Title: Blue v. Aetna Life Ins. Co.

State: kansas

Issuer: Kansas Supreme Court

Document:

208 Kan. 937 (1972)
494 P.2d 1145
RALPH E. BLUE, Appellant,
v.
AETNA LIFE INSURANCE COMPANY, Appellee.
No. 46,476

Supreme Court of Kansas.
Opinion filed March 4, 1972.
Gerald W. Scott, of Wichita, argued the cause and was on the brief for the appellant.
Jerry G. Elliott, of Foulston, Siefkin, Powers & Eberhardt, of Wichita, argued the cause, and Mikel L. Stout, of the same firm, was with him on the brief for the appellee.
The opinion of the court was delivered by
OWSLEY, J.:
This is an action by plaintiff, an employee of Boeing Aircraft to recover benefits under a group policy issued to Boeing by defendant for the benefit of employees.
*938 The issue was whether plaintiff was entitled to eighteen months or twenty-four months of payments under the "occupational disability" provisions of the "permanent and total disability" definition set forth in policy No. GL707. The trial court held that plaintiff was entitled to eighteen months only and plaintiff appeals.
The plaintiff, Ralph E. Blue, was employed by Boeing Aircraft Company, Wichita, Sedgwick County, Kansas, and while so employed was insured by Aetna Life Insurance Company under group policies Nos. GL707, GC707, and GC62250. The plaintiff became disabled on July 3, 1967, and following a six-months elimination period applied for his benefits under these insurance policies. Payment was declined by Aetna Life Insurance Company, and the plaintiff filed his petition herein seeking payment of his disability benefits and attorney fees on the grounds that the defendant's refusal to make disability payments was unreasonable, arbitrary, and without just cause.
At a pretrial conference held September 2, 1970, the plaintiff's counsel made an oral motion for partial summary judgment on the first portion of the insurance policies, which provided for disability and other payments during a period of time the plaintiff or employee was prevented from "performing the duties of his own occupation, or other appropriate work made available by the participant employer," commonly referred to as "occupational disability." No motion was made for that portion of the policy which provided for disability payments if the plaintiff was prevented "from working in any reasonable occupation," commonly referred to as "general disability." The trial court granted the plaintiff's motion for summary judgment, but limited payment under its ruling to the period of time commencing six months after the plaintiff's disability started, through the twenty-fourth month following the starting of the plaintiff's disability or a total of eighteen months of compensation.
We do not have the policy before us, but both parties agree the issue to be determined is controlled by a proper interpretation of the following portion of the policy which reads:
Plaintiff summarizes the policy as follows, claiming that this language controls the issue in this action:
Plaintiff argues that the judgment of the trial court should be reversed on one of two theories.
He first claims the court erred in its interpretation of the policy as providing a six-months waiting period and payments for eighteen months to satisfy the requirements of the policy for the first two years of such disability instead of interpreting the policy as providing for payments for a total of twenty-four months under the occupational disability definition.
He also claims the provisions as to the length of time payments would be made for the first two years of disability were ambiguous and the court erred in failing to apply the construction most liberal to plaintiff.
Our approach to the problem is controlled by the rule frequently stated in our cases and recently restated in Fowler v. United Equitable Ins. Co., 200 Kan. 632, 438 P.2d 46, as follows:
We have attempted to interpret the words of the policy from the standpoint of "a reasonable person in the position of the insured" and "in their plain, ordinary, and popular sense." We are inclined to believe that the insured, from the language used, would form an impression, since two years was the only period mentioned, that he was entitled to two years of benefits. It is only when a careful analysis of the language is made that difficulty arises.
The problem centers around the use of the word "such." We are unable to determine whether the antecedent of the word "such" is "disability" or "permanent and total disability." If it refers to "disability" it would imply a payment for eighteen months. If it refers to "permanent and total disability" it would imply a payment for twenty-four months.
The language of the policy plainly discloses that "permanent and total disability" does not exist until the six-months period has passed. We are unable to determine whether the policy provides payments for twenty-four months after "permanent and total disability" comes into existence or whether the policy provides payments for twenty-four months after "disability" occurs.
In view of the foregoing, we cannot avoid the conclusion that the policy was vague and ambiguous. The conclusion could easily have been avoided by a statement in the policy that payments would be made for eighteen months or twenty-four months following a determination that the insured was totally and permanently disabled.
It then becomes incumbent upon us to construe the policy most favorable to the insured. (Fowler v. United Equitable Ins. Co., supra; Lavin v. State Farm Mutual Automobile Ins. Co., 193 Kan. 22, 391 P.2d 992.) In so doing, we hold that the policy should provide benefits for a period of twenty-four months.
*941 We direct the trial court to make proper orders providing for an additional payment to plaintiffs for the six-months period in dispute.
Reversed with directions.