311 Ga. App. 646
Ga. Ct. App.2011Background
- Laun obtained a disability income policy from Equitable in 1983 with separate accident and sickness total disability provisions.
- Accident total disability provides lifetime benefits for disability caused by injury; sickness total disability ends at age 65 and includes sickness-related disabilities.
- Laun was diagnosed with bilateral basal osteoarthritis of the thumbs in 2003, reducing his ability to perform surgery; he stopped practicing in November 2003.
- Laun submitted a total disability claim in November 2004; DMS classified it as sickness total disability and began benefits in February 2004.
- In December 2004 Laun injured his right wrist; he later predicted he would not recover to perform surgery and sought reclassification to accident total disability in 2005.
- DMS refused to reclassify, finding the disability was caused or contributed to by thumb illness; the trial court granted summary judgment for defendants.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether reclassification from sickness to injury total disability is allowed by policy terms | Laun argues policy permits reclassification when injury predominates. | Equitable/DMS contend policy requires sole injury basis for accident total disability; sickness contribution bars reclassification. | Disability cannot be reclassified under policy terms. |
| Whether Laun's disability was solely due to wrist injury or also due to thumb illness | Laun asserts wrist injury dominates andThumbs play a lesser role. | Defendants find disability caused or contributed to by sickness; not solely injury. | Disability was caused or contributed to by the thumb illness as well as the wrist injury. |
| Whether the elimination period or choice of governing law affects the outcome | Laun claims misinterpretation of elimination period and improper reliance on foreign law. | Elimination period issue is moot; court may consider law from other jurisdictions. | Elimination period interpretation irrelevant; no error in considering applicable law. |
Key Cases Cited
- Livoti v. Aycock, 263 Ga. App. 897 (Ga. App. 2003) (contract interpretation governs in determining policy intent)
- Estate of Sam Farkas, Inc. v. Clark, 238 Ga. App. 115 (Ga. App. 1999) (ambiguity absent when policy language clear)
- State Farm, etc., Ins. Co. v. Staton, 286 Ga. 23 (Ga. 2009) (disallowing strained readings of policy language)