Boyd v. Travelers Insurance Company

421 S.W.2d 929, 1967 Tex. App. LEXIS 2851
Court of Appeals of Texas·Decided November 15, 1967·No. 59·Published·Cited by 13 cases

Opinion

SAM D. JOHNSON, Justice.

This suit was brought by appellant, Frank R. Boyd, against appellee, Travelers Insurance Company, for benefits under a group insurance policy. Liability on the policy was denied by appellee, Travelers Insurance Company, on the grounds that a condition in the policy had not been met and as a result, that the policy was not in effect at the time of the loss.

The policy of insurance under which appellant sought coverage provided that employees who applied were to be eligible for insurance on the date on which they completed one month of service, but provided under “effective dates of insurance” that:

“Any Employee, who is not actually at work on the date his Employee Insurance is to'become effective shall not be insured until he actually returns to work. An Employee who is not actually at work because he is on vacation or it is his day off shall, for the purpose of this Insurance be deemed actually at work on his last scheduled working day prior to such vacation or day off.”

Appellant’s contention was that even though he had not been at work on the date the policy was to have become effective, the “actually at work” policy condition had been *931 waived, or in the alternative, that the appel-lee had estopped itself from asserting it. The case was tried to a jury and after the appellant had closed, the jury was instructed to return a verdict in favor of appellee.

The pertinent dates are as follows: on May 5, 1959, appellant Boyd commenced employment for Air Control Products, the company for whose employees the master policy was issued. On May 12, 1959, appellant Boyd^applied for insurance coverage. On June 1, 1959, he sustained an injury to his finger while working for Air Control Products; however, he does not seek recovery in this case for the finger injury. June 1, 1959, the date of the finger injury, was the last day on which appellant Boyd worked. June 4, 1959, was the date on which the employee insurance coverage would have become effective if appellant Boyd had been actually at work. On June 13, 1959, appellant Boyd was involved in an accident and sustained the loss of a leg. It is for the loss of the leg that appellant Boyd seeks recovery in this case.

Appellant concedes that he was not at work on June 4, 1959, but contends that he is entitled to coverage because the appellee had committed certain acts which constituted a waiver of its right to rely on the restrictive provisions of the policy and for the further reason that the defendant was es-topped from asserting the policy’s limiting provisions. The appellee contends that since the plaintiff was not “actually at work” on the date the employee insurance was to become effective and never returned to work thereafter, that appellant never had coverage under the policy at any time. Ap-pellee further contends that waiver and es-toppel cannot, as a matter of law, operate to afford the appellant coverage under the facts of this case and in the alternative, that there is no evidence of waiver or estoppel.

By numerous points appellant attaches error on the part of the court below in instructing a verdict for appellee, alleging that there were numerous acts on The part of appellee that would indicate that the policy condition had_ been waived. These are that appellee accepted and retained premium payments which appellant had made, that appellee delivered a certificate of insurance and identification card to appellant, that appellee took proofs of loss from the appellant, and that appellant made and ap-pellee accepted, a partial payment "of ~ the proceeds due under the policy. He contends further error on the part of the court below in that the jury should have been permitted to determine whether or not the appellee was estopped to assert certain policy provisions of the master policy that were not fully contained in the delivered certificate of insurance, and also in that the jury should have been allowed to determine whether dr not appellant was induced to make additional policy premium payments by reason of the payment of part of the proceeds due under the policy.

The record before this court will support neither the contention that appellee accepted and appellant made a premium payment on the policy of insurance in question nor that Air Control Products was the agent of appellee, Travelers Insurance Company, for the purpose of receiving and paying over such premiums. Even if the question of agency were resolved in appellant’s favor, the mere acceptance of premiums will not constitute waiver so as to “create a new and different contract with respect to risks covered by the policy.” Great American Reserve Ins. Co. v. Mitchell, 335 S.W.2d 707 (Tex.Civ.App. 1960), writ ref.

The record will not support the contention that appellant signed or submitted a proof of loss which appellee accepted. Even if this fact were conceded, this would not constitute a waiver of the policy provisions so as to initially create contractual liability on the part of appellee. Washington Nat. Ins. Co. v. Craddock, 130 Tex. 251, 109 S.W.2d 165, 113 A.L.R. 854 (Com.App. 1937). There the insurance company furnished the plaintiff proof of loss forms and the plaintiff incurred expense in filling *932 them out and sending them in. The Texas Commission of Appeals held, however, that contractual liability cannot be created by waiver. “A waiver cannot operate to bring within the terms of the policy a loss which is expressly excepted therefrom or supply a failure of proof that a loss was covered by the policy.” Washington Nat. Ins. Co. v. Craddock (supra).

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Boyd v. Travelers Insurance Company, 421 S.W.2d 929, 1967 Tex. App. LEXIS 2851 (Tex. Ct. App. 1967).

421 S.W.2d 929 (Boyd v. Travelers Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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