Keen v. St. Elizabeth Hospital Medical Center

575 N.E.2d 668, 1991 Ind. App. LEXIS 1287, 1991 WL 147028
CourtIndiana Court of Appeals
DecidedJuly 30, 1991
DocketNo. 23A01-9103-CV-59
StatusPublished
Cited by4 cases

This text of 575 N.E.2d 668 (Keen v. St. Elizabeth Hospital Medical Center) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Keen v. St. Elizabeth Hospital Medical Center, 575 N.E.2d 668, 1991 Ind. App. LEXIS 1287, 1991 WL 147028 (Ind. Ct. App. 1991).

Opinions

RATLIFF, Chief Judge.

STATEMENT OF THE CASE

Sandra Keen, individually and in her capacity as Administratrix of the Estate of Richard Keen, appeals a summary judgment entered against her in an action brought against St. Elizabeth Hospital Medical Center, as Plan Administrator of the St. Elizabeth Hospital Medical Center Health Care Benefits Plan for Employees (St. Elizabeth). We reverse and remand.

ISSUE

Whether the trial court erred in concluding as a matter of law that Richard Keen's injuries "arose out of" and "in the course of" his proprietorship of Keen's Inn?

FACTS

The facts most favorable to the non-movant reveal that Richard Keen (Keen) was the husband of Sandra Keen. Keen owned and operated Keen's Inn, an establishment that served food and alcoholic bev-ecrages.

On June 20, 1988, Keen was present at Keen's Inn along with Mickey Stanley, the bartender, and Geraldine Walizer, a waitress. Also present were Ralph Williams and his girlfriend, Elizabeth Thornton. Throughout most of the evening, Keen, Williams, and Thornton were engaged in friendly conversation.

Prior to the tavern's closing, Keen told Williams and Thornton (the only remaining patrons) to finish their beers and leave. Later that evening, when Thornton told Williams it was time to leave, Williams became angry and started calling Thornton vulgar names. When Walizer joined in the conversation and told Williams to stop calling Thornton vulgar names, Williams began calling Walizer vulgar names as well. Then Keen told Williams that he could not talk to Thornton and Walizer in such manner and to take his domestic squabble outside. This resulted in an argument between Keen and Williams. Keen told Williams to leave the tavern and barred him from returning. Williams responded that Keen was not big enough to throw him out. Thornton told Williams that she was leaving and told him to accompany her. As Thornton walked toward the door, Keen and Williams started pushing each other. Keen was located behind the bar while Williams was in front of the bar.

Finally, as Williams left the tavern, Keen followed him outside. While outside, the two men began pushing each other again. Walizer unsuccessfully attempted to come between them. Keen told her "she had better get out of the way if she didn't want to get hurt because they [Keen and Williams] were going to get a piece of each other". The scuffle ended with a punch by Williams to Keen's face. Keen fell backwards, struck his head on the pavement, and was rendered unconscious. He was taken to a Kokomo hospital and later, by Life Line Helicopter, transferred to Methodist Hospital in Indianapolis, Indiana. On March 12, 1989, Keen died of a respiratory [670]*670arrest due to seizure activity as a consequence of the head injury suffered on June 20, 1988.

As a result of the incident, Sandra Keen, an employee of St. Elizabeth Hospital requested that St. Elizabeth extend coverage under the St. Elizabeth Hospital Benefit Plan to reimburse her for her husband's care and medical expenses,. By virtue of Sandra's employment, she and her husband were covered by the St. Elizabeth Hospital Benefit Plan. The plan covered employees and their eligible dependents. However, St. Elizabeth denied coverage of Keen's costs and medical expenses arising out of the June 20, 1988 incident because Keen's injuries were "job-related". The plan expressly excludes coverage for care received through a job-related injury.

Sandra Keen brought this action against St. Elizabeth; St. Elizabeth filed a motion and was granted summary judgment. Sandra Keen appeals.

DISCUSSION AND DECISION

Sandra Keen contends that the trial court erred when it concluded as a matter of law that Keen's injuries "arose out of" and "in the course of" his proprietorship of Keen's Inn.

Our standard of review when determining the grant of summary judgment is identical to the trial court's: summary judgment is appropriate only where there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Ind. Trial Rule 56(C); Mauller v. City of Columbus (1990), Ind.App., 552 N.E.2d 500, 502. In determining whether a genuine issue of material fact exists, we consider all matters in a light most favorable to the non-movant. Id. at 502. Furthermore, this court in Liebner v. Dobson (1985), Ind.App., 474 N.E.2d 1039, 1040, trans. denied, concluded that every available inference must be resolved in favor of the plaintiff against the defendant. Therefore, even if the basic facts of a case are not disputed, a good faith dispute of the inferences which may be drawn from the undisputed facts will also preclude summary judgment. In summary, the trial court will apply the law to the facts only when there are no disputable facts or inferences to be drawn therefrom. Id.; Board of Aviation Commissioners of St. Joseph County, Indiana v. Hestor (1985), Ind.App., 473 N.E.2d 151, 153.

This court has not yet addressed such an exclusionary clause under an employee health benefit plan as it applies to these facts; however, we recognize that other jurisdictions have applied principles of workmen's compensation law in similar cases. See American Life Insurance Co. v. Barth (1983), 167 Ga.App. 605, 307 S.E.2d 113, cert. denied; Carter v. Metropolitan Life Insurance Co. (1933), 47 Ga.App. 367, 170 S.E. 535; Hubred v. Control Data Corp. (Minn.1989), 442 N.W.2d 308; Automobile Club Inter-Insurance Exchange v. Bevel (Mo.1984), 663 S.W.2d 242; Gage v. Connecticut General Life (Mo.Ct.App.1954), 273 S.W.2d 761.

Under the Workmen's Compensation Act, an injury is compensated if it arises both "out of" and "in the course of" one's employment, IND. CODE § 22-8-6-1. In contrast, most insurance policies exclude coverage for injuries "arising out of" and "in the course of" employment in order to avoid duplication and overcompensation.

This brings us to the heart of this controversy: What constitutes "arising out of" and "in the course of" employment within the scope of Keen's proprietorship? In Blaw-Knox Foundry & Mill Machinery, Inc. v. Dacus (1987), Ind.App., 505 N.E.2d 101, 102, we determined the cireum-stances in which an injury occurs in the course of one's employment: "an accident occurs in the course of employment when it takes place within the period of employment, at a place where the employee may reasonably be, and while he is fulfilling the duties of his employment, or is engaged in doing something incidental thereto." The Dacus court also found an accident "arises out of" employment when there is a causal relationship between the employment and the injury. This causal relationship is established when the accident arises out of a risk which a reasonably prudent person [671]*671might comprehend as incidental to the work.

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575 N.E.2d 668, 1991 Ind. App. LEXIS 1287, 1991 WL 147028, Counsel Stack Legal Research, https://law.counselstack.com/opinion/keen-v-st-elizabeth-hospital-medical-center-indctapp-1991.