Rider v. Westinghouse Elec. Corp., 58564

• Decision Date: 19 March 1980
• Docket Number: No. 58564,58564
• Citation: 152 Ga.App. 805,264 S.E.2d 276
• Parties: RIDER v. WESTINGHOUSE ELECTRIC CORPORATION et al.
• Court: Georgia Court of Appeals

Page 276

264 S.E.2d 276

152 Ga.App. 805

RIDER v. WESTINGHOUSE ELECTRIC CORPORATION et al.

No. 58564.

Court of Appeals of Georgia.

Submitted Sept. 6, 1979.

Decided Dec. 4, 1979.

Rehearing Denied Dec. 19, 1979.

Certiorari Granted March 19, 1980.

Ben F. Smith, Brown & Browning, Thomas J. Browning, Marietta, for appellant.

Frederick E. Link, Williston C. White, J. Kirk Quillian, Atlanta, for appellees.

CARLEY, Judge.

Appellant brought suit, as beneficiary of her deceased husband, to recover under a group occupational travel accident insurance policy provided by the appellee-Westinghouse to its employees and underwritten by the appellee-Insurance Company of North America (INA).

For the years 1974 and 1975 appellant's husband received a statement from Westinghouse which purported to inform him of his accrued benefits as an employee of that corporation. The statements were personalized, being headed by the name, social security number, date of birth and other identifying characteristics of the deceased. The documents for both years contained a standardized printed list of employee benefits, with spaces where the value or amount of the individual employee's entitlement to those benefits, which varied according to tenure and salary, were added by computer printout. From 1974 to 1975, while appellant's husband's entitlement to certain benefits was increased, the statements contained the following: "For ACCIDENTAL death, the following would also be paid: If death results from an accident ON THE JOB $20,000 Personal Accident Insurance Plan PLUS any Workmen's Compensation which applies. If death should result from an accident while you are traveling on Company business, $25,000 Travel Accident Insurance would ALSO be paid." The statements also contained the following advice to Westinghouse employees: "It is important to note that your benefits package represents a valuable part of your total compensation from the Company. Some of your benefits provide for immediate needs, while others are a source of lifelong protection for you and your family. And, as your pay and length of service grow, your benefits keep growing too. It is also important that you take this statement home and review it with members of your family. Not only will this give them a better idea of the value of the benefits provided by the Company, but it will help them to know the full extent of what you have in the benefits 'bank' and what you can count on if the need arises." Apparently appellant's husband heeded this advice, discussed the statement with appellant and other family members and concluded that, based on this statement, his death benefits coverage was adequate.

Upon the accidental death of her husband in 1975, appellant applied for and received all the benefits to which she was entitled under the statements save one. She was refused the $25,000 "Travel Accident Insurance" benefits. She was informed that entitlement to these benefits was based upon a group policy which specifically excluded from coverage those employees, such as her husband, whose principal job assignment was driving company owned or leased motor vehicles, unless they were traveling outside their territory. Appellant's husband was a Westinghouse truck driver who was killed in an accident which occurred in his regularly assigned territory.

Appellant brought suit against Westinghouse and INA for the $25,000 in travel accident benefits. Appellees answered that the statements issued to appellant's husband which indicated, by way of typing in the "$25,000" figure next to the printed designation of "Travel Accident Insurance" benefits was a computer printout error which would not be controlling over the specific exclusion from coverage contained in the group policy. After discovery both sides moved for summary judgment. Appellant's motion was denied but the trial court granted summary judgment in favor of Westinghouse and INA.

1. As against INA, appellant seeks to recover on a group policy which specifically excludes her husband from coverage under the circumstances of his death operation, as his principal job assignment, of a company vehicle, in his territory of regular assignment. She urges that, in compiling and issuing the statements furnished to her husband, Westinghouse was the "agent" of INA and that, since the statements purported on their face to extend unqualified coverage for death resulting from an accident while traveling on company business, INA should be estopped to deny coverage based on the exclusions of the master policy.

There is no evidence that in compiling and issuing the statements Westinghouse was acting as INA's agent. There is no reference whatsoever in the statements to INA, the insurer, and no reference to a specific policy of insurance as the basis for the issuance. Compare Lipshitz v. New Zealand Ins. Co., 34 Ga.App. 825, 131 S.E. 924 (1926); Metropolitan Life Ins. Co. v. Fields, 53 Ga.App. 76, 79, 184 S.E. 752 (1936); Lancaster v. Travelers Ins. Co., 54 Ga.App. 718, 189 S.E. 79 (1936); Cherokee Credit Life Ins. Co. v. Baker, 119 Ga.App. 579, 168 S.E.2d 171 (1969). The statements are complete and entire documents by which Westinghouse, in its capacity as employer, advised appellant's husband, its employee, of the benefits he derived by virtue of his employment. The statements do not purport to be "part" of a contract of insurance, the missing elements of which are supplied by reference to a specific policy issued by INA. Compare Underwriters' Agency v. Sutherlin, 46 Ga. 652 (1872). There is nothing in the statements which would connect or interlock them with the group policy issued by INA upon which appellant seeks to recover; the statements and the policy are not contemporaneous instruments, each affecting and controlling the same subject matter. Compare Carruth v. Aetna Life Ins. Co., 157 Ga. 608, 122 S.E. 226 (1924). For all intents and purposes the statements are what they appear to be documents, entire and complete unto themselves, by which the employer, in that capacity, sought to inform its employee of the benefits to which he was entitled, without specifying the ultimate source, other than the fact of employment, from which that benefit flowed.

"Under the group-insurance policy, the employer is acting for itself and on behalf of its members in order to obtain cheap insurance for them through a group plan. It is representing itself and its members, not the insurance company. Its only authority is to issue a certificate of insurance to its employees and to remit the premium therefor to the insurance company, but this does not make it a general agent. The employer is not in the insurance business, but is rendering all the service it can for its employees. It receives no compensation from the insurance company . . . Applying the above rules to the facts in this case, we do not think the employer . . . was an agent of the insurer, or clothed with any power to waive any of the conditions of the group policy of insurance covering the employees of such employer . . ." Lancaster v. Travelers Ins. Co., 54 Ga.App. 718, 724, 189 S.E. 79, 82, supra.

Furthermore, even assuming Westinghouse were the agent of INA in issuing the statements, it would not afford appellant any basis for recovery under the circumstances. "(T)he coverage of the policy (may not) be extended by estoppel or by waiver. The doctrines of implied waiver and of estoppel, based upon the conduct or action of the insurer, or its agent, are not available to bring within the coverage of a policy risks not covered by its terms, or risks expressly excluded therefrom. (Cits.)" Ballinger v. C. & S. Bank, 139 Ga.App. 686, 689, 229 S.E.2d 498, 1501 (1976).

Appellant contends that the above stated rules do not apply where, as apparently was the case with her husband, no information is supplied by either the employer or the insurer that there is a group policy in effect which may be inspected or that the coverage afforded is subject to exclusions. She urges that since the only information given to her husband was the single statement that if he was killed while traveling on company business $25,000 in "Travel Accident Insurance" benefits would be paid, without reference to a group policy as the source of those benefits, he would not be chargeable as a matter of law with knowledge of the exclusions. It is contended that under these circumstances, her husband was entitled to rely upon the unequivocal statement of coverage. We do not agree that the fact that Westinghouse failed to inform appellant's husband of the group policy or of the exclusion affords the basis for estopping INA from raising the exclusion. The policy in question defined "Persons Insured" as: "All officers and employees of the Policyholder (Westinghouse) in a class or unit designated by the Policyholder (Westinghouse) as eligible for insurance hereunder, including all persons coming within the scope of such description at any time during the policy term, but excluding those whose principal job assignment is the driving of cars, trucks or other Company owned or leased motor vehicles except while they are traveling outside...