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HOOD v. PRUDENTIAL INS. CO. OF AMERICA

March 13, 1991

WILLIAM H. HOOD, Plaintiff,
v.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendant/Third-Party Plaintiff; GLORIA JENSON ROSSI JORGENSEN, et al., Defendants, v. HARI P. AGARWAL, Third-Party Defendant



The opinion of the court was delivered by: BOUDIN

 MICHAEL BOUDIN, UNITED STATES DISTRICT JUDGE

 This case comes before the Court on the motion of defendant Prudential Insurance Company of America ("Prudential") for summary judgment. Plaintiff William H. Hood filed a three-count amended complaint, seeking recovery of life insurance proceeds from Prudential on contract, misrepresentation and agency theories. Prudential alleges that the policy was voided by false statements and material omissions made on the insurance application by the decedent, Nancy L. Jenson, about the state of her health. For the reasons stated below, the motion for summary judgment will be granted as to Count I. Counts II and III will be dismissed for failure to state a claim on which relief can be granted.

 I. THE FACTS

 As presented by the record, the pertinent facts of this case are simple and not subject to reasonable dispute. On May 23, 1988, decedent Jenson applied for a life insurance policy with Prudential through one Hari P. Agarwal, an insurance agent or broker located in Lanham, Maryland. Although Jenson was a District of Columbia resident, the application for insurance listed Agarwal's Maryland address as her mailing address. *fn1" The application also represented that Jenson had no adverse health history, no drug or alcohol problems, and had received no medical attention in the past five years other than a "routine physical." It further represented that Jenson had never been refused life or health insurance coverage. *fn2" Prudential issued the policy to Jenson on August 2, 1988.

 In fact Jenson had an extensive history of medical problems, including chronic alcohol abuse, anemia, and a fractured wrist, and had undergone numerous medical tests and consultations related to those conditions throughout 1987. Jenson also had previously applied for life insurance with The Metropolitan Life Insurance Company, which application was denied on health grounds in April of 1988. Jenson died on July 8, 1989, at age 36. On her death certificate, the immediate cause of death listed was "fatty metamorphosis of the liver"; the contributing cause was "chronic ethanolism by history." When plaintiff Hood asserted his claim as beneficiary of the $ 100,000 policy, Prudential denied liability, declared the policy void, and tendered a refund of all premiums.

 This suit followed. In his amended complaint, Hood asserted as his first count that he was entitled to recover under the insurance policy. His second and third claims, premised on "misrepresentation" and "agency," are discussed at the conclusion of this opinion. Following discovery and contingent third-party claims not at issue here, *fn3" Prudential sought summary judgment on the ground that Jenson's application contained deliberate material misstatements and omissions that rendered the policy void. Hood opposed the motion, and oral argument was held on January 11, 1991.

 II. DISCUSSION

 A. Count I

 The principal questions presented by Count I are (1) whether Prudential may avoid the policy claim on grounds that Jenson's application contained false statements and material omissions that invalidated the policy, and (2) whether Prudential is estopped from asserting this defense due to the actions of Agarwal, who is alleged by Hood to have been acting as Prudential's agent. Summary judgment is appropriate only if "there is no genuine issue as to any material fact and . . . the moving party is entitled to a judgment as a matter of law." Fed. R. Civ. P. 56(c); see Celotex Corp. v. Catrett, 477 U.S. 317, 323-24, 91 L. Ed. 2d 265, 106 S. Ct. 2548 (1986). The Court concludes under this standard that Prudential's defense is valid, and that any estoppel argument offered by Hood must fail.

 Jenson was a District of Columbia resident, and it is asserted by Prudential, and not disputed by Hood, that all of the pertinent events occurred here. Accordingly, District law governs this case. Section 35-414 of the District of Columbia Code provides:

 
The falsity of a statement in the application for any policy of insurance shall not bar the right to recovery thereunder unless such false statement was made with intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the company. D.C. Code Ann. § 35-414 (1981).

 The statute establishes a two-tiered test, which requires a false statement and either deceptive intent on the part of the applicant or materiality as defined by the statute. Skinner v. Aetna Life and Casualty, 256 U.S. App. D.C. 150, 804 F.2d 148, 149 (D.C. Cir. 1986). Jenson's insurance application plainly contained both substantial omissions and positive misrepresentations about her adverse medical history. The application, filed in 1988, showed that her last medical consultation was a "routine physical" in November of 1986, and affirmatively and falsely stated "no" to the question asking whether Jenson had consulted a doctor within the past five years other than as disclosed in the application. In fact, according to Prudential's statement of material facts not in issue, Jenson had visited the George Washington University Medical Center for medical treatment at least half a dozen times in 1987, once for acute alcohol intoxication. None of these visits was disclosed in the application. In his reply to Prudential's statement of material facts, Hood fails to dispute any of these visits, or the falsity of Jenson's answers.

 Once an applicant's statement is determined to be false, the next question under District of Columbia law is whether the false statement either was made with intent to deceive or had a material effect on the insurance company's acceptance of the risk. The issue of Jenson's intent to deceive need not be reached, since the false statements on her ...


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