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Fraud and Concealment

Most insurance policies contain a fraud and concealment provision similar to the following which states:

Fraud And Misrepresentation

"We do not provide coverage for any covered person who had made fraudulent statements or engaged in fraudulent conduct in connection with any accident or loss for which coverage is sought in this policy."

It is well settled in Georgia that policy provisions such as that quoted above are valid and enforceable. Perry v. State Farm Fire & Casualty Co., 734 F.2d 1441 (11th Cir. 1984); Pittman v. American Mutual Fire Ins. Co., 129 Ga. App. 399, 199 S.E.2d 893 (1973); American Alliance Ins. Co. v. Pyle, 62 Ga. App. 156, 8 S.E.2d 154 (1940); Smith v. Federated Mut. Ins. Co., 124 Ga. App. 693 (1971); Allstate Ins. Co. v. Baugh, 173 Ga. App. 615 (1985).

The law imposes upon Insureds the utmost of honest good faith dealing with the insurer. See: Fortson v. Cotton States Mut. Ins. Co., 168 Ga. App. 139 (1983); Chaacou v. American Central Ins. Co., 241 F.2d 889 (5th Cir. 1957); Washington v. Interstate Fire Ins. Co., 163 Ga. App. 15 (1982).

Fraudulent concealment or misrepresentations by an insured need not be under oath in order to void the insured’s claim. See: American Diver’s Supply and Mftg. Corp v. Boltz, 482 F.2d 795 (1973); Mercantile Trust Co. v. New York Underwriters Ins. Co., 376 F.2d 502 (1967).

It is not necessary that the misrepresentation be proven by direct and positive proof, but it may be shown by circumstances. If the facts and circumstances shown in evidence are such that it would lead a reasonable man to the conclusion that fraud exists, this is all the proof that the law requires. Patillo v. Thompson, 106 Ga. App. 808 (1962); Rollins v. Great Southwest Fire Ins. Co., 162 Ga. App. 139 (1982).

A fraudulent misrepresentation is a misrepresentation of fact, knowingly made. It is not necessary that the insurance company actually be deceived by such misrepresentation. Life Ins. Co. of Virginia v. Shiflett, 359 F.2d 501 (5th Cir. 1966); Chaacou v. American Central Ins. Co., 241 F.2d 889 (5th Cir. 1957); Mercantile Trust Co. v. New York Underwriters Ins. Co., Supra.

A misrepresentation is material if a reasonable insurance company, in determining its course of action, would attach importance to the fact misrepresented. Chaacou v. American Central Ins. Co., Supra; Long v. Insurance Co. of North America, 670 F.2d 930 (10th Cir. 1982).

Pittman, Supra, involved a claim wherein an insured sought to recover under a fire policy for the loss of a home and its contents, including a color television set. The policy contained a provision which read as follows:

"This entire policy shall be void if, whether before or after a loss, the insured has wilfully concealed or misrepresented any material fact or circumstance concerning this insurance or the subject thereof, or the interest of the insured therein, or in case of any fraud or false swearing by the insured relating thereto."

The charred remains of an old television set were found in Pittman's residence, but it was determined that this was not the 23-inch RCA color set claimed on the proof of loss. A witness had previously seen the charred remains of an old television set in the trunk of Pittman's car on the day preceding the fire. The same witness additionally testified that she had seen other items claimed to have been destroyed in the fire in Pittman's apartment following the fire.

Citing the above quoted policy provision, the trial court ruled that the verdict in favor of the insurer was authorized by the evidence as a result of false statements made by the insured to his insurer.

In American Alliance, Supra, the policy sued on provided that it would be void "in the case of any fraud or false swearing by the insured touching any matter relating to this insurance or the subject thereof, whether before or after the loss."In that instance, the insured submitted an inflated proof of loss as to the value of property insured under a fire insurance policy. The court held:

"...fraudulent false swearing....in the examinations which the insurers have a right to require, [will void] the policies."

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. See 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).


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