White v. Continental Cas. Co. , 9 N.Y.3d 264 (2007)
An insurance policy’s definition of “total disability” is unambiguous if its language has a definite and precise meaning, and an insured is not considered totally disabled if they are capable of performing any gainful occupation for which they are reasonably fitted by education, training, or experience.
Summary
Dr. White, an orthopedic surgeon, sought disability benefits under a policy with Continental Casualty after a hip condition prevented him from performing surgery. The policy defined “total disability” as the inability to perform the substantial duties of his occupation and the inability to perform any gainful occupation for which he was reasonably suited. The court held that the definition was unambiguous. Despite his inability to perform surgery, Dr. White was still capable of rendering medical opinions, performing independent medical examinations, and serving as an expert witness; therefore, he did not meet the policy’s definition of total disability. The court affirmed the lower court’s summary judgment dismissal of Dr. White’s claim.
Facts
In 1992, Dr. White obtained a disability income policy. This policy was transferred twice, eventually to Life Insurance Company of Boston & New York (LICOBNY). The policy initially defined total disability as being “unable to perform the substantial and material duties of [his] occupation.” After the transfer to LICOBNY, a second provision was added, requiring that Dr. White also be unable to “[perform] the duties of any gainful occupation for which [he is] reasonably fitted by education, training, or experience.” In December 2001, Dr. White informed LICOBNY that he could no longer perform orthopedic surgeries due to a hip condition and filed a claim for disability benefits.
Procedural History
LICOBNY denied Dr. White’s claim, leading him to sue for breach of contract in Supreme Court. The Supreme Court granted LICOBNY’s motion for summary judgment, dismissing the complaint. The Appellate Division affirmed this decision, with two justices dissenting. Dr. White appealed to the New York Court of Appeals based on the two-justice dissent on a question of law.
Issue(s)
Whether the definition of “total disability” in the disability income policy is ambiguous, and if not, whether Dr. White satisfied the requirements of that definition as a matter of law.
Holding
No, the definition of “total disability” is not ambiguous because the policy language has a “definite and precise meaning.” No, Dr. White did not satisfy the requirements of the policy’s definition of total disability because he was capable of performing other gainful occupations for which he was reasonably fitted.
Court’s Reasoning
The court reasoned that unambiguous provisions of an insurance contract must be given their plain and ordinary meaning. A contract is unambiguous if its language has “ ‘a definite and precise meaning, unattended by danger of misconception in the purport of the [agreement] itself, and concerning which there is no reasonable basis for a difference of opinion’ ” (quoting Greenfield v Philles Records, 98 N.Y.2d 562, 569 (2002)). The court found that the definition of total disability in the policy was clear and unambiguous. Although Dr. White could no longer perform surgery, the evidence showed that he was still rendering second medical opinions, performing independent medical examinations, and serving as an expert medical witness. Therefore, he was “performing the duties of [a] gainful occupation for which [he is] reasonably fitted by [his] education, training, or experience.” The court emphasized that while the question of whether a policyholder’s condition falls within the policy’s definition of total disability is typically one for a jury, Dr. White failed to present any evidence demonstrating the existence of a triable issue of fact. The court rejected the argument that the second provision of the definition rendered the coverage illusory, highlighting that the policy required both conditions to be met for total disability benefits to be payable.