Chief Justice TOAL:
John and Charlene Turner (Petitioners) brought an action against Douglas A. Milliman (Milliman), Consumer Benefits of America (CBA), NIA Corporation, MidAmerica Life Insurance Co. (MidAmerica), World Service Life Insurance Co., Provident American Life and Health Insurance Co. (Provident American), Provident Indemnity Life Insurance Co. (Provident Indemnity), and Central Reserve Life Insurance Co. (Central Reserve) (collectively, Respondents)
In November 1996, John Turner (Turner) was employed at his family's radiator service business and was in need of health insurance coverage for himself and his son. Petitioners contacted Milliman, a local insurance agent, to inquire about purchasing health insurance coverage. Petitioners and Milliman discussed Turner's health insurance options.
Turner alleged Milliman represented to him that a group policy with CBA would be a good option because the future premiums would not increase as dramatically as the premiums with individual insurance plans. Turner also contended Milliman represented to him that group health insurance would be beneficial because of the following: (1) Turner was at an age when he could start developing medical problems and group coverage would allow him to keep his coverage; (2) companies
MidAmerica issued the coverage to Turner, and the coverage was concurrently assumed and reinsured by Provident Indemnity.
November 1996: $101.703 June 1997: $109.70 June 1998: $143.38 December 1998: $194.50 June 1999: $230.90 December 1999: $271.95 June 2000: $331.81 December 2000: $456.21 June 2001: $646.194 July 2001: $799.615
Turner attested he anticipated increasing premiums, but by the end of 1999 he thought the increases were getting out of hand.
In June 2001, Provident American notified Turner his policy would be terminated on September 30, 2001. Turner was offered a different policy for the same premium, $799.61, but with fewer benefits. Also in June 2001, the South Carolina Department of Insurance responded to an inquiry made by Petitioners. The Department of Insurance informed Petitioners
The circuit court granted summary judgment to Respondents, finding that (1) Petitioners' claims were barred by the three year statute of limitations, (2) Milliman's statements as to future events were not actionable, (3) allegations of unfair and deceptive practices in the context of insurance are not actionable pursuant to SCUTPA, and (4) Charlotte Turner was not a proper party plaintiff. The court of appeals reversed the grant of summary judgment in relation to the three year statute of limitations, finding it was a jury issue as to when Petitioners should have known of any potential claims. Turner, 381 S.C. at 111, 671 S.E.2d at 642. However, the court of appeals affirmed the grant of summary judgment regarding Milliman's alleged representations, finding they were not actionable as mere statements of unfulfilled promises or statements as to future events and no evidence was presented to show Milliman made the statements only to induce Petitioners to procure the policy. Id. at 113, 671 S.E.2d at 643.
When reviewing a grant of summary judgment, appellate courts apply the same standard applied by the trial
Petitioners argue the court of appeals erred in affirming the circuit court's grant of summary judgment because Milliman's statements were false statements of fact, which would support their fraud and negligent misrepresentation claims. Specifically, Petitioners contend the representation by Milliman that the policy was a group policy presents a genuine issue of material fact such that the grant of summary judgment by the circuit court was improper. We agree.
In order to establish a claim for fraud in the inducement to enter a contract, a party must establish the following by clear and convincing evidence: (1) a representation; (2) its falsity; (3) its materiality; (4) either knowledge of its falsity or a reckless disregard of its truth or falsity; (5) intent that the representation be acted upon; (6) the hearer's ignorance of its falsity; (7) the hearer's reliance on its truth; (8) the hearer's right to rely thereon; and (9) the hearer's consequent and proximate injury. M.B. Kahn Constr. Co. v. S.C. Nat'l Bank of Charleston, 275 S.C. 381, 384, 271 S.E.2d 414, 415 (1980).
Ordinarily, to be actionable, a statement must relate to a present or preexisting fact, and cannot be predicated on unfulfilled promises or statements as to future events. Davis v. Upton, 250 S.C. 288, 291, 157 S.E.2d 567, 568 (1967).
Under the elements for both fraud and negligent misrepresentation, the representation at issue must be false. See Fields v. Melrose Ltd. P'ship, 312 S.C. 102, 105, 439 S.E.2d 283, 285 (Ct.App.1993) ("To be actionable, the representation must relate to a present or pre-existing fact and be false when made."). Respondents argue the health insurance policy sold to Turner was a group health insurance policy. The Certificate of Insurance of both the MidAmerica and Provident American insurance policies states, "This certificate summarizes the provisions of the Group Policy that are important to you. . . . The Group Policy, alone, constitutes the entire contract under which rights and benefits are provided." Moreover, Dr. Tim Ryles, an expert in insurance regulation, testified the insurance coverage purchased by Petitioners was a group insurance policy. Respondents also contend Petitioners' belief that the policy was not a group policy is based on a misunderstanding about how coverage is issued under the policy. At all times when Turner's health insurance was in effect, CBA was identified as the policyholder to which the master group policy of insurance was issued. Within that framework, Turner completed an individual application, a term specifically defined within the group policy, to obtain coverage under the group policy.
Petitioners point to a certificate issued November 6, 2001 by Provident Indemnity which states the coverage issued was individual coverage. Petitioners note this correspondence stands in sharp contrast to other correspondence from the same company stating the product was group coverage. Petitioners also point to a letter from Continental General Insurance Company dated July 18, 2001 stating Turner was not eligible for insurance coverage because he was trying to replace an individual policy. We find this evidence meets the scintilla of evidence standard such that a grant of summary judgment as to the negligent misrepresentation claim was inappropriate. However, the fraud claim requires proof by
Petitioners have presented at least a scintilla of evidence that the policy issued was an individual policy, not a group policy. Hence, the grant of summary judgment on the negligent misrepresentation claim is reversed. However, due to the heightened standard of review regarding fraud, the grant of summary judgment on the fraud claim is affirmed.
PLEICONES, BEATTY, KITTREDGE and HEARN, JJ., concur.