Court Opinion

ID: 9635084
Source: CourtListenerOpinion
Date Created: 2023-08-22 13:35:51.020686+00
Date Added: 2024-06-11T18:09:17.648645
License: Public Domain

WINTERSHEIMER, Justice,
dissenting.
I respectfully dissent from the majority opinion because the suit filed was an action at law and not a claim under workers’ compensation. The Court of Appeals erroneously enforced the policy exclusions and that decision should be reversed.
Kentucky has long had the public policy of construing insurance contracts strictly so as to make the insurance effective. Our case law has also supported the principle of contract construction that insurance policies must be construed so as to benefit the party who did not prepare the contract. Generally, insurance policies are contracts of adhesion. Kentucky has adopted four basic principles of insurance policy construction. See Eyler v. Nationwide Mut. Fire Ins. Co., 824 S.W.2d 855 (Ky.1992). They are as follows: 1) all exclusions are to be narrowly interpreted and all questions resolved in favor of the insured; 2) exceptions and exclusions are to be strictly construed so as to render the insurance effective; 3) any doubt as to the terms of the policy should be resolved in favor of the insured; and, 4) because the policy is drafted in all details by the insurance company, it must be held strictly accountable for the language employed.
The workers’ compensation exclusion does not apply because workers’ compensation was neither the exclusive remedy nor the remedy sought by these claimants. Section III, Paragraphs B3, B4 and B5 of the policy provide in relevant parts as follows:
This insurance does not apply to any of the following:
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3. Workers’ Compensation
Any obligation for which the “insured” or the “insured’s” insurer may be held liable under any workers’ compensation, disability benefits, or unemployment compensation law or any similar law.
4. Employee Indemnification and Employer’s Liability
“Bodily injury” to:
a. An “employee” of the “insured” arising out of and in the course of:
(1) Employment by the “insured”; or
(2) Performing the duties related to the conduct of the insured’s business; ...
5. Fellow Employee
*542“Bodily injury” to any fellow “employee” of the “insured” arising out of and in the course of the fellow “employee’s” employment or while performing duties related to the conduct of your business.
A careful review of this matter demonstrates that the Court of Appeals erred in enforcing the policy exclusions because the suit filed was as an action at law and not a claim under workers’ compensation. The employer here did not have workers’ compensation coverage. That being the case, O’Banion and Garcia could proceed under the Act or maintain an action at common law. KRS 342.690(2). They did the latter and the policy exclusions cited above have no application here. If the insurance company intended to exclude responsibility for such damages, it was required to include the language in the contract of insurance.
As correctly noted by the Court of Appeals, the question of coverage under the contract ultimately turns on the policy definition of the term “employee.” Pursuant to the policy, employees of the insured are excluded from coverage. A “leased worker” is specifically included within the definition of “employee” although a “temporary worker” is specifically excluded. The relevant terms were defined in the policy as follows:
H. ‘Leased worker’ means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. ‘Leased worker’ does not include a ‘temporary worker.’
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N. ‘Temporary worker’ means a person who is furnished to you for a finite time period to support or supplement your workforce in special work situations such as ‘employee’ absences, temporary skill shortages and seasonal workloads.
O’Banion was a “temporary worker” as that term is defined in the insurance policy. He was working for Willowbank for the summer before attending college in the fall. O’Banion was working for a “finite time period” and was hired temporarily to assist with “seasonal workloads.” Consequently, the employee exclusion does not apply to him and he is covered under the policy.
Garcia was also a “temporary worker” under the policy. He was a migrant laborer who worked primarily in the summers. Garcia would show up sporadically and would be permitted to work if it was available. He was not on the regular payroll and his employer did not consider him an employee. Accordingly, Garcia was entitled to coverage as a “temporary worker.”
The Court of Appeals erred in using the definitions set out in the Workers’ Compensation Act. KRS 342.615 defines both “temporary worker” and “temporary help service” for workers’ compensation. Neither of those definitions applies here. As it was already observed, this is a common law action, not a workers’ compensation case.
Moreover, the insurance contract does not incorporate Kentucky’s workers’ compensation statute by reference. Generally, Kentucky courts require that an insurance policy expressly and clearly incorporate any extrinsic document, statutory or otherwise. See Twin City Fire Ins. Co. v. Terry, 472 S.W.2d 248 (Ky.1971). That was not done in this case, and reliance on the definitions in the Act is improper.
Indiana Insurance focuses on three words, “furnished to you”, contained within the definition of “temporary worker” and contend that O’Banion and Garcia must have been “furnished to [Willowbank]” to qualify for “temporary worker” status. As was correctly determined by Chief Judge *543Heyburn in a similar case, this phrase is ambiguous. Ayers v. C & D General Contractors, 237 F.Supp.2d 764 (W.D.Ky.2002). That ambiguity is highlighted by the inconsistencies between the definitions of “temporary worker” and “leased worker” in the policy. In defining “leased worker” the policy clearly states that the person must be leased from “a labor leasing firm.” However, when defining “temporary worker”, the policy does not state from whom that “temporary worker” must be furnished. The phrase “furnished to you” is insufficient to convey all the meaning that indiana insurance now wishes to use.
The Court of Appeals erroneously adopted the reasoning of the Missouri Court of Appeals in American Family Mut. Ins. Co. v. Tickle, 99 S.W.3d 25 (Mo.Ct.App.2003), rather than the decision in Ayers, supra, which applied Kentucky law. In order to give meaning to the phrase “furnished to you”, Tickle, supra, embarks on an extremely confusing analysis which dissects sentences and analyzes grammar. Undergoing this type of sentence structure analysis in order to determine the meaning of the contract certainly indicates the ambiguity that exists.
Moreover, the Court of Appeals and the majority failed to recognize that Kentucky and Missouri have different policies on the doctrine of incorporation by reference. Missouri courts routinely turn to the workers’ compensation statute to define the term “employee.” See Tickle, 99 S.W.3d at 29. As it was previously observed in this dissenting opinion, Kentucky courts require that an insurance policy expressly and clearly incorporate any extrinsic document, statutory or otherwise. See Terry, supra. The policy here does not incorporate the definitions from the Workers’ Compensation Act.
Pursuant to the doctrine of “reasonable expectations” an insured is entitled to all the coverage he may reasonably expect to be provided according to the terms of the policy. Woodson v. Manhattan Life Ins. Co. of New York, N.Y., 743 S.W.2d 835 (Ky.1987). A court charged with the responsibility of interpreting a policy of insurance is to determine and carry out the original intentions of the parties. Wilcox v. Wilcox, 406 S.W.2d 152 (Ky.1966). It is also to interpret the terms used in the light of the usage and understanding of an average person. Fryman v. Pilot Life Ins. Co., 704 S.W.2d 205 (Ky.1986). Unless the terms contained in an insurance policy contain a technical meaning in the law, they must be interpreted according to the usage of the average man and as they would be read and understood by him in light of the prevailing rule that uncertainties and ambiguities must be resolved in favor of the insured. Fryman, supra.
In this case, it was entirely reasonable for Zehnder to expect that Garcia and O’Banion were both temporary workers and that both would be covered under his policy. An affidavit presented by the insurance company to the contrary is unconvincing. The reasonable expectations of an expert in the field would naturally differ from that of an average man. Indiana Insurance failed to provide a clear, unequivocally conspicuous and plain manifestation of the company’s intent to exclude coverage. Coverage is reasonably expected.
Indiana Insurance is obligated to indemnify and defend its named insured, Willow-bank, and its additional insured, Akers. Clearly, the fellow employee exclusion does not apply to Willowbank. Nor does the employer indemnification exclusion relieve the insurance company of its duty because O’Banion and Garcia were not “employees” under the policy. Finally, the workers’ compensation exclusion does not *544apply because this was a common law action.
Akers is also entitled to be indemnified and defended by Indiana Insurance. According to the policy, the exclusions to each “insured” should be read separately. In Section 11(A)(1) of the Business Auto Coverage Form, “insured” is defined to include the named insured and “anyone else while using with your permission a covered ‘auto’ you own, hire or borrow.” The exclusions for “employees” and “fellow employees” would not apply to either Garcia or O’Banion as against Akers because neither of them were “employees.” Nor does the workers’ compensation exclusion apply- against Akers because he is not the employer and has no obligation under the Act.
I would reverse the decision of the Court of Appeals and reinstate the summary judgment granted by the circuit court.
LAMBERT, C.J., joins this dissenting opinion.