Koren v. National Home Life Assur. Co., 21651

• Decision Date: 25 February 1982
• Docket Number: No. 21651,21651
• Citation: 288 S.E.2d 392,277 S.C. 404
• Court: South Carolina Supreme Court
• Parties: Joanne R. KOREN, as Executrix of the Estate of Alfred F. Koren, Appellant, v. NATIONAL HOME LIFE ASSURANCE COMPANY, Respondent.

Page 392

288 S.E.2d 392

277 S.C. 404

Joanne R. KOREN, as Executrix of the Estate of Alfred F Koren, Appellant, v. NATIONAL HOME LIFE ASSURANCE COMPANY, Respondent.

No. 21651.

Supreme Court of South Carolina.

Feb. 25, 1982.

William J. Dean and J. Michael Jordan, of Burns, McDonald, Bradford, Erwin & Patrick, Greenwood, for appellant.

Robert J. Sheheen, of Savage, Royall, Kinard, Sheheen & Byars, Camden, for respondent.

LITTLEJOHN, Justice:

Joanne R. Koren (claimant) appeals from an order of summary judgment denying her claim for insurance benefits against defendant National Home Life Assurance Company (Insurance Company).

Following the death of her husband in July, 1978, claimant (executrix of deceased husband's estate) filed a complaint for $15,000 accidental death benefits. Insurance Company answered alleging that deceased's insurance policy did not include coverage for death caused by accident. Claimant argues that Insurance Company should be estopped from denying coverage based upon its prior representation to the contrary (i.e. that the doctrine of equitable estoppel should apply).

A brief review of the facts is necessary. In July, 1971, husband purchased basic hospital insurance (base policy) from Insurance Company and paid $5.90/month premium until December, 1972. In December, he added to his base policy, coverage for death caused by accidental bodily injury, for which his total premium was increased to $9.50/month. Claimant-wife generally attended to the family's bookkeeping duties, although both she and her husband paid the monthly premiums.

In May, 1973, Claimant mailed to Insurance Company the $9.50/month premium notice. The "$9.50" was crossed out and replaced by "$5.90" and the following notation was handwritten at the bottom:

Please cancel the other policy we had--we just want our Reg. Hospitalization we had for $5.90. Which we had from the Beginning--

Thank you

[sig]

Mrs. Koren

Widow and husband added various forms of insurance coverage (riders) to their base plan during the following years. The monthly premium notice specified only the total premium due for the base plan and additional riders; it did not reflect which riders were effective or what proportion of the total premium was being applied to each rider.

On March 4, 1976, Insurance Company mailed to deceased a letter which reads in pertinent part as follows:

Dear Mr. Koren:

Thank you for your letter.

Your hospital insurance policy [policy no.] pays the following basic benefits...

You have added Accidental Death and Dismemberment benefits to your policy. If an accidental injury results in the death or dismemberment of anyone on your policy we will pay benefits as listed in the 'Principal Sum' Section of this rider. (Copy enclosed).

It has been my pleasure to help you.

Enclosed with the letter was an "Accidental Death and Dismemberment Rider" showing the table of benefits provided under the rider.

Insurance Company argues that the letter was a clerical mistake and that no additional premium was ever paid by the Korens after the letter was sent.

Claimant testified in her deposition that she routinely paid the amount specified on the Insurance Company premium notice, and that the amount did, in fact, increase after receipt of the above letter.

The letter from the Insurance Company might be more intelligently interpreted if we had the benefit of Mr. Koren's letter to which it responded. Unfortunately the Insurance Company could not find Mr. Koren's letter in its records and the Claimant-wife was unable to testify as to its contents.

Based upon these summarized facts, both parties moved for summary judgment; the motion was granted to Insurance Company.

Where there is no genuine dispute as to either the material facts or the reasonable inferences deducible therefrom, then the trial judge may put an end to the litigation prior to trial by granting motion for summary judgment as authorized under Circuit Court Rule 44. In making his determination, he must view the evidence then before him in the light most favorable to the non-moving party. Thus, in granting Insurance Company's motion for summary judgment, the...