The definition of “total disability” is among the most important definitions in a disability policy and, consequently, in disability lawsuits. It is also one of the most confusing. For example, can you recover disability benefits for total disability if you can still perform some aspects of your job?
In a recently published Sixth Circuit case, Leonor v. Provident Life & Acc. Co., (2015), the court wrestled with an insurance company’s interpretation of its definition of “total disability,” and construed it in favor of the insured. The Plaintiff, the insured, a practicing dentist who also managed several dental offices, suffered a spinal injury that prevented him from performing dental procedures. He was still able, however, to manage his dental offices. In fact, after his injury, he bought more dental offices. Those investments proved lucrative and the Plaintiff’s overall income actually increased after his injury.
Following his injury, Plaintiff claimed total disability benefits under each of his three disability policies. Initially, the Defendants, the insurance companies, began paying his disability benefits. Later, the Defendants stopped paying disability benefits under two of the policies when they discovered that the Plaintiff was able to manage his dental offices. In denying the Plaintiff’s disability claim, the Defendants pointed to the definition of total disability in his policies:
“’Total disability’ means that because of Injury or Sickness:
You are unable to perform the important duties of Your Occupation….”
Defendants maintained that, under the policies, the Plaintiff would have a “total disability” only if he could not perform all of his occupation’s important duties. The Defendants pointed out that the Plaintiff could still perform the “owner/operator” duties of his occupation, and, therefore, did not have a total disability.
Plaintiff then filed a disability policy case on the basis of breach of contract. The trial court ruled in favor of Plaintiff on his breach of contract claim. Defendants appealed to the Sixth Circuit. The Sixth Circuit quickly cut to the issue: “the appeal turns entirely on the question of whether the words ‘the important duties’ necessarily means ‘all the important duties.’”
Why are those words important? As the court explained, if “the important duties” meant Plaintiff was “totally disabled” only if he could not perform “all the important duties,” then Defendants were correct in denying Plaintiff’s claim since he could still clearly perform some of the duties of his occupation—in this case running his various dental offices. However, if the words “the important duties” meant Plaintiff was “totally disabled” if he could not perform “some of the important duties,” then Defendants were incorrect in denying Plaintiff’s claim on the basis that he could not perform some of the important duties of his occupation, most notably performing dental procedures.
After providing a grammatical analysis of the meaning of the “definite plural” (which covers phrases like “the important duties”), the court ruled that the words at issue meant “most of the important duties” and not “all important duties.” As a result, the court determined that the Plaintiff had a “total disability” because he could not perform some of the important duties of his occupation.
Significantly, the court in Leonor did not use Plaintiff’s higher post-disability income against him. As the court noted, “while income can be relevant to an analysis of total disability, it is far from dispositive.”
For Tennessee residents with disability claims and for lawyers who handle disability cases, the Leonor case offers two helpful arguments: (1) “The important duties” does not mean “all the important duties”; and (2) a person with a disability policy might have a winning disability claim even if his or her income does not decrease after the onset of the disability.