Case Law -
Fioretti v. Mass. General LifeMassGen agreed to underwrite Anthony
Fioretti's life insurance policy, contingent only upon his execution of the
Statement of Good Health. (1)
Even after the expiration of the contestability period, an insurer may
deny a claim if the insured committed fraud in the policy application.
To rescind a policy, an insurer need not show that the insured actually
intended to deceive. Even an innocent misrepresentation can
constitute equitable fraud justifying rescission. (even
after lapse of contestability period, a health insurer may deny coverage
based on insured's nondisclosure of a serious illness in his insurance
application); (recession authorized when insured knowingly
misrepresents material health information to health insurer); (same when
misrepresentations made to life insurer).
at the time he completed this
Statement of Good Health, Anthony Fioretti knew: (1) that he was HIV-
positive; (2) that he had previously been declined life insurance by another
carrier (Columbian Mutual); and (3) that he had previously consulted with at
least two doctors concerning his HIV status. In short, every representation
made by Anthony Fioretti in the Statement of Good Health was false
The California Court of Appeal, for the first time since 1988, has agreed
that when an insured misrepresents or conceals, in an application for
insurance, facts subjectively material to the underwriter who agreed to the
risk, the insurer may effectively rescind the policy
The rule that an insurer is estopped to claim
misrepresentation in an insurance
application caused by the insurance
agent's
negligence does not apply where the applicant receives a copy of his
application,
unless some action by the
agent
prevents the applicant from reading the policy or leads the applicant to
believe that the misstated or omitted answers are not material.
Rutherford v. Prudential Ins. Co. of America
234 Cal.App.2d 719
Cal.App.1.Dist.,1965.
Question in application for
life insurance as to whether applicant had ever had headaches, chest pains,
above normal blood pressure, and whether applicant had consulted physician
during past five years for any other cause, called for matters of fact
normally within knowledge of every layman, and there was substantial,
though mainly indirect, evidence that answers of deceased in application
constituted both knowing misrepresentations and concealment of truth.
Anaheim Builders Supply, Inc. v. Lincoln Nat. Life Ins. Co. (App. 5 Dist.
1965) 43 Cal.Rptr. 494, 233 Cal.App.2d 400.
Insurance

