Carney v. Paul Revere Life Insurance

832 N.E.2d 257, 359 Ill. App. 3d 67, 295 Ill. Dec. 106, 2005 Ill. App. LEXIS 606
CourtAppellate Court of Illinois
DecidedJune 21, 2005
Docket1-03-1852
StatusPublished
Cited by8 cases

This text of 832 N.E.2d 257 (Carney v. Paul Revere Life Insurance) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carney v. Paul Revere Life Insurance, 832 N.E.2d 257, 359 Ill. App. 3d 67, 295 Ill. Dec. 106, 2005 Ill. App. LEXIS 606 (Ill. Ct. App. 2005).

Opinion

JUSTICE GARCIA

delivered the opinion of the court.

The defendant insurer, The Paul Revere Life Insurance Company (Paul Revere), paid benefits to the plaintiff, Andrew L. Carney, M.D., under a disability insurance policy, after Dr. Carney filed a claim stating that he was disabled by “sickness.” The policy provided a maximum benefit period until age 65 for a total disability due to “sickness,” and a lifetime benefit for a total disability due to “injury.” Shortly before the policy’s “sickness” benefits were to expire, Dr. Carney sought to recharacterize his disability as an “injury.” Paul Revere refused the reclassification, and in March 1998, Dr. Carney filed a complaint against Paul Revere alleging that Paul Revere refused to act in accordance with the policy.

Subsequently, the parties filed cross-motions for summary judgment seeking judgment as a matter of law regarding whether Dr. Carney’s disability was the result of a “sickness” or an “injury.” In June 2003, the circuit court classified Dr. Carney’s disability as the result of an “injury” and granted summary judgment in favor of Dr. Carney. Paul Revere appeals, arguing Dr. Carney’s disability was a “sickness,” rather than an “injury,” and its obligation to pay under the terms of the policy expired upon Dr. Carney’s sixty-fifth birthday.

BACKGROUND

On February 5, 1981, Dr. Carney, a cardiovascular and neurovascular surgeon, purchased a disability insurance policy from Paul Revere. The policy provides a maximum benefit period to age 65 for a total disability due to “sickness,” and a lifetime benefit for a total disability due to “injury.” Under the “definitions” section of the policy, several terms are defined, including, inter alia-.

“ ‘Injury’ means accidental bodily injury sustained while this policy is in force.
‘Sickness’ means sickness or disease which first manifests itself while this policy is in force.
‘Total Disability’ means that as a result of such injury or sickness the Insured is unable to perform the duties of his regular occupation and is not engaged in any other gainful occupation.”

The policy did not define “accidental bodily injury.” The “benefit provisions” portion of the policy provided for either total disability by “Accident” (Provision A) or by “Sickness” (Provision B). The language in each provision was identical except for the use of “injury” or “sickness,” and Provision B stated that “sickness” must occur “while the policy is in force”:

“If such injury [sickness] results in continuous total disability [while this policy is in force] and requires the regular and personal attendance of a licensed physician, the Company will pay periodically the Monthly Indemnity for Total Disability from Accident [Sickness] at the rate set forth in the Policy Schedule, beginning with the standard commencement date for accident [sickness] and during the continuance of such total disability for a period not exceeding the Maximum Benefit Period for *** Total Disability from Accident [Sickness] specified in the Policy Schedule ***.”

The policy schedule contains a table of benefits:

TOTAL COMMENCEMENT RATE OF MAXIMUM DISABILITY DATE MONTHLY BENEFIT
INDEMNITY PERIOD FROM 91st DAY OF $3,500.00 LIFETIME ACCIDENT DISABILITY
FROM 91st DAY OF $3,500.00 TO AGE 65 SICKNESS DISABILITY

On August 18, 1986, Paul Revere received a disability proof of claim form signed by Dr. Carney and his attending physician, Dr. John Dwyer. The form claimed total disability due to “sickness” that began on March 22, 1986, the last day Dr. Carney performed surgery. The details of the “sickness” were described as, “[p]ain in both forearms as well as paresthesias of the ulnar distribution of both hands— progressive now cannot sustain grip when operating.” Dr. Carney was subsequently diagnosed as suffering from pronator teres syndrome. 1

In his deposition, Dr. Carney testified that on November 25, 1985, he had “an acute onset of pain and numbness that extended from [his] elbow, the medial aspect of [his] elbow, to [his] hand.” Dr. Carney also testified that besides numbness, he had a great deal of pain. Dr. Carney testified that he sought medical care because “[t]here was a mass on the medial aspect of my arm, that distribution, the distribution of the median nerve.” Dr. Carney testified that pronator teres syndrome is the compression of the median nerve at the elbow. Dr. Carney testified that prior to his diagnosis he had experienced symptoms of pronator teres syndrome, specifically, he had difficulty with alternating mechanical motions. Dr. Carney testified that he tried but failed to tighten a shackle with a wrench, he experienced edema and muscular tremors, and he had spasms throughout his right hand and into his fingers. Dr. Carney testified that he did not attach any significance to these problems until he began reading about pronator teres syndrome. Dr. Carney performed surgery until the latter part of March 1986.

Dr. Carney’s treating physician, Dr. Dwyer, was also deposed and testified he first saw Dr. Carney in May 1986. Dr. Dwyer testified that he was an orthopedic surgeon and that Dr. Carney had asked him for a consultation, as he was having difficulty with his upper extremities. Dr. Dwyer testified that he diagnosed Dr. Carney as having

“compression neuropathy about the elbow primarily on the side with some evidence on the right side, and it was such that the nerves to the — extending through the elbow were compressed. And there was neuropathy which manifests itself with pain, weakness, numbness, loss of strength and loss of endurance.”

Dr. Dwyer testified that as a cardiovascular surgeon, Dr. Carney would be required to use both hands, have dexterity, control of his movements, modulated strength, endurance, and the ability to feel what his other hand was doing. Dr. Dwyer testified that in August 1986, he came to the conclusion that Dr. Carney could not continue his occupational duties. Dr. Dwyer testified that he saw Dr. Carney as a patient for more than 10 years, and at no time was he able to return to work as a surgeon.

Dr. Dwyer testified that Dr. Carney’s condition could not be linked to any “single or sentinel” trauma. Instead, repetitive trauma brought Dr. Carney’s symptoms to a head. Dr. Carney’s attorney then asked a question to Dr. Dwyer regarding repetitive trauma:

“[Dr. Carney’s Attorney]: With respect to the repetitive trauma, is that something that was caused by some kind of sickness or illness in Dr. Carney?
[Dr. Dwyer]: No, not that I was aware of. He has no constitutional or systemic disease that would explain the symptomatology and findings.
[Dr. Carney’s Attorney]: There was no bacterial or viral infection that caused it?
[Dr. Dwyer]: Nor any diabetic or circulatory disruption, no, there was none.
[Dr.

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Cite This Page — Counsel Stack

Bluebook (online)
832 N.E.2d 257, 359 Ill. App. 3d 67, 295 Ill. Dec. 106, 2005 Ill. App. LEXIS 606, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carney-v-paul-revere-life-insurance-illappct-2005.