Wilson v. Prudential Ins. Co. of America, 47348
| Decision Date | 22 October 1974 |
| Docket Number | No. 1,No. 47348,47348,1 |
| Citation | 528 P.2d 1135 |
| Parties | Martha J. WILSON and C. F. Wilson, Appellants, v. The PRUDENTIAL INSURANCE COMPANY OF AMERICA, Appellee |
| Court | United States State Court of Criminal Appeals of Oklahoma. Court of Civil Appeals of Oklahoma |
Morehead, Savage, O'Donnell, McNulty & Cleverdon by James R. Elder, Tulsa, for appellants.
Gable, Gotwals, Rubin, Fox, Johnson & Baker by Richard W. Gable, Tulsa, for appellee.
An appeal by Martha J. Wilson and C. F. Wilson, plaintiffs in the trial court, from the sustaining of the demurrers to the petition of The Prudential Insurance Company of America, defendant in the trial court.
The parties will be referred to as they appeared in the trial court; Martha J. Wilson and C. F. Wilson (appellants) will be referred to as plaintiffs, and The Prudential Insurance Company of America (appellee) will be referred to as defendant and Prudential.
The petition alleges that Prudential issued a group policy of insurance providing hospitalization and medical benefits, a copy of which was attached to the petition. The petition also alleged that Mrs. Wilson was injured while working at St. John's Hospital and that such injuries necessitated hospitalization and medical treatment, the charges for which she seeks reimbursement from Prudential pursuant to the terms of the insurance policy. She alleges that she filed a separate and independent (Prudential was not a party) claim under the Workmen's Compensation Act for benefits and compensation and that such claim was denied on the ground that plaintiff's type of employment was not covered by the Workmen's Compensation Act. Copy of State Industrial Court's Order was attached to the petition.
Plaintiff Martha J. Wilson's injuries allegedly arose out of, or in the course of, her employment for wage or profit. The first cause of action seeks recovery of the insurance benefits. Plaintiff C. F. Wilson in a second cause of action seeks additional compensation for alleged 'financial embarrassment and mental anguish because of the burden and responsibility for said debt' and alleged that he was 'tortiously damaged.' Defendant filed various combined motions including a 'Demurrer to First Cause of Action' and 'Demurrer to Second Cause of Action' which pointed out that the charges for which plaintiffs sought reimbursement were excluded by the terms of the policy as shown on the face of the petition. Briefs were filed by both parties and after argument, the trial court sustained the demurrers, and entered judgment in favor of the defendant. Plaintiffs appeal.
Plaintiffs allege three propositions for reversal of trial court as follows:
Plaintiffs allege in their Proposition I that 'the sustaining of Defendant's Demurrer to its Petition is clearly against the weight of authority under Oklahoma law, . . .' Plaintiffs attempt to justify this statement by citing a number of cases which illustrate the general proposition that pleadings are liberally construed and that all allegations of fact are taken as true, together with all reasonable inferences therefrom. But plaintiffs do not cite any authority from any jurisdiction in support of their Proposition I. Plaintiffs apparently assume that since pleadings are liberally construed and all allegations of fact are taken as true, that a demurrer should never be sustained. The point that plaintiffs miss is that such liberal construction and acceptance of facts and inferences lead to the inescapable conclusion that the charges sought to be recovered are excluded by the terms of the policy. The trial court accepted plaintiffs' allegations including the important and critical fact alleged in the petition that the charges were necessitated by an injury arising out of, or in the course of, her employment.
The real disagreement and issue presented in this appeal is presented in plaintiffs' Proposition II.
Plaintiffs disagree with the trial court's interpretation of an exclusionary provision in the policy. The applicable provision, which plaintiffs concede to be the key issue or dispute in this lawsuit, provides in material parts that the following charges, among others, are excluded:
'Charges incurred in connection with (a) injury arising out of, or in the course of, any employment for wage or profit Or (b) disease covered, with respect to such employment, by any workmen's compensation law, occupational disease law or similar legislation.' (Emphasis added.)
Since the petition admits that the medical expense charges were necessitated by an injury that occurred in the course of plaintiff's employment, the petition, on its face, discloses that plaintiffs would not be entitled to any recovery.
Plaintiffs contend that the limiting language relating to workmen's compensation laws found in clause (b) also applies with equal force to the separate clause (a), even though it is not a part of clause (a). Such an interpretation would require a rearrangement of the clauses or a change of the disjunctive 'or' to the conjunction 'and' and a deletion of the clause separating devices (a) and (b). Such a restructing of the sentence would do violence to the contract language and would be in violation of established grammatical rules of construction.
Clauses (a) and (b) are connected by the disjunctive word 'or' and are separated by the separating device of using (a) and (b). Charges in connection with injuries arising in the course of employment are excluded regardless of coverage or lack of coverage by any workmen's compensation laws. The qualifying words of limitation relating to workmen's compensation laws are properly restricted to the last antecedent 'diseases' and do not limit or restrict the more remote antecedent 'injury.' This rule of English grammar is well recognized by the courts, including the Supreme Court of the State of Oklahoma. Cases illustrating the applicability of the 'last antecedent' doctrine include Board of Trustees of F & P Fund v. Templeton, 184 Okl. 281, 86 P.2d 1000; Barten v. Turkey Creek Water Shed Joint District No. 32, 200 Kan. 489, 438 P.2d 732 (1968); Puget Sound Electric Railway v. Benson, 253 F. 710 (9th Cir.); Ledoux v. The Travelers Insurance Company, 223 So.2d 684 (4th Cir. La.App.1969); Employers Casualty Company v. Patterson, 344 S.W.2d 199 (Ct.Civ.App.Tex.1961), and Kosick v. Hospital Service Corp., 139 N.E.2d 619 (Ill.1956). The cases cited by plaintiffs represent abstract propositions of law discussing general rules of interpretation of insurance policies in favor of the insured and favoring the construction in accordance with ordinary language. The Ledoux, Patterson and Kosick cases, supra, are factually similar to the case now under review.
In Ledoux, supra, plaintiffs sued Travelers for benefits under a hospitalization policy for medical expenses incurred as a result of a work-connected injury suffered by Mrs. Ledoux. Travelers' position, which was recognized and adopted by the trial judge, was that the plaintiffs' claim was excluded by the specific terms of the contract of insurance. The hospitalization policy contained the following exclusionary provision:
'No payment shall be made under this Part on account of expenses incurred as a result of any of the following charges:
* * *
* * *
'(6) Charges incurred in connection with (a) injuries sustained while doing any act or thing pertaining to any occupation or employment for remuneration or profit, or (b) disease for which benefits are payable in accordance with the provisions of any workmen's compensation or similar law.'
It was stipulated that Mrs. Ledoux accidentally injured her back while in the scope of her employment with J. C. Penney. She received the maximum workmen's compensation benefits and brought suit against Travelers for medical expenses greatly in excess of the maximum workmen's compensation benefits. Mrs. Ledoux took the position that Paragraph (a) of the exclusionary clause only referred to those charges which were paid under workmen's compensation medical benefits. The trial and appellate...
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