Court Opinion

ID: 9624537
Source: CourtListenerOpinion
Date Created: 2023-08-22 07:07:43.822812+00
Date Added: 2024-06-11T18:05:49.398184
License: Public Domain

PAYNE, Justice, dissenting. I respectfully dissent. The clause of the insurance policy which gives rise to this dispute is ' not ambiguous. The clause reads: No payment shall be made under this policy in any event with respect to (1) Charges incurred in connection with (a) injury 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. The clause is divided into subparts (a) and (b) and divided by a comma. The subparts should be read in the disjunctive. The majority reads the clause “for which benefits are payable in accordance with the provisions of any workmen’s compensation or similar law” as modifying subpart (a) as well as subpart (b). I do not read the clause in that manner. The clause not being ambiguous on its face, there is no need to look outside the clause to determine its meaning. Because the insured was injured while doing an act pertaining to his employment he is not entitled to benefits under the policy, regardless of whether he was entitled to benefits under the workmen’s compensation law. The Oklahoma Court of Appeals in interpreting an identical provision stated: 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). . 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. Wilson v. Prudential Insurance Company of America, 528 P.2d 1135, 1137 (Okl.App.1974). The court in Wilson cites with approval the reasoning of the Texas courts: “We are convinced the clause as written is not ambiguous and this court is without authority to rewrite the terms thereof to arrive at a conclusion more favorable to the injured than the plain language of the policy and certificate permits. The language of the exclusion clause referred to being plain and unambiguous, the contract of insurance must be enforced as made. Home Ins. Co. of N. Y. v. Rose, 152 Tex. 222, 255 S.W.2d 861; United American Ins. Co. v. Pittilio, Tex.Civ.App., 308 S.W.2d 241. 528 P.2d at 1138, 1139. For the reasons set forth I respectfully dissent.