Filed: Aug. 27, 1999
Latest Update: Feb. 21, 2020
Summary: F I L E D United States Court of Appeals Tenth Circuit UNITED STATES COURT OF APPEALS AUG 27 1999 FOR THE TENTH CIRCUIT PATRICK FISHER Clerk MARILYN CRANER, Plaintiff-Appellant, v. No. 98-4145 (D.C. No. 96-CV-1063-G) THE NORTHWESTERN MUTUAL (D. Utah) LIFE INSURANCE COMPANY, dba Northwest Mutual Life, Defendant-Appellee. ORDER AND JUDGMENT * Before PORFILIO , BARRETT , and HENRY , Circuit Judges. After examining the briefs and appellate record, this panel has determined unanimously that oral argu
Summary: F I L E D United States Court of Appeals Tenth Circuit UNITED STATES COURT OF APPEALS AUG 27 1999 FOR THE TENTH CIRCUIT PATRICK FISHER Clerk MARILYN CRANER, Plaintiff-Appellant, v. No. 98-4145 (D.C. No. 96-CV-1063-G) THE NORTHWESTERN MUTUAL (D. Utah) LIFE INSURANCE COMPANY, dba Northwest Mutual Life, Defendant-Appellee. ORDER AND JUDGMENT * Before PORFILIO , BARRETT , and HENRY , Circuit Judges. After examining the briefs and appellate record, this panel has determined unanimously that oral argum..
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F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
AUG 27 1999
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
MARILYN CRANER,
Plaintiff-Appellant,
v. No. 98-4145
(D.C. No. 96-CV-1063-G)
THE NORTHWESTERN MUTUAL (D. Utah)
LIFE INSURANCE COMPANY, dba
Northwest Mutual Life,
Defendant-Appellee.
ORDER AND JUDGMENT *
Before PORFILIO , BARRETT , and HENRY , Circuit Judges.
After examining the briefs and appellate record, this panel has determined
unanimously that oral argument would not materially assist the determination of
this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is
therefore ordered submitted without oral argument.
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
Plaintiff Marilyn Craner appeals the district court’s grant of summary
judgment in favor of defendant The Northwestern Mutual Life Insurance Co.
(Northwestern). As plaintiff has not raised a genuine issue as to any material fact
and Northwestern is entitled to judgment as a matter of law, we affirm.
On February 23, 1996, plaintiff’s late husband, Stephen Craner, contacted a
Northwestern agent to obtain life insurance. The agent informed Mr. Craner that
he needed to undergo a medical examination as a prerequisite for coverage. On
February 27, 1996, Mr. Craner underwent a medical examination, which included
completing a medical questionnaire. In the questionnaire, Mr. Craner denied
having been diagnosed with or treated for any psychological condition, including
anxiety, depression, or stress, and denied consulting with any health care
provider, including a psychologist, other than the health care providers already
identified. Both of these answers were false, as Mr. Craner had been consulting
with a psychologist on a weekly basis, and had been diagnosed with dysthymia,
which is a form of depression.
The next day, Mr. Craner filled out an application for $500,000 in life
insurance and paid the first month’s premium. In return, he was given a “Receipt
for Payment and Conditional Life Insurance Agreement,” which contained the
following provisions:
I. Unacceptable Risks–No Insurance in Force. No insurance or
additional benefits will be in force at any time under the terms of this
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Agreement if the proposed insured is not a risk acceptable to
Northwestern Mutual Life on the Underwriting Date according to its
rules and standards.
II. Acceptable Risks–Insurance in Force. The policy applied for
will be in force as of the Underwriting Date if the proposed insured
is a risk acceptable to Northwestern Mutual Life on the Underwriting
Date for the policy applied for.
....
III. Underwriting Date–When Insurance Begins. For acceptable
risks insurance begins on the Underwriting Date, which is the later
of:
A. The date of application ...; or,
B. the date of the nonmedical, paramedical or medical examination.
Appellant’s App. at 38-39.
In addition, the front page of the Agreement stated in bold language that it
was “ Not a ‘Binder’–No Insurance if Section I Applies ,” and the second page
stated in bold lettering that the Agreement was “ NOT A ‘BINDER’–NO AGENT
MAY MODIFY THE TERMS OF THIS AGREEMENT–NO INSURANCE IF
SECTION I APPLIES .”
Id.
On March 8, 1996, Mr. Craner participated in a telephone interview with a
Northwestern representative. During this interview, Mr. Craner disclosed, for the
first time, his psychological treatment. Also during this interview, he responded
negatively when asked whether he had ever been convicted of violating a criminal
law other than a traffic violation. Northwestern then attempted to contact the
psychologist to obtain his treatment records. Although numerous attempts were
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made to obtain the records, Northwestern did not receive the complete treatment
information until May 6, 1996. The psychologist’s records disclosed that
Mr. Craner had been diagnosed with depression, and that he was being treated for,
inter alia, several incidents of sexual activities with children. A follow-up
investigation revealed that Mr. Craner had been convicted of lewdness with a
child in November 1991, and that in 1996 he was facing three felony counts of
sexual assault on a child.
On April 5, 1996, while Northwestern’s investigation was still underway,
Mr. Craner was killed in a one-car accident. On May 14, 1996, Northwestern
determined that Mr. Craner was not an insurable risk as of the underwriting date,
based on his recurrent psychological problems, his criminal conviction, and the
pending criminal charges. Contemporaneously with its decision, Northwestern
returned the first month’s premium paid by Mr. Craner.
On November 18, 1996, plaintiff filed an action in state court against
Northwestern and its agent, alleging breach of contract, breach of the implied
covenant of good faith and fair dealing, fraudulent inducement, infliction of
emotional distress, and negligent delay. The case was removed to federal court
on diversity grounds. On March 6, 1997, the district court dismissed the
complaint against Northwestern’s agent, and on July 15, 1998, the court granted
Northwestern’s motion for summary judgment. The district court concluded that
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(1) the conditional life insurance agreement was not ambiguous; (2) it contained a
condition precedent requiring that Mr. Craner be determined an acceptable risk
before the coverage would be effective; (3) Northwestern’s determination that
Mr. Craner was not an acceptable insurance risk was not arbitrary or capricious;
and (4) plaintiff’s remaining claims failed as a matter of law. Plaintiff appeals
only the court’s decision regarding her breach of contract claim.
We review a grant of summary judgment de novo, applying the same
standard as the district court. See Siemon v. AT & T Corp. ,
117 F.3d 1173, 1175
(10th Cir. 1997). Summary judgment is appropriate if “there is no genuine issue
as to any material fact and . . . the moving party is entitled to judgment as a
matter of law.” Fed. R. Civ. P. 56(c). We examine the factual record and the
inferences reasonably drawn therefrom in the light most favorable to the party
opposing summary judgment. See Siemon , 117 F.3d at 1175.
Plaintiff argues that the conditional life insurance agreement was a
temporary contract of insurance that covered Mr. Craner unless it was terminated
by Northwestern before his death. Alternatively, plaintiff argues the agreement
was ambiguous and should be construed in favor of coverage. We disagree with
both these arguments.
Because this is a diversity case, we examine Utah law to determine the
meaning and effect of the agreement. See Novell, Inc. v. Federal Ins. Co. , 141
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F.3d 983, 985 (10th Cir. 1998) (holding in diversity case that insurance contract
would be interpreted pursuant to Utah law). When an applicant completes a life
insurance application and tenders the first premium, Utah law recognizes two
different relationships that may be created between the applicant and the insurer.
If the insurer issues a “binder” or a “binding receipt,” and manifests an intention
to provide immediate coverage subject to certain conditions, a temporary
insurance contract is created. See Long v. United Benefit Life Ins. Co., Inc. ,
507
P.2d 375, 376-77 (Utah 1973) (holding temporary insurance in effect when agent
advised applicant he was insured from time he signed application; receipt for first
premium did not say it was “conditional”; there was no evidence applicant was
not insurable; and receipt stated insurance was effective on date of application
subject to certain conditions); Phoenix Indem. Ins. Co. v. Bell ,
896 P.2d 32, 35-36
(Utah Ct. App. 1995) (noting “‘binder’ is a term of art in the insurance industry
for a temporary contract for insurance”). Such temporary insurance may be
terminated only when the application is rejected and the applicant is given notice
of the rejection. See Long , 507 P.2d at 379; Stevenson v. First Colony Life Ins.
Co. ,
827 P.2d 973, 978 (Utah Ct. App. 1992).
If, however, the insurer issues a conditional receipt stating clearly that no
insurance will take effect unless certain conditions are met, in particular the
condition of insurability, Utah courts will not find coverage if the condition
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precedent is not satisfied. See Wade v. Utah Farm Bureau Ins. Co. ,
700 P.2d
1093, 1095-96 (Utah 1985) (holding that condition precedent to coverage was not
fulfilled when applicant’s death before the medical exam “made it impossible to
learn whether she was an insurable risk”); Williams v. First Colony Life Ins. Co. ,
593 P.2d 534, 537 (Utah 1979) (holding coverage not effective under plainly-
worded conditional receipt when applicant died before conditions met, stating
“the insurer should be accorded the protection of the plainly stated provisions of
its contract as to the conditions prerequisite to its providing insurance coverage”);
Winger v. Gem State Mut. of Utah ,
449 P.2d 982, 982-83 (Utah 1969) (holding no
insurance coverage when insurer acted with reasonable dispatch in determining
applicant was not insurable, and “conditional receipt” clearly conditioned
coverage on determination that applicant was insurable according to insurer’s
rules and practices); see also Machinery Center, Inc. v. Anchor Nat’l Life Ins.
Co. ,
434 F.2d 1, 5-6 (10th Cir. 1970) (construing Utah law to enforce plainly
written condition precedent in conditional receipt, and distinguishing between
binders and conditional receipts).
In Prince v. Western Empire Life Ins. Co. ,
428 P.2d 163 (Utah 1967), the
Utah Supreme Court described the effect of a receipt conditioning coverage on
insurability as follows:
Where a binding receipt is issued to the applicant with a provision
that the insurance be binding from the date of the application or the
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medical examination if the insurance company is satisfied that the
applicant was an insurable risk at that time, the general rule is that a
contract of preliminary insurance is created with the reserved right in
the insurer to determine in good faith the applicant's insurability.
Hence if, at the time of the application or medical examination, the
insured was an insurable risk, the temporary contract of insurance is
in force[.] If, however, the applicant at the time of the application or
the medical examination was not an insurable risk, the company will
not be liable under the ‘binding receipt.’ The rationale behind this
holding is simply that the language of the receipt clearly expresses
the intention of the parties.
Id. at 167. The court in Prince found coverage because the receipt was labeled
“binding receipt,” there was proof that the applicant was an insurable risk, and
both parties intended that the insurance would take effect before the applicant’s
other insurance lapsed. See
id. at 166-67.
Moreover, the distinction between these two types of receipts and their
effects appears to be codified by statute in Utah. Section 31A-21-102(1) of the
Utah Insurance Code provides:
“Binder” means a writing which describes the subject and amount of
insurance and temporarily binds insurance coverage pending the
issuance of an insurance policy. “Binder” does not include
conditional receipts by life insurance companies under which
issuance of the policy or coverage under the policy is contingent
upon the acceptability of the risk to the insurer.
Utah Code. Ann. § 31A-21-102(1) (1999 Repl.).
In the case before us, the conditional receipt very clearly stated that
insurance coverage was conditioned on Mr. Craner’s insurability as of the date of
underwriting. There is nothing ambiguous about Northwestern’s language, which
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emphasized, and later reemphasized, that coverage would not become effective if
the applicant was not an insurable risk when he completed the application or the
medical examination, whichever occurred later. Based on the Utah statute and
case law, we hold that the district court correctly interpreted the receipt to
preclude coverage ab initio when Northwestern determined Mr. Craner was not an
acceptable risk. As no temporary insurance was created, plaintiff is not entitled
to benefits under the policy. 1
Plaintiff attempts to recast Northwestern’s rejection of the risk as the
insurer’s termination of Mr. Craner’s temporary insurance based on his
misrepresentations. She then argues that such a termination was based on his
failure to satisfy a condition subsequent, and that, therefore, the temporary
coverage was still in effect when he died. The record does not support this
1
In an attempt to place herself within the factual situation of Long v. United
Benefit Life Ins. Co. , plaintiff misrepresents the insurance agent’s testimony,
stating “Lambert [the insurance agent] advised Craner at the time of delivery of
the Conditional Receipt that coverage existed from that time forward unless later
terminated.” Appellant’s Br. at 7. The referenced testimony actually states that
the agent “explained to him that if Mr. Craner was an acceptable risk to
Northwestern Mutual on the underwriting date , as explained here, that his
coverage would take effect on the later of the signing of the application or the
dating of the medical exam; and that [the signed application, completed medical
exam, and premium payment] created a conditional life insurance amount that
would be payable if he were an acceptable risk to Northwestern Mutual.”
Appellant’s App. at 93, Depo. p. 43:8-17 (emphasis added). No coverage was
created, therefore, by the agent’s statements to the applicant about the effective
date of coverage.
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reading, however. Because Northwestern did not rely on Mr. Craner’s
misrepresentations to decline coverage, the district court did not address the
propriety of terminating coverage on this basis, and neither will we.
The judgment of the United States District Court for the District of Utah is
AFFIRMED.
Entered for the Court
James E. Barrett
Senior Circuit Judge
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