerable evidence to induce the trial court to enter a summary final judgment for the defendant, the evidence cannot be said to be so substantial as to show that there was “no genuine issue as to any material fact.” The extent of the questions asked by the insurance agent, the correctness of the answers given by the plaintiff, and plaintiff’s alleged misrepresentation, or knowledge of the seriousness of the “heart murmur”, were disputed questions of fact to be resolved by a jury.

We. quote with approval the discussion of misrepresentation, concealment, and breaches of warranty or condition in 18 Fla.Jur. Insurance § 455:

“In general, in suits on insurance contracts, if the evidence is susceptible of different inferences, the question of whether there has been misrepresentation, concealment, or a breach of warranty or Condition, is one of fact, for resolution by the jury. Accordingly, where it is contended that the insured has misrepresented the condition of his health in applying for insurance or in securing .reinstatement, and the evidence is not conclusive on the point, it is for the jury to resolve the question; and in so doing it is within their province to reject expert testimony and rely on lay evidence. Whether or not the insured falsely represented material facts that induced the insurer to issue policies solely on the strength of the insured’s statements, without regard to an independent investigation made by it, is likewise a question of fact.”

The summary final judgment is therefore reversed and the cause remanded for a trial by jury.

It is so ordered.


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Citator

Cited By (11 total)

  • …rmony with the general rule approved in other jurisdictions.7 The certified question in answered in the negative. DREW, O’CONNELL and ERVIN, JJ., concur. THORNAL, C. J., dissents. . 359 F. 2d 501 (C.C.A.5th 1966). . Lamm v. Prudential Ins. Co., 179 So. 2d 238 (Fla.App.3rd 1965). . American Bankers Life Assurance Co. v. Toth, 165 So. 2d 804 (Fla.App.3rd 1964), cert. den. 169 So. 2d 389 (Fla.1964). . Douglas v. Mutual Life Ins. Co., 191 So. 2d 483 (Fla.App.2d 1966). . Life Insurance Co. of Va. v. Shiffl…
  • Travelers Ins. Co. v. Zimmerman, 309 So. 2d 569 (Fla. 3d DCA 1975)
    …s asked by the insurance agent, the accuracy of the answers given by the insured and the insured’s alleged misrepresentation become disputed questions of fact to be resolved by the jury. Lamm v. Prudential Insurance Company of America, Fla.App.1965, 179 So. 2d 238; Hyman v. Life Insurance Company of North America, 481 F. 2d 444 (5th Cir. 1973). Furthermore, whether or not the insured falsely represented material facts that induced the insurer to issue policies solely on the strength of the insured’s statement…
  • Underwriters Nat'l Assurance Co. v. Earle A. Harrison, 338 So. 2d 58 (Fla. 3d DCA 1976)
    …See, e. g., Hyman v. Life Insurance Company of North America, 481 F. 2d 444 (5th Cir. 1973) (decided upon Florida law); Traveler's Insurance Company v. Zimmerman, 309 So. 2d 569 (Fla.3d DCA 1975); and Lamm v. Prudential Insurance Company of America, 179 So. 2d 238 (Fla.3d DCA 1965). This general rule is applicable to the instant appeal and the factual issues pertaining to appellee’s representations on the application for insurance were properly submitted to the jury for a determination. Upon a defendant’s, h…

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