Jackson v. Metropolitan Life Ins. Co.

• Decision Date: 23 May 1973
• Docket Number: No. 72-696,72-696
• Citation: 34 Ohio St.2d 138,296 N.E.2d 679,63 O.O.2d 232
• Parties: , 63 O.O.2d 232 JACKSON, Appellee, v. METROPOLITAN LIFE INS. CO., Appellant.
• Court: Ohio Supreme Court

Page 138

34 Ohio St.2d 138

296 N.E.2d 679, 63 O.O.2d 232

JACKSON, Appellee, v. METROPOLITAN LIFE INS. CO., Appellant.

No. 72-696.

Supreme Court of Ohio.

May 23, 1973.

Syllabus by the Court

1. The meaning of the phrase 'actively at work,' in a group life insurance policy, is clear and unambiguous, and where on the date decedent would have been eligible for coverage under the policy he was not performing his job or assigned duties because the plant was closed down for annual inventory, he was not 'actively at work' and was not within the coverage of the insurance policy.

2. The requirement in a group life insurance policy that the employee be 'actively at work' in order to qualify for coverage is not waived because of a hindrance in performance where the promisor of the contract had nothing to do with the hindrance of performance.

Arta Jackson, plaintiff-appellee, is the mother of decedent, James E. Egler, who was hired by Delco Products Division of General Motors Corporation in Dayton, Ohio, on or about July 18, 1968. As a result thereof, he was issued insurance certificate No. 3401 by the defendant, Metropolitan Life Insurance Company, pursuant to Group Policy No. 15500-G, which was entered into between Metropolitan Life and General Motors Corporation. He named his mother, the plaintiff, sole beneficiary of the policy.

Decedent commenced work on July 22, 1968, and continued through July 26, 1968. He was scheduled to become eligible for coverage under this group insurance policy on August 1, 1968, 'provided he was actively at work on date of his eligibility.' At that time, however, the Delco Products Division plant was shut down until August 5, 1968, for the purpose of making its annual inventory. Decedent was scheduled to return to work on August 5, 1968, but he died the day before, August 4, 1968.

Plaintiff filed an action in the Common Pleas Court of Montgomery County to recover $7,000 for ordinary death benefits and $3,500 for death by accidental benefits from the defendant, Metropolitan Life, under the provisions of the Group life insurance policy issued to her son. The complaint was amended to include transition insurance, and the amount sought to be recovered was increased to $12,900, plus interest and costs. The claim for accidental death benefits was later withdrawn. The trial court rendered judgment for the plaintiff to recover death benefits within the limits of the policy, plus interest and costs.

Defendant filed an appeal in the Court of Appeals, and the judgment of the Common Pleas Court was affirmed.

This cause is before this court pursuant to the allowance of a motion to certify the record.

Smith & Schnacke, Lloyd H. O'Hara and John H. Dawson, Cleveland, for appellee.

Cowden, Pfarrer, Crew & Becker, Charles P. Pfarrer and Randall N. Bothmann, Dayton, for appellant.

WILLIAM B. BROWN, Justice.

The court in this case is called upon to interpret a provision of an insurance policy to determine whether the decedent qualified for coverage under the contract and whether his mother, as sole beneficiary, can collect thereunder.

The relevant provision of the insurance policy is included in the Stipulation of Facts. It provides:

'4. Effective January 1, 1968, General Motors Corporation and the Defendant, Metropolitan Life Insurance Company entered into an Agreement amending and revising Group Policy No. 15500-G under which employees of General Motors Corporation, including Delco Products Division, were insured * * *. An employee employed subsequent to January 1, 1968, becomes eligible for insurance on the first day of the calendar month next following the month in which employment with the employer commences. The insurance on any employee becomes effective on the date of his eligibility, provided he is actively at work on the date of his eligibility, and insurance on any employee not actively at work on the date when his insurance would otherwise become effective or on the next following day on which he is actively at work.' (Emphasis added.) Whether decedent qualified for coverage depends upon an interpretation of the phrase 'actively at work.'

Appellee contends that decedent became eligible for coverage under the provisions of the contract on August 1, 1968, three days prior to his demise, on two alternate grounds: (1) The determinative phrase in the policy, 'actively at work,' is ambiguous and therefore should be interpreted against the insurer, or (2) the requirement that he be 'actively at work' was a condition precedent to the performance of the contract which was waived.

Appellee contends that where a phrase in an insurance contract is ambiguous it must be construed 'liberally in favor of the insured and strictly against the insurer.' American Financial Corp. v. Fireman's Fund Ins. Co. (1968), 15 Ohio St.2d 171, 173, 239 N.E.2d 33, 35. However, the provisions of this insurance contract are set out in express and unambiguous terms. In such an instance 'this court cannot make a new contract for the parties where they themselves have employed express and unambiguous terms. In the construction of contracts the language employed must be given its usual and ordinary meaning * * *.' Fidelity & Cas. Co. v. Hartzell Bros. Co. (1924), 109 Ohio St. 566, 569, 143 N.E. 137, 138.

The adjective 'active' is defined in Webster's Third New International Dictionary as 'characterized by action rather than by contemplation or speculation * * * productive of action or movement * * * engaged in an action or activity.' The adverb carries the same connotation. 'At work' means performing a job or one's job or one's duties. 'At work' connotes on the job, performing one's job or occupation; it does not, however, require physical presence at the location of the company, if one can perform his job elsewhere. In Augusta v. John Hancock Mutual Life Ins. Co. (1958), 11 Misc.2d 111, 118, 170 N.Y.S.2d 908, 916, the court held that '* * * while in a hospital, one may be actively at work, if his activity consists of...