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Legal Issues |
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Fraud and Concealment
Most insurance policies contain a fraud
and concealment provision similar to the following which states:
"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:
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:
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).
Fraud And Misrepresentation
"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."
"...fraudulent false swearing....in
the examinations which the insurers have a right to require, [will void] the
policies."
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