Schilling v. Huntington County Community School Corp., et al., No. 35A02-0803-CV-191 (Ind. Ct. App. 12/18/08).
Ruling: The Indiana Court of Appeals upheld summary judgment for the employer, finding a clause in the claimant's health care plan clearly and unambiguously excluded him from coverage.
What it means: In Indiana, where a school's health care plan provides that individuals who could otherwise be covered by workers' compensation are not covered under the terms of plan, an employee with a second job may not be able to recover medical benefits for an auto accident that occurred during his second job.
The claimant worked as a bus driver for the school approximately half of the year and was self-employed as a farmer the rest of the year. He was injured in an auto accident while hauling grain to the market during his time off from bus driving and sought medical benefits under the school's health plan. Even though he was covered by the health plan, the school denied coverage. The school's plan included an exclusionary clause, which essentially provided that an injury resulting from secondary employment which could be covered by workers' compensation, whether or not workers' compensation had actually been purchased, was not covered by the plan.
The Court of Appeals agreed with the school's argument that the policy's language was unambiguous as required under Indiana law. The court pointed out that under Indiana law, carriers are free to limit coverage, as long as all exceptions, limitations, and exclusions are plainly expressed, and any exclusionary clauses "clearly and unmistakably" express the particular act or omission that triggers the exclusion.
February 17, 2009
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