Carson v. Canada Life Assurance Co.

28 F. App'x 262
CourtCourt of Appeals for the Fourth Circuit
DecidedJanuary 25, 2002
Docket01-1418, 01-1452
StatusUnpublished
Cited by3 cases

This text of 28 F. App'x 262 (Carson v. Canada Life Assurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carson v. Canada Life Assurance Co., 28 F. App'x 262 (4th Cir. 2002).

Opinions

OPINION

PER CURIAM.

Jeanine Carson commenced this action against Canada Life Assurance Company for wrongfully denying Carson her claim for long-term disability benefits. A jury awarded Carson $350,000 in compensatory damages on her breach-of-good-faith claim and $750,000 in punitive damages, and the court computed breach-of-contract damages at $54,536. On Canada Life’s post-verdict motion for judgment as a matter of law, the district court affirmed the compensatory damage award and vacated the punitive damage award. On the cross-appeals of the parties, we affirm.

I

Beginning as an employee in 1995, Carson worked as a senior accounting technician with the City of San Juan Capistrano, California (the “City”), which provided its employees with long-term disability insurance through a policy issued by Canada Life. The policy provided that employees would receive 67% of their monthly earnings up to $6,000 per month for total disability.

In May 1997, Carson was diagnosed with severe fibromyalgia by Dr. Mark Jason, a rheumatologist. Fibromyalgia is a complex, chronic condition that causes widespread pain and profound fatigue, as well as a variety of other symptoms, including sleep disturbances, stiffness, headaches, cognitive disorders, and depression. The American College of Rheumatology specifies that fibromyalgia’s diagnosis is characterized by widespread, musculoskeletal pain for longer than three months in all four quadrants of the body, by an absence of other systemic disease that could be the cause of the pain, and by the presence of 11 of 18 designated “tender points” (points of extreme tenderness) at characteristic locations on the body. No cure is available, but the symptoms can often be mitigated by narcotic medications. The disease can be permanent and its causes are unknown.

After Carson was placed on disability by her primary care physician, Dr. Lisa Majer, Carson tried unsuccessfully to work part time. In January 1998, Dr. Majer placed Carson on full time disability.

In February 1998, Carson submitted a claim to Canada Life for long-term disability benefits. Along with her claim, she provided Canada Life with a release, allowing Canada Life to obtain her medical records from Dr. Majer, her primary care physician, and Dr. Jason, the rheumatologist who first diagnosed and continued treating Carson’s fibromyalgia.

The medical director at Canada Life, Dr. Lund, who was not a rheumatologist, reviewed the claim, and, without consulting Carson’s doctors, concluded that Carson “does not meet the criteria for FM [fibromyalgia] ... [because] [t]o be approved, medically, for FM, a client must have 11 out of 18 ‘tender points’ in the body, client has only a few.” Canada Life denied Carson’s claim for benefits on April 14, 1998, [264]*264stating that her medical record did not “support a diagnosis of Fibromyalgia” and that her condition did not prevent her from performing her job.

Carson appealed that determination within Canada Life, and with her letter of appeal, she included a letter from Dr. Jason, who explained his diagnosis of Carson’s disability, pointing out that Carson showed positive at all 18 tender points for pain and concluding that “the patient is totally disabled for her own or any other occupation.”

Canada Life then concluded that the diagnosis of fibromyalgia was “now clear,” but it indicated that because the diagnosis does not prove a disability, Carson should undergo a “functional capacity evaluation.” This evaluation demonstrated that Carson could perform only a limited sedentary job and that she had only a 20-minute tolerance for sitting. The functional capacity evaluation did not evaluate Carson’s mental capacities or ability to concentrate, both of which had also been adversely affected by her fibromyalgia. Carson’s appeal was reviewed at Canada Life by Dr. John Wolff, also not a rheumatologist, who agreed that the diagnosis of fibromyalgia was probably the “best choice” of diagnosis, but he denied the claim for benefits because, as he concluded, Carson could return to work at “light duty.” At trial he corrected this conclusion, stating that he actually meant “light work.” He said “light duty” was a term of art defined as work involving lifting a maximum of 20 pounds.

Because Carson was unable to support herself without disability benefits, she moved from California to Maryland to live with relatives. After she arrived in Maryland, Canada Life formally denied her appeal.

Carson commenced this action against Canada Life, alleging, among other things, breach of contract and breach of the implied covenant of good faith and fair dealing, and she demanded both compensatory and punitive damages.

The jury returned a special verdict in favor of Carson and awarded damages on the claim for breach of good faith in the amount of $300,000 and punitive damages in the amount of $750,000. On the breach-of-contract claim, the jury found for Carson and the district court calculated the damages at $54,536 and included that amount in the judgment. On Canada Life’s motion for judgment as a matter of law, the district court vacated the punitive damage award but affirmed the remainder of the judgment. In vacating the punitive damage award, the court concluded that under California law, which the parties agreed was applicable, Carson had failed to introduce required evidence of Canada Life’s ability to pay a punitive damage award.

Carson appealed the district court’s decision to strike the punitive damage award, and Canada Life cross-appealed the denial of its Rule 50 motion on the breach-of-contract and breach-of-good-faith claims.

II

Addressing first the assignments of error with respect to liability, we consider Canada Life’s contention that the district court erred in submitting to the jury the question of what was required under the policy to establish total disability. While the interpretation of contract terms is ordinarily a question of law for the court, when a term is ambiguous, extrinsic evidence of its meaning may be received and its meaning becomes a question of fact for resolution by the jury. See Waller v. Truck Ins. Exch., Inc., 11 Cal.4th 1, 44 Cal.Rptr.2d 370, 378, 900 P.2d 619 (Cal. 1995); Regus v. Gladstone Holmes, Inc., [265]*265207 Cal.App.2d 872, 25 Cal.Rptr. 25 (Cal.Dist.Ct.App.1962).

The provision at issue in this ease is the policy’s definition of “totally disabled.” The policy provides:

“Totally disabled” means that the person is unable to work and fulfills either of the two conditions below:
Condition 1 — During the elimination period and for the next 24 months after the elimination period in a continuous period of disability, the person is unable to perform with reasonable continuity the substantial and material duties of his own occupation in the usual or customary way, or
Condition 2 — After the elimination period plus the next 24 months in a continuous period of disability, the person is unable to perform with reasonable continuity the substantial and material duties of any occupation for which he is qualified in view of his age, education, training, experience, station in life, and physical and mental capacity.

Each party advances a plausible interpretation of this provision.

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28 F. App'x 262, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carson-v-canada-life-assurance-co-ca4-2002.