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98 N.C. App. 410

390 S.E.2d 742

Lockwood v. Porter

Court of Appeals of North Carolina · decided 1990-05-01

Cited by 18 later decisions — most recently January 2013

3 federal appellate · 11 state decisions

Key passage — most relied on by later courts

“1. Cooperate with us in the investigation, settlement or defense of any claim or suit.”

quoted by 2 later decisions, including BOWYER BY BOWYER v. Thomas, 1997 Conn. Super. Ct. 11193 - Fleming v. State Farm Mut. Auto. Ins. Co., No. Cv 96 0560907 (Oct. 31, 1997)

“because he did not want to waste his time with a doctor who was not going to do anything for him and would report to [the insurer] that nothing was wrong with him when that was not so”

quoted by 1 later decision, including VanHaaren v. State Farm Mutual Automobile Insurance

Relies on MacClure v. Accident & Casualty Insurance Co. · Hedgecock v. Jefferson Standard Life Insurance · 360 F. Supp. 223 - Orozco v. State Farm Mutual Automobile Insurance Co.

Good law ✅— No negative treatment on recordhow we know

Decided 1990-05-01

View the full empirical analysis of this case →

PHILLIPS, Judge.

¶1 Plaintiff, driving a vehicle owned by Janice G. McGlen and insured by Aetna Casualty & Surety Company, suffered injuries as a consequence of a three-car collision caused by defendant Porter, an uninsured motorist. His suit as an unnamed insured under McGlen’s policy against the alleged uninsured motorist for medical payments was answered by Aetna in its own name as G.S. 20-279.21(b)(3)a permits. In answering Aetna also moved for sum *411 mary judgment based upon plaintiffs failure to comply with policy provisions mandating that:

¶2 A person seeking any coverage must:

1. Cooperate with us in the investigation, settlement or defense of any claim or suit.
3. Submit, as often as we reasonably require, to physical exams by physicians we select. We will pay for these exams.

¶3 Following a hearing on appellee’s motion plaintiff’s action was dismissed by summary judgment because the materials of both parties indicated without contradiction that plaintiff refused to appear for a doctor’s appointment that Aetna scheduled under the foregoing policy provisions. In his affidavit plaintiff stated in substance that: Aetna made an appointment for him to be examined at 9:30 a.m. on 25 April 1984 by Dr. John Roper, an orthopedic physician; he failed to keep the appointment because he did not want to waste his time with a doctor who was not going to do anything for him and would report to Aetna that nothing was wrong with him when that was not so; and he thought the whole situation was a rip-off.

¶4 The foregoing facts give rise to the following legal conclusions: The cooperation clause was binding upon plaintiff as an additional insured operating an automobile with the permission of the insured. 8 J. Appleman, Insurance Law and Practice Sec. 4775 (1981). Aetna’s right to have plaintiff examined by its physician is a material part of the insurance contract, and plaintiff’s unjustified refusal to be so examined violated the cooperation clause of the policy and bars his action as a matter of law. Orozco v. State Farm Mutual Insurance Co., 360 F.Supp. 223 (S.D. Fla. 1972), aff’d, 480 F.2d 923 (5th Cir. 1973). Though failure to cooperate under an insurance policy is an affirmative defense upon which Aetna has the burden of proof, MacClure v. Accident & Casualty Insurance Co. of Winterthur, Switzerland, 229 N.C. 305, 49 S.E.2d 742 (1948), the dismissal was nevertheless correct, since plaintiff’s own sworn admission established the defense as a matter of law. Hedgecock v. Jefferson Standard Life Insurance Co., 212 N.C. 638, 194 S.E. 86 (1937).

¶5*412 Affirmed.

Judges COZORT and LEWIS concur.
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