Prudential Insurance Co. of America v. Sweet

69 S.W.2d 748, 253 Ky. 643, 1934 Ky. LEXIS 680
CourtCourt of Appeals of Kentucky (pre-1976)
DecidedFebruary 16, 1934
StatusPublished
Cited by8 cases

This text of 69 S.W.2d 748 (Prudential Insurance Co. of America v. Sweet) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky (pre-1976) primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Prudential Insurance Co. of America v. Sweet, 69 S.W.2d 748, 253 Ky. 643, 1934 Ky. LEXIS 680 (Ky. 1934).

Opinion

Opinion op the Court by

Judge Dietzman

Affirming.

In this suit by the appellee against the appellant to recover on a group insurance policy issued by the appellant to the Louisville & Nashville Railroad Company to protect its employees against accidents and disabilities, the appellee recovered .the full amount sued for, and from that judgment this appeal is prosecuted.

The appellee had for a number- of years prior, to 1930 *644 been in the employ of the Louisville & Nashville Railroad Company, hereinafter called the railroad company, as a section hand. In March of that year he was injured; the extent of that injury being in dispute in this case. As we view the controlling issue, however, this dispute is immaterial. At all events, in April following, the appellee returned to work. Appellant claims that the appellee thereafter did the same character and kind of work he was doing prior to his accident. On the other hand, the appellee claims that he was given much lighter work to do than that which he had been doing before his accident. There had been issued 'to the appellee in 1925 a certificate of insurance under the group policy which the railroad company carried for the benefit of its employees. The certificate in part provided:

“If the said Employee, while less than sixty years of age, and while the insurance on the life of said employee under said policy is in full force and effect, shall become totally and permanently disabled or physically or mentally incapacitated to such an extent that he or she by reason of such disability or incapacity is rendered wholly, continuously and permanently unable to perform any work for any kind of compensation of financial value during the remainder of his or her lifetime, the amount of insurance pavable at death from natural causes (in this case $1,000) will be paid to said employee in monthly installments during two years.”

The certificate also provided that, when the insurance on the life of the employee terminated by reason of termination of employment for any reason whatsoever, the insurance company would on the terms set out in the certificate issue a converted form of insurance to the ' employee. The master policy is not in the' record. There is not the slightest doubt from the evidence adduced in this record but that the appellant had constituted the railroad company its agent to handle all matters pertaining to the premiums and claims under the master policy and the certificates issued pursuant thereto.

On April 18, 1931, the officer of the railroad company who had in charge this matter of' group insurance wrote to the appellee on a form in the heading of which appeared this: “Notice to employee laid off or granted leave of absence.” In the body of the letter this officer stated that, in view -of the fact that appellee’s name *645 might not appear on the railroad company’s payrolls subsequent to the month of May, his group insurance would terminate unless the premiums were' promptly paid. The letter then reads:

“If laid off, it is possible that you may return to the service in the near future and this insurance will be continued for the month of April, 1931, if you will pay 85 cents representing your proportion of the premium for one month on or before April 30, 1931,”

to the officer mentioned in the letter. The letter continues :

“If you are laid off and do not make this payment, it will be understood that you do not wish to continue your insurance, in which event attention is called to the conversion privilege in your certificate. ’ ’

Appellant did cease on orders from the railroad company to labor for it in April, 1931, and has not labored for it since. In the fall of that year he made claim under his certificate for total disability. He had continued to send in his premiums to the railroad company, and they continued to receive them. On March 1, 1932, the railroad company returned certain of these premiums to appellee’s lawyer in a letter which in part read:

“With my letter of February 19th, I sent you postal money order and draft to be delivered to Mr. Sweet representing ‘premiums he remitted to our treasurer but which could not be accepted for the reason his insurance has not been in force since the close of December, 1931.”

Whatever may have been the condition of the appellee prior to October, 1931, the evidence is uncontradicted that, when examined by physicians at that time, he was found to be totally and permanently disabled, within the protection afforded by the certificate of insurance if that certificate was then in full force and effect and if appellee at that time was under 60 years of age. It is the contention of the appellant that the certificate was not in full force and effect, first, because the appellee was not then in the employ of the railroad company, and, secondly, that he was over 60 years of age, and that there was no evidence to show that he had be *646 come totally and permanently disabled prior to October, 1931. It will be noted that at the time the railroad company wrote to the appellee in April, 1931, it did not inform him that he was discharged or that his-employment with the railroad company had terminated. The letter was written on a form indicating that it was sent to employees who were laid off -or granted leave of absence. The wording of the letter itself indicates that the attitude of the railroad company was that appellee had been or would be simply laid off, for it told him how he could continue his group insurance during the lay off, and informed him what he must do should he elect to terminate his service with the railroad company. It did nothing later to contradict this portion until the following March. Th§ letter of March, 1932, further indicates that the railroad, which, as we have said, was the agelit of the appellant in these matters, considered the policy on the appellee in full force and effect even as late as December, 1931, and this could only have been on the assumption that from April to December appellee did not occupy the status of a discharged employee, but only that of an employee who had been laid off or granted a leave of absence.

We do -not construe the provision in the certificate to the effect that the group- insurance terminates when the employment terminates comprises or includes a temporary lay off or leave of absence. If the master policy contained any provisions bearing on this subject, it was the duty of the insurer to produce it, and, failing that, we are left only to the certificate to ascertain the terms of ’the insurance. The railroad company itself did not so construe the certificate, for it continued to receive the premiums from the appellee knowing that he was no longer actually at work for the railroad company. Usually these group policies, and especially the master policies, provide specifically that the termination of employment does not cover a temporary lay off or leave of absence.

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Bluebook (online)
69 S.W.2d 748, 253 Ky. 643, 1934 Ky. LEXIS 680, Counsel Stack Legal Research, https://law.counselstack.com/opinion/prudential-insurance-co-of-america-v-sweet-kyctapphigh-1934.