Kopczynski v. Prudential Insurance

Opinion

KINGSLEY, Acting P. J.

This case involves the plaintiff’s attempt to secure a third item of recovery for an injury. For the reasons set forth below, we affirm the action of the trial court in denying this latest attempt.

Plaintiff was employed on a vessel which, at the time involved, was docked at Los Angeles Harbor. While assisting in unloading some empty oil drums, he slipped and suffered a major back injury. He first applied for a recovery under the Longshoreman Harbor Workers Compensation Benefits Act (LHWC) and secured over $17,000 under that claim. He then was advised to seek recovery from the ship owner under the so-called “Jones Act” and, after a jury trial, received a verdict for his injuries.

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While that action was still pending on appeal, he brought the present action to recover under a group insurance policy taken out by his employer with defendant insurance company. The insurer denied liability under an “exclusion”

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clause in that policy. The trial court agreed and granted summary judgment against the plaintiff. He has appealed; we affirm.

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Plaintiff here contends that the policy language’s exclusion clause is inherently ambiguous, and becomes additionally ambiguous because of language in the informational booklet provided to him by the insurer. We agree with the trial court that the policy language is not ambiguous, and we conclude that, even if the booklet language were to be considered,

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no ambiguity would be created.

The policy language here pertinent, reads as follows:

“Generally Excluded Charges

“(1) Occupational Injury or Disease Charges—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. ”