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Amex Life Assurance Company v. Superior Court

Supreme Court of California
930 P.2d 1264 (1997)


Facts

In 1991, Jose Morales applied for life insurance with Amex Life Assurance Company (Amex) (plaintiff). Morales was HIV positive and knew he was human immunodeficiency virus (HIV) positive. On his application, Morales denied that he was HIV positive or had acquired immune deficiency syndrome (AIDS). Amex required Morales to undergo a medical exam as part of the application process. Morales had another man appear for the medical exam. This man was heavier and taller than Morales. The paramedic conducting the examination noted that this man was “unhealthy or older than stated age.” The man was not asked for, and did not produce, identification. A blood sample taken from the man tested HIV negative. Amex issued Morales a life-insurance policy that was effective as of May 1, 1991. The policy contained an incontestability clause. According to the language of the incontestability clause, Amex would “not contest coverage under the Certificate [of insurance] after it [had] been in force during the life of the Covered Person for two years from the Certificate Effective Date, if all premiums have been paid.” On June 11, 1993, Morales died from AIDS-related causes. At that time, all the insurance payments due under Morales’s policy with Amex had been paid. Morales’s beneficiary filed a claim with Amex. Amex later learned that Morales had hired an imposter to undergo the medical exam. As a result, Amex denied the claim. In the action that followed, Amex sought to assert the imposter defense.

Rule of Law

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Issue

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Holding and Reasoning (Chin, J.)

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  • A “yes” or “no” answer to the question framed in the issue section;
  • A summary of the majority or plurality opinion, using the CREAC method; and
  • The procedural disposition (e.g. reversed and remanded, affirmed, etc.).

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