Elam v. First Unum Life Insurance

57 S.W.3d 165, 346 Ark. 291, 2001 Ark. LEXIS 595
CourtSupreme Court of Arkansas
DecidedOctober 18, 2001
Docket00-1430
StatusPublished
Cited by85 cases

This text of 57 S.W.3d 165 (Elam v. First Unum Life Insurance) is published on Counsel Stack Legal Research, covering Supreme Court of Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Elam v. First Unum Life Insurance, 57 S.W.3d 165, 346 Ark. 291, 2001 Ark. LEXIS 595 (Ark. 2001).

Opinion

Donald L. Corbin, Justice.

This case involves the interpretation of an insurance policy. Appellant James E. Elam purchased a long-term-disability policy from Appellee First Unum Life Insurance Company, through his employer, Smith-Barney. In 1994, Elam elected coverage under the policy for disability due to his having bipolar affective disorder. First Unum recognized Elam’s disability and paid benefits to him from August 9, 1994, through August 9, 1996. First Unum declined to pay further benefits because of a twenty-four-month policy limitation applicable to disability due to mental illness. Elam filed suit against First Unum, contending that the term “mental illness,” as used and defined in the policy, is ambiguous as it applies to his illness. The crux of Elam’s argument is that bipolar affective disorder is a physical illness, with a biological origin, that is treated with medication. The Garland County Circuit Court granted summary judgment to First Unum and found that the plain, ordinary meaning of the term encompassed bipolar affective disorder. We reverse the trial court’s judgment and remand for trial.

The insurance policy at issue provides: “Benefits for disability due to mental illness will not exceed 24 months of monthly benefit payments,” unless the insured meets one of two possible situations not applicable in this case. The policy then provides: “ ‘Mental illness’ means mental, nervous or emotional diseases or disorders of any type.” The parties do not dispute the fact that Elam suffers from bipolar affective disorder. Instead, they dispute whether bipolar affective disorder is a “mental illness” within the meaning of that term as set out in the disability policy.

The record demonstrates that Elam filed a motion for summary judgment, asserting that there were no material issues of fact to be resolved and that the court need only determine the legal issue of whether the policy language was ambiguous. Elam contended that the affidavits of Dr. Bradley C. Diner, M.D., and Dr. Charles L. Bowden, M.D., showed that bipolar affective disorder was a physical, rather than mental, illness. Dr. Diner stated in his affidavit that “[i]t is well accepted in the scientific community that bipolar disorder is a biological condition with hereditary predisposition, and an alteration in brain chemistry is being responsible for the mood disturbance and altered thought process.” Similarly, Dr. Bowden stated that, in his opinion, bipolar affective disorder has a biological origin. Dr. Bowden also opined that “there is no longer any reasonable doubt among informed members of the medical community that Bipolar Affective Disorder has a biological origin” and that this principle has gained “near universal acceptance in the medical community.”

First Unum also filed a motion for summary judgment, contending that the policy plainly and unambiguously excluded further benefits to Elam for disability due to mental illness and that bipolar affective disorder is a mental illness. In support of its motion, First Unum submitted portions of depositions given by Dr. Diner and Dr. Joe Backus, M.D., Elam’s treating physician. In particular, First Unum relied on the following information: (1) the precise cause of bipolar affective disorder is unknown, as it cannot be detected by such diagnostic tools as brain scans or blood tests; (2) diagnosis is based primarily on the patient’s behavior, clinical presentation, and history; (3) psychiatrists are unable to predict the onset of symptoms based on any physical or biological indicator; (4) individuals suffering from the disorder are treated exclusively by psychiatrists, using a combination of drugs and psychotherapy; and (5) the medical and psychiatric communities officially classify bipolar affective disorder as a mental illness, regardless of their opinion that the disorder has a biological origin.

In response to First Unum’s motion, Elam submitted the depositions of Drs. Diner and Backus in their entirety, which reflected the following information: (1) bipolar affective disorder is caused by an imbalance of chemicals or neurotransmitters in the brain; (2) the disorder is distinguishable from a personality disorder, which is triggered by social stress, such as the death of a loved one; and (3) the disorder is treated with medication, to stabilize the neurotransmitter blood levels in the brain, while psychotherapy is used primarily to help educate the patient about the illness and to help him adapt to the life changes that the illness brings. Elam also offered his own affidavit, to which were attached approximately twenty-five articles from various sources, including newspapers, magazines, mental-health pamphlets, and a law journal. Collectively, these sources report that certain disorders of the brain, including bipolar affective disorder, are no longer viewed as mental illnesses due to the apparent consensus in the medical community that such disorders have physical origins. Finally, Elam relied on the affidavit of Dr. Diner, which reflected that there is a general trend in psychiatry to move away from the classification of illnesses by symptoms in favor of classifying them according to their causes or origins. As an example of this trend, Dr. Diner’s affidavit contained the following disclaimer from the introduction to the Fourth Edition of the Diagnostic and Statistical Manual (DSM-IV):

Although this volume is titled The Diagnostic and Statistical] Manual of Mental Disorders, the term mental disorder unfortunately implies a distinction between “mental” disorders and “physical” disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much “physical” in “mental” disorders and much “mental” in “physical” disorders. The problem raised by the term “mental” disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of the DSM-IV because we have not found an appropriate substitute.

After considering the evidence offered by both parties, the trial court ruled that the definition of “mental illness” provided in the disability policy is unambiguous when the term is afforded its plain and ordinary meaning. The trial court , found that Arkansas law requires that contract terms, such as those contained in insurance policies, be interpreted according to a layperson’s understanding of those terms. The trial court concluded:

The common, ordinary and lay understanding of the term “mental illness” encompasses bi-polar affective disorder. This interpretation is further supported by the testimony of Plaintiff s treating and consulting psychiatrists, Dr. Bradley Diner and Dr. Joe Backus, that the psychiatric community classifies bi-polar affective disorder as a mental illness regardless of the precise cause or etiology of that disease. As used in Defendant’s insurance policy, that term is not ambiguous.

Based on these conclusions, the trial court granted summary judgment to First Unum.

Elam appealed to the Arkansas Court of Appeals. After reviewing the evidence submitted by the parties, as weH as varying case law on this issue from other jurisdictions, the court of appeals concluded that the policy’s language was ambiguous. It thus reversed the trial court’s judgment and remanded for trial on the issue of whether Elam’s disorder is a mental illness. See Elam v. First Unum Life Ins. Co., 72 Ark. App.

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Cite This Page — Counsel Stack

Bluebook (online)
57 S.W.3d 165, 346 Ark. 291, 2001 Ark. LEXIS 595, Counsel Stack Legal Research, https://law.counselstack.com/opinion/elam-v-first-unum-life-insurance-ark-2001.