Heard v. Sexton

In Heard v. Sexton, 243 Ga. App. 462, 463 (532 SE2d 156) (2000) the insured met with his agent to discuss replacing his existing health insurance coverage. With the help of his agent, the insured applied for and was issued a policy excluding coverage for: (1) rheumatic heart disease and (2) hyperlipoproteinemia. The insured met with the agent, concerned as to the meaning of the exclusions, and was assured that he was covered for any illness or condition other than a rheumatic heart problem. The insured subsequently required bypass surgery and filed suit when the insurer refused to cover the surgery under the second exclusion. The insured in Heard had read his policy; however, in finding that an exception to the rule existed, it necessarily followed that TEI was excused of its duty to exercise ordinary diligence "to ensure that no ambiguity existed between the requested insurance and that which was issued." Heard, supra.