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You are here: BAILII >> Databases >> England and Wales Court of Appeal (Civil Division) Decisions >> Friends Life Ltd v Miley [2019] EWCA Civ 261 (28 February 2019) URL: http://www.bailii.org/ew/cases/EWCA/Civ/2019/261.html Cite as: [2019] EWCA Civ 261 |
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ON APPEAL FROM THE HIGH COURT OF JUSTICE,
QUEEN'S BENCH DIVISION
Mr Justice Turner
HQ15X03146
Strand, London, WC2A 2LL |
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B e f o r e :
LORD JUSTICE MOYLAN
and
LORD JUSTICE HADDON-CAVE
____________________
FRIENDS LIFE LIMITED |
Appellant |
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- and - |
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CHARLES THOMAS MILEY |
Respondent |
____________________
David Callow (instructed by EMW Law LLP) for the Respondent
Hearing date: 5 February 2019
____________________
Crown Copyright ©
Lord Justice McCombe:
(A) Introduction
"101. … I am satisfied that the claimant has discharged the burden of demonstrating that he suffers from CFS at a level sufficiently debilitating to entitle him to the requisite benefits under the policy. I find that he has not deliberately fabricated or exaggerated the extent of his disability and that his subjective assessment of the severity of his condition is not materially worse than the objective truth."
(B) The Grounds of Appeal
"For the avoidance of doubt, the permission does not permit any challenge to the judge's finding that Mr Miley did not act dishonestly in making the allegedly untruthful statements and/or misrepresentations of material fact relied upon as falling within clause 5.1(b) of the Policy."
"6. As a matter of mixed fact and law, the learned Judge failed to address the Appellant's case that irrespective of dishonest intent, the Respondent made objectively untruthful statements and/or misrepresentations of material fact as to his health and functional capacity, which fell within clause 5.1(b) of the policy, and which would have entitled the Appellant to cease payment of Benefit. …"
(C) The Policy, the CCFs and the FRFs
"If in connection with the happening or purported happening of any event insured by this Policy, the Member makes an untrue statement of a Material Fact or omits to disclose a Material Fact, the cover provided by the Policy in respect of that Member will immediately become void and no benefit whatsoever will be payable in respect of him."
Material Facts are defined as:
"Material Facts are facts which are likely to influence Friends Provident in the assessment of an application for insurance or in the assessment of a claim. …
The questions we ask in connection with a claim cover the Material Facts commonly relevant to making a decision on the validity of that claim. They include:
- details of the Member
- confirmation of membership and entitlement to Benefit
- the Member's state of health, the nature and implications of his incapacity
- his duties and the steps which have been taken to adjust the work to with incapacity
- Continuing Income and Pre-incapacity earnings."
"I hereby declare that I am the person referred to above, that I have read over the replies to all the questions in this form, that to the best of my knowledge and belief all the information given is true and that I have not withheld any material fact. I shall inform Friends Life immediately of any change…" (emphasis added)
The FRFs contained a broadly similar declaration in these terms:
"I hereby declare that I am the claimant/member referred to in this financial review form and that I have read over the replies to all the questions in this form, that to the best of my knowledge and belief all the information given is true and that I have not withheld any material fact. I shall inform Friends Life immediately of any changes in my work, or financial situation described in the replies given. This includes performing any work whether paid or unpaid. I understand and accept that if I fail to disclose a material fact that is known to me or give false information, Friends Life is entitled to decline this claim and cancel the policy." (emphasis added)
(D) Ground 6
"… i) In June 2013, the claimant kept an activity diary in which he recorded, for example: going on cycle rides, working on emails, socialising and painting the garage door. Save for one venial occasion upon which he records going for a coffee with a friend when, in fact, he went out for an alcoholic drink, there is no direct contrast between what he says he was doing and what he is seen to be doing. Moreover, the fact that he recorded significant activity at a time when he was not being filmed enhances rather than undermines his credibility.
ii) I do not consider, upon a fair and objective assessment of the evidence as a whole, as the defendant contends, that the evidence reveals that the claimant has only good days as opposed to a pattern of good and bad days. In this context, I note, in particular, that any bad days are likely to have been those upon which he did not venture out of the house and were thus not captured on video.
iii) The evidence reveals that the claimant has the cognitive ability, on occasion, to deal with emails, to initiate transactions on the internet, to engage with strangers and to socialise with friends. He has been able to ski, drive and travel alone on the train. Yet again, however, he has never denied being able to perform both mental and physical activities at some level. Although he reported being blocked by a mental fug, he was also stating in 2013, before the payments under the policy were stopped, that he still tried to do at least one mental task a day and was able to read, look at his emails and use the internet for short periods. I do not find that there is a sufficient level of contrast, between (i) what the claimant has been shown to be able to do in the surveillance and other objective evidence and (ii) his own account freely given, to support the suggestion that he is lying. It is to be noted when it falls to be determined whether the level of his symptoms satisfy the threshold test for his entitlement to benefits that his work with PJL had involved long hours, frequent evening meetings and very significant and sustained levels of concentration. I must take into account, as I do, the nature of the claimant's employment when applying the contractual test of entitlement under the policy.
iv) The defendant rightly points out that the claimant has taken frequent holidays both at home and abroad. Doubtless, this required a certain level of stamina but not one which I find to be inconsistent with the claimant's honesty or accuracy. The claimant was simply never asked about holidays at any relevant time before the payments were stopped under the policy and I am not satisfied that he could reasonably be expected to volunteer this information unprompted.
v) The point is fairly made on behalf of the claimant that the defendant, armed as it was with hours and hours of DVD footage, could have asked him direct and specific questions the answers to which may well have put beyond doubt whether or not he was being honest and straightforward. This they chose not to do.
vi) The evidence of the extent to which the claimant is able to shop and socialise does not significantly contradict his accounts of the extent of his limitations and carries the allegation of misrepresentation no further.
vii) The defendant suggests that the video evidence does not reveal that the claimant's friends and family behave any differently towards him than if he were fully fit. In the circumstances of this case, however, it is not apparent to me quite what overt demonstrations of assistance or concern could reasonably have been expected to have been portrayed."
"85. I have reached the conclusion that the surveillance evidence, whether taken on its own or in combination with all the other evidence in the case, falls very far short of undermining the claimant's case that he is telling the truth about his levels of disability or that his medical condition is sufficiently serious to entitle him to claim under the policy. I make the following observations:
i) Once more, there is a lack of flat and unequivocal contradiction between what the surveillance evidence reveals and what the claimant says he has done. Had the claimant, for example, denied ever going to the pub or going cycling then the defendant's case would have been immeasurably strengthened. As it is, the value of the surveillance evidence is undermined by the far weaker contrast between the general and the specific.
ii) Consistently with the claimant's evidence and that of his wife, the video evidence reveals no occasion upon which the claimant goes out in the evening whether with friends or otherwise.
iii) There are a number of days on which he is not seen to leave the house at all.
iv) Despite the fact that Mrs Miley is in work, there are a number of occasions when she undertakes other duties, such as mowing the lawn and doing the school run when the claimant does not appear to be otherwise occupied.
v) The footage of the second visit to the CPAD assessment clearly shows the claimant struggling to walk the distance to the car. The defendant is constrained to explain this by speculating that the claimant was putting on a show because he may have suspected that he was under surveillance. However, this suggestion does not explain why, if the claimant were alerted to the possibility that he was being watched, that he did not curtail his activities for a longer period. The claimant said under cross examination that he was unaware that he was being filmed at any stage and I believe him."
"27. … In so far as the notion of a beer festival might, to the uninitiated, conjure up images of the participants cavorting in lederhosen whilst brandishing overflowing beer steins in scenes of infectious Bavarian gaiety, they must be dispelled. In reality, this was a rather understated affair in which patrons of the local public house were given the leisurely opportunity to sample a range of craft beers."
It is somewhat ironic that FL should have been complaining about exaggeration.
(E) Ground 7
"Other Income (income from investments may be ignored)
(a) Are you receiving or have you received any other income during the course of this claim? (You should include any continuing salary, bonus, pensions, commissions, etc.)
(b) Are you expecting to receive any other income in the future?"
"47. In the context of this case, I am satisfied, on the application of a straightforward interpretation of the word within the context in which it appears on the Financial Review Form, that the restricted shares which were owned by the claimant were an "investment". The shares comprised the property into which money had been invested. When the value of the shares was realised, the money generated represented income from that investment and thus fell within that category of income which expressly fell to be ignored under the wording of the Financial Review Form.
…
49. … whoever is filling out the pro forma is informed that they are entitled, expressly and without qualification, to "ignore income from investments". Thus it matters not that the investment, when originally made, represented a bonus which formed part of the remuneration from his employment. When it was vested in the claimant it gave rise to income from an investment and was thus excluded from further consideration whether it could be characterised as amounting to a bonus or not. If the defendant had wished to provide for a more draconian consequence it would have been a simple matter to draft the form so as to make it clear that the investment income exemption was subject to the wording of what followed and not, by implication, the other way round…"
"54. I am satisfied that it is entirely credible that, despite the relatively large sums involved, the claimant formed the view, when filling out the forms, that the additional income, relating as it did to shares issued to him before his period of incapacity, would not be material to the information which the defendant was seeking. It follows that, despite the fact that the claimant is likely to have been fully aware of the share income at the time of filling in the Financial Review Forms, I am satisfied that he genuinely did not consider it either necessary or appropriate to disclose it."
"7. The learned Judge erred in fact and law in his approach to the issue of contractual construction. The learned Judge wrongly held [paras.40 to 47] that the surplus income of approximately £79,000 over and above Benefit under the Policy, which was received by the Respondent in the tax years 2011-12 and 2012-13, was "income from investment" which did not need to be declared on the Financial Review Forms completed by the Respondent during the course of the claim for Benefit. The learned Judge should have held that this additional income should have been declared (and would have been declared had the Respondent been acting honestly), because:
7.1 The learned Judge (correctly) held that the surplus income derived from shares allocated in 2007 and 2008, expressly as part of the Respondent's total remuneration from his employment. When the value of those shares was realised immediately upon vesting in the Respondent, it constituted income from employment and was declared and taxed as such, and not as a capital gain. It therefore constitute income, which constituted a "Material Fact" which the Respondent was required to disclose under the terms of the Policy. The learned Judge wrongly mischaracterised that income as "income from investment" in reliance on a judgment (Re Lilly's Will Trusts [1948] 2 All E.R. 906) which neither parties' counsel were invited to address, and against the natural meaning of the words of the Policy. In his approach to this issue of pure contractual construction, the learned Judge failed properly to adopt the ratio of Arnold v Brittain [2015] UKSC 36 that the Court's role when construing a contract is to give effect to the parties'objective intentions, by reference (inter alia) to the natural meaning of the words used, and that "a judge should avoid re-writing it in an attempt to assist an unwise party or to penalise an astute party." (S20)
7.2 The Respondent himself did not assert that his failure to declare this income was because he considered it was "income from investment". He gave several inherently improbable explanations in his oral evidence, but expressly said that if he had been in any doubt about whether it should be declared or not, he would have sought advice.
7.3 The learned Judge should have concluded that the Respondent had provided untrue information on the Financial Review Form, and that consequently clause 5.1 (b) of the Policy was triggered, with the effect that the claim should be dismissed, and the Counterclaim allowed."
(Clearly, the challenge to Mr Miley's honesty at the beginning of ground 7 cannot survive the terms of Henderson LJ's order.)
"38. When challenged with these discrepancies in cross examination, the claimant struggled to account for them, speculating that they may be explained by an oversight or by a matter which had been dealt with on his behalf by his wife. His unpreparedness for this particular line of questioning, however, is not entirely surprising since the point had not featured, other than in the broadest generic form, either in the pleadings or in the skeleton arguments. No objection to this line of cross examination was taken on the claimant's behalf on the basis that it was conceded that the defendant's decision to keep its powder dry on this issue fell within the legitimate tactical boundaries of the adversarial process.
39. One consequence of this unheralded turn of events was that the "financial fraud" argument rather took on a life of its own and generated further written submissions, disclosure and, eventually, an unsuccessful application on the part of the defendant that I should recuse myself from the case on the grounds of apparent bias. My determination of this issue is to be found at Miley v Friends Life Limited [2017] EWHC 1583 (QB) and there is no need for me further to map out that particular procedural cul-de-sac in this judgment."
(F) Conclusion
Lord Justice Moylan:
Lord Justice Haddon-Cave: