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Legal Issues |
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Misrepresentation In The Application
The law in Georgia with respect to misrepresentations is as follows:
Misrepresentation, omissions, concealment
of facts and incorrect statements [in an application for insurance] shall not
prevent a recovery under the policy in conflict unless:
Fraudulent;
Material either to the acceptance of the risk
or to the hazard assumed by the insurer; or
The insurer in good faith would have either not
issued a policy or contract or would not have issued a policy or contract in as
large an amount or at the premium rate applied for and would not
have provided coverage with respect to the hazard resulting in the loss if the
true facts had been known to the insurer as required either by the application
for the policy or contract otherwise. [O.C.G.A. § 33-24-7].
If an insurer seeks to void a policy,
ab initio, due to misrepresentations in the application, it is incumbent
upon the insurer to return all premiums to the insured for that policy term,
less it waive the defense or misrepresentation in the application.
Massachusetts Bay Insurance Company v.
Hall, 186 Ga. App. 19, (1990). An insurer who fails to return the
premiums acts inconsistently with his intention that the policy is void because of
the application misrepresentation and, as such, waives that defense.
State
Farm Fire & Casualty Company v. Jenkins, 167 Ga. App. 4 (1983);
Loeb v. Nationwide Mutual Fire Insurance Company, 162 Ga.
App. 561 (1892).
As indicated above, under O.C.G.A. §
33-24-7, to determine whether a misrepresentation is material or would
change the nature, extent or character of the insured interest, the insurer
must show that the misrepresentation would either: (1) influence the insurer in determining whether to accept the
risk initially; or (2) result in the charge of a higher premium for the risk
sought to be insured. Haugseth
v. Cotton State Mutual Insurance Company, 192 Ga. App. 853
(1989); Lee v. Metropolitan
Life, 158 Ga. 517 (1924).
Furthermore, the misrepresentation made by the insured need not be made
intentionally in order for the insurer to void coverage.
Misrepresentations made innocently, in good
faith, and without knowledge that it is false, are sufficient to void the
policy so long as same is material to the risk.O.C.G.A. §33-24-7(b)(3); Haugseth v. Cotton State Mutual
Insurance Company, Supra; United Family Life Insurance
Company v. Shirley, 242 Ga. 235 (1978).
Contracts of insurance are governed
generally by the laws which are applicable to contracts in the State of
Georgia. Pursuant to Georgia law, once
a contract has been breached, absent ratification by the non-breaching party,
the breach cannot be undone. In other
words, once the contract has been breached, the complying party is free to
treat the contract as if it were at an end, and is relieved of any duty to
perform under the terms of the contract.Rollins v. Gault, 153 Ga. App. 781, 266 S.E.2d 560
(1980). Insurance in the State of
Georgia is a matter of contract, and insurance contracts are treated no
differently than any other form of contract.Grange Mutual
Casualty Company v. King, 174 Ga.
App. 716, 331 S.E.2d 41 (1985); Richmond v. Georgia Farm Bureau
Mutual Insurance Company, 140 Ga. App. 215, 231 S.E.2d 245 (1976).
The burden of proof, however, is on an
Insurer to prove affirmative defenses such as failure of the insured to comply
with policy conditions, misrepresentations made by the insured or fraud. See:
O.C.G.A. § 24-4-1; Equitable Life Assur. v.
Florence, 47 Ga. App. 711, 171 S.E. 317 (1933); Masonic
Relief Ass'n v. Hicks, 47 Ga. App. 499, 171 S.E. 215 (1933); Pennsylvania
Threshermen & Farmers Mutual Cas. Ins.
Co. v. Taylor, 81 Ga. App. 277, 58 S.E.2d 542 (1950); Employers
Liab. Assur. Corp v. Sheftall, 97 Ga. App. 398, 103 S.E.2d 143
(1958).
It is also important that the agent not
have any knowledge about misrepresentations made by the insured in the
application. In Gustafson v. Cotton States, 230 Ga. App.
310, 496 S.E.2d 346 (1998), Cotton States was able to prevail on Summary
Judgment in a matter where the insured has misrepresented her five (5) prior
fire losses as well as the fact that they had a Chow on the premises. The Court
of Appeals reversed, stating that there were too many fact questions remaining
which had to be resolved by a jury.
The Court of Appeals found in Gustafson
that even if an application contains material misrepresentations sufficient to
void the policy under O.C.G.A. 33-24-7, if an agent of the
insurer has actual knowledge that the statement on the application is false,
then the agent’s knowledge is imputed to the insurer and the insurer is
thereafter estopped from asserting the misrepresentation in the application as
a defense. See: O’Kelley v. Southland Life Ins. Co., 167
Ga. App. 455, 305 S.E.2d 873 (1983);
Jones v. United Ins. Co., 177 Ga. App. 102, 338 S.E.2d
532 (1985); Graphic Arts. Mut. Ins. Co. v. Pritchett, 220
Ga. App. 430, 469 S.E.2d 199 (1996); Millan v. Residence Inn,
226 Ga. App. 826, 487 S.E.2d 431 (1997); Gustafson v. Cotton States,
Supra.
When determining whether material
misrepresentations were made in the application, the insured is permitted to
state what their "subjective" understanding of the question was when they read
the policy application. See: Jackson National Life v. Snead,
231 Ga. App. 406 ; 499 S.E. 2d 173 (1998).
Omissions in an insured’s policy
application are an affirmative defense under Georgia law. As such, it must be
plead and pointed out to the insured. Any failure of the insurer to assert the
defense initially will result in a waiver of that defense by the insurer. See:
Hamilton v. Mecca, Inc., 930 F. Supp. 1540 (S.D. Ga. 1996).
If Insurance Company intends to void the policy as a
result of misrepresentations in the application, it is essential that it do so
immediately. Where a company discovers a misrepresentation in the application,
but continues to treat the policy as valid and binding, and retains the insureds’
premiums as earned, the misrepresentation defense is waived. See: State
Farm Fire & Cas. Co. v. Jenkins, 167 Ga. App. 4, 305 S.E.2d 801
(1983); Loeb v. Nationwide Mut. Fire. Ins. Co., 162 Ga.
App. 561, 292 S.E.2d 409 (1982); Haugseth v. Cotton States Mut. Ins.
Co., 192 Ga. App. 853, 386 S.E.2d 725 (1989); Jones v.
Carter, 227 Ga. App. 401, 489 S.E.2d 141 (1997).
The Georgia Court of Appeals has ruled on
three occasions that automobile policies may, in fact, be voided to the date of
inception pursuant to O.C.G.A. § 33-24-7.
In Bourne v. Balboa Insurance
Company, 147 Ga. App. 55 (1977), the insured owned a motorcycle and
completed an application for a policy of insurance with Balboa.
Balboa maintained that when he made the
application, he was asked no question about his driving record and signed the
application in blank. The application
had, in fact, inquired of Bourne if he had ever had his license suspended or if
he had suffered a moving traffic violation in the past two years. The completed
application indicated "no" to both questions.
In fact, Bourne's driving reflected, and
Bourne admitted, that several months before the issuance of the policy, he was
convicted of driving under the influence and that his license had been
temporarily suspended. Shortly after
the policy was issued, Bourne's motorcycle was stolen and a claim was
filed. During its investigation, Balboa
discovered the violation mentioned above and refused the claim, maintaining
that the policy was void ab initio, based on false and material
misrepresentations in the application.
During litigation, Bourne admitted that he
was not unable to read the application, or that the agent prevented Bourne from
reading the application. The court
found that one who signs a written document without reading it, unless
prevented from doing so by some fraud or artifice, is chargeable with knowledge
of its content. As such, Bourne was
chargeable with knowledge that the information contained in the application was
incorrect, even though he may not have provided same.
The trial court granted summary judgment
to the insurer, holding that the policy was void ab initio due to
material misrepresentations in the application.
Balboa Insurance Company established that the insurance would not
have been issued to anyone who had been convicted of DUI or to anyone who had
suffered a license suspension in the past.
As such, Balboa was well within its rights to void the policy ab
initio and decline to pay the claim based on material misrepresentations in
the application. The Court of Appeals
affirmed the trial court's result and approved the propriety of voiding the
motorcycle policy ab initio due to the material misrepresentations in
the application. It should be noted
that this particular case was decided in 1977, well after the Georgia
Legislature's enactment of Georgia's Motor Vehicle Insurance Cancellation
statute found in O.C.G.A. § 33-24-45 in 1968. See Ga.
L. 1968,p. 1126, § 1.
More recently,
the Court of Appeals approved use of voiding automobile policies to the date of
inception in Haugseth v. Cotton States Mutual Insurance Company,
192 Ga. App. 853 (1989) and Platt v. National General Insurance Co.,
205 Ga. App. 705, 423 S.E.2d 387 (1992).
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