Dale G. Button and Glorianna Button, Husband and Wife v. Connecticut General Life Insurance Company and Cigna Insurance Company

847 F.2d 584, 1988 U.S. App. LEXIS 7024, 1988 WL 52077
CourtCourt of Appeals for the Ninth Circuit
DecidedMay 26, 1988
Docket86-2741
StatusPublished
Cited by25 cases

This text of 847 F.2d 584 (Dale G. Button and Glorianna Button, Husband and Wife v. Connecticut General Life Insurance Company and Cigna Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dale G. Button and Glorianna Button, Husband and Wife v. Connecticut General Life Insurance Company and Cigna Insurance Company, 847 F.2d 584, 1988 U.S. App. LEXIS 7024, 1988 WL 52077 (9th Cir. 1988).

Opinion

BOOCHEVER, Circuit Judge:

Dale and Glorianna Button (Button) appeal from a grant of summary judgment in favor of Connecticut General Life Insurance Company and Cigna Insurance Company (CGL) in Button’s action for continued benefits under a disability insurance policy. The issues presented on this appeal are whether: (1) Button is entitled to lifetime benefits for a back injury causing disability independent of other causes; (2) the policy’s incontestability clause prevents CGL from relying on a preexisting condition to deny coverage; and (3) a change in classification of Button’s injury, resulting in termination of benefits, constituted bad faith and/or estopped the company from refusing to pay lifetime benefits. We affirm.

FACTS

In September of 1975, CGL issued a policy of disability income indemnity insurance to Button. On or about December 16, 1979, Button twisted his lower back while lifting a sheet of roofing material in the wind. Button has been totally disabled since. Pursuant to Button’s claim, CGL paid monthly benefits for sixty-eight months from December 16, 1979 through August 9, 1985. CGL initially classified the claim as an injury arising out of an accident and its actuary set aside a lifetime reserve for benefit payments. CGL subsequently reclassified the disability as arising out of sickness, but did not notify Button of the change until shortly before termination of benefits. Under the policy, the maximum indemnity period for disability caused by sickness is sixty months. Indemnity for disability caused by injuries may extend over a lifetime.

Button suffered from recurring back problems prior to the 1979 lifting accident. Button was treated for back pain by his physician, Dr. Toll, in the 1960s and in 1973 and 1974. A lifting accident in 1976 forced Button to see Dr. Toll again for back pain. In a deposition, Button testified that between May 1977 and December 1979, he continued to suffer intermittent back problems. It is undisputed that Button suffers from a condition known as degenerative disc disease. CGL claims that the disease contributed to Button’s disability, and that Button’s disability therefore should be deemed a sickness as defined in the policy. Button contends his previous condition did not contribute to his disability. He insists that the 1979 accident was the sole cause of his disability. Button further argues that the incontestability clause in the policy bars CGL from reducing his claim on the basis of a preexisting disease.

The district court granted CGL’s motion for summary judgment. The court concluded that Button’s injury was caused or contributed to by his degenerative disc condition. The court also held that the incontestability clause did not invalidate other provisions in the policy.

DISCUSSION

I. Causation

This diversity case is governed by the substantive law applicable in the forum state. As such, Arizona law is controlling. See Strassberg v. New England Mutual Life Ins. Co., 575 F.2d 1262, 1263 (9th Cir.1978). The dispositive issue is whether Button’s disability was the direct result of an accident, independent of all other *586 causes. The insurance policy provides in relevant part:

Total Disability Defined. The Insured will be considered to be totally disabled if, as a result of sickness contracted and commencing while this policy is in force, or as a result directly and independently of all other causes of accidental bodily injuries sustained while this policy is in force, he becomes wholly and continuously disabled....
Certain Disabilities Deemed Sickness. For purposes of this policy, a period of disability shall be deemed to result from sickness if it (a) results from injuries caused or contributed to by disease, or (b) results from disease or infection, or medical or surgical treatment therefor ... whether the disease or infection is the proximate or a contributing cause of the loss....

In order to receive lifetime benefit payments, Button’s total disability must be the result of an accident independent of all other causes.

In New York Life Ins. v. Greber, 55 Ariz. 261, 100 P.2d 987 (1940), the Arizona Supreme Court formulated the following test for determining whether death results solely from accidental causes:

(a) When an accident causes a diseased condition which, together with the accident, results in death, the accident alone is considered the cause of death; (b) when at the time of the accident the insured was suffering from some disease, but such disease had no causal connection with the death resulting from the accident, the accident is the sole cause of the death, and (c) when at the time of the accident there was an existing disease which, cooperating with the accident, resulted in the death, the accident cannot be considered as the sole cause, independent of all other causes.

Id. at 263, 100 P.2d at 987.

The Arizona Supreme Court has applied the Greber test to a disability insurance case. See Dickerson v. Hartford Accident & Indem. Co., 56 Ariz. 70, 74-75, 105 P.2d 517, 519-20 (1940).

In Watkins v. Underwriters at Lloyds, London, 107 Ariz. 56, 481 P.2d 849 (1971), the Arizona Supreme Court applied a two-step inquiry to determine whether the plaintiff’s death was directly or indirectly caused or contributed to by disease: (1) was there a disease, and (2) did the disease cause or contribute to the injury or death. Id. at 62, 481 P.2d at 855. Where there is no dispute as to the existence of a disease and the effect thereof, the issue becomes a question of law and the Greber test applies. Id.

The deposition testimony of Dr. Toll, Button’s physician, clearly indicates that Button had a preexisting disc problem. Dr. Toll confirmed that Button’s degenerating disc became progressively more symptomatic. In his opinion, Button’s disability from the injury was not independent of his prior back condition. 1 There is no testimony that indicates that the accident caused Button’s disability independent of the preexisting disc problem.

We agree with the district court that Button’s degenerative disc condition falls within the third category of Greber. Because the accident was not the sole cause of Button’s disability, he is not entitled to lifetime benefits.

Button contends that in interpreting the policy, the court should use an ordinary layman’s understanding of the term “disease.” He argues that since there is no *587 evidence that his condition would have become totally disabling without the injury, his preexisting condition was not a disease. This argument is without merit.

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847 F.2d 584, 1988 U.S. App. LEXIS 7024, 1988 WL 52077, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dale-g-button-and-glorianna-button-husband-and-wife-v-connecticut-ca9-1988.