Crawford v. Prudential Insurance Co. of America

773 P.2d 678, 13 Kan. App. 2d 452, 1989 Kan. App. LEXIS 299
CourtCourt of Appeals of Kansas
DecidedApril 28, 1989
DocketNo. 62,718
StatusPublished
Cited by2 cases

This text of 773 P.2d 678 (Crawford v. Prudential Insurance Co. of America) is published on Counsel Stack Legal Research, covering Court of Appeals of Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crawford v. Prudential Insurance Co. of America, 773 P.2d 678, 13 Kan. App. 2d 452, 1989 Kan. App. LEXIS 299 (kanctapp 1989).

Opinion

Brazil, J.:

Prudential Insurance Company of America (Prudential) appeals a district court decision finding that insurance coverage exists and awarding prejudgment interest and attorney fees to Ronnie Crawford. We reverse.

A. I. Leonard was hired by John McCullough of Pittsburg Aluminum Recycling to repair the recycling plant’s roof. Leonard, in turn, hired or contracted with Crawford to help him at $8.00 per hour. The men drove to the job site in Leonard’s truck and used Leonard’s tools.

McCullough did not hire Crawford and did not know Crawford was helping Leonard. Upon completion of the job, McCullough [453]*453paid Leonard, who then paid Crawford. McCullough did not withhold any money from Leonard’s check.

Crawford testified that he was working for Leonard. He said Leonard instructed him on what to do and could fire him. Leonard testified that he and Crawford entered a 50/50 deal and an employer-employee relationship was not created.

Leonard, who had no workers’ compensation insurance, testified he was a self-employed general contractor with a payroll of less than $10,000 per year.

On the third day of the reroofing job, Crawford fell through the roof. Crawford sustained medical expenses as result of the fall totaling $8,366.80.

Crawford filed a claim under his wife’s group health insurance policy which she received through her place of employment. The policy was issued by Prudential. Prudential refused to cover the injury on the basis of the occupational injury or disease exclusion. The exclusion states that generally excluded charges include: “charges incurred in connection with (a) injury arising out of, or in the course of, any employment for wage or profit.”

This case was submitted to the trial court on stipulated facts. The trial court granted judgment for Crawford and ordered Prudential to pay Crawford $8,366.80 under the insurance policy. The district court also ordered Prudential to pay ten percent annual interest from August 26, 1987, until entry of the judgment and attorney fees in the sum of $2,788.93. The district court based its judgment on the following findings:

1. that Crawford was not an employee of Pittsburg Aluminum Recycling;
2. that Crawford was not an employee of Leonard;
3. that even if Crawford was an employee of Leonard, his injury would not be compensable through workers’ compensation because Leonard’s payroll was below the statutory minimum;
4. that Crawford’s injury did not “arise out of and in the course of employment” and is not compensable under the Kansas Workers’ Compensation Act;
5. that the exclusion Prudential relies on does not apply unless (a) workers’ compensation benefits have been recovered or (b) the injured party has a legal right to recover workers’ compensation benefits, regardless of whether a claim is made for benefits;
[454]*4546. that the purpose of the exclusion is to prevent double recovery;
7. that the exclusion does not apply in this case because Crawford did not recover workers’ compensation benefits and does not have a legal right to recover benefits.

1. Insurance policy exclusion.

The facts of this case are not in dispute. The parties are in disagreement as to whether the insurance contract exclusionary clause regarding occupational injury prohibits Crawford from receiving insurance to cover his injuries. The standard of review in an insurance contract construction case was set forth in Farm Bureau Mut. Ins. Co. v. Horinek, 233 Kan. 175, 177, 660 P.2d 1374 (1983). The court stated:

“The construction and effect of insurance contracts are questions of law to be determined by .the court. None of the facts are disputed by the parties. If the facts are admitted, then it is for the court to decide whether they come within the terms of the policy, and the function of the appellate court is the same as the trial court.”

This court should review the policy and determine whether it covers Crawford’s claims.

If the insurance contract is unambiguous, “the words are to be taken and understood in their plain, ordinary and popular sense, and there is no need for judicial interpretation.” American Media, Inc. v. Home Indemnity Co., 232 Kan. 737, Syl. ¶ 5, 658 P.2d 1015 (1983).

Prudential argues that the language of the policy has acquired a definite meaning pursuant to Bienz, Administratrix v. John Hancock Mutual Life Ins. Co., 195 Kan. 422, 407 P.2d 222 (1965). Prudential asserts that the language of the policy exclusion has the same meaning the words “injury by accident arising out of and in the course of employment” (K.S.A. 1988 Supp. 44-501[a]) have in the Workers’ Compensation Act and, if strictly construed, would prohibit Crawford from receiving benefits under the policy. Prudential argues that the trial court erred in finding Bienz means the policy exclusion applies only when the injured worker has recovered or has the right to recover benefits from workers’ compensation.

In Bienz, the insured was killed when his private plane crashed while returning from a business trip. The insured’s [455]*455estate sought to recover death benefits. The insurance company claimed that payment of benefits was excluded because the policy provided that no payment should be made “for any loss of life caused by ‘injuries arising out of and in the course of employment for wage or profit.’ ” 195 Kan. at. 423. The trial court granted judgment to the insurance company, and the Supreme Court affirmed. 195 Kan. at 423, 429.

In deciding the case, the court stated that the words “ ‘injuries arising out of and in the course of employment for wage or profit’ . . . have, by judicial construction, acquired a definite meaning which is generally recognized, and when used in an exception clause in a group insurance policy, were intended to have the same meaning they have in the Workmen’s Compensation Act.” 195 Kan. 422, Syl. ¶ 1. The court further stated: “We are of the opinion that the phrase as used in the exclusion clause of the defendant’s policy was intended to exclude from the benefits of the policy persons whose claims might be based on injuries compensable under the Workmen’s Compensation Act.” (Emphasis added.) 195 Kan. at 426.

In this case, the trial court extended Bienz by holding that the exclusion does not apply unless workers’ compensation benefits have been recovered or the injured party has a legal right to recover workers’ compensation benefits. The trial court in effect held that the injury may arise out of, or in the course of, employment for wage or profit, but if workers’ compensation is not available for some other reason, the exclusion is not applicable. We disagree, and read Bienz to say only that workers’ compensation law should be used to determine whether an injury

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Crawford v. Prudential Insurance Co. of America
783 P.2d 900 (Supreme Court of Kansas, 1989)

Cite This Page — Counsel Stack

Bluebook (online)
773 P.2d 678, 13 Kan. App. 2d 452, 1989 Kan. App. LEXIS 299, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crawford-v-prudential-insurance-co-of-america-kanctapp-1989.