Giddens v. Equitable Life Assurance Society of the United States

445 F.3d 1286, 2006 U.S. App. LEXIS 8970, 2006 WL 932077
CourtCourt of Appeals for the Eleventh Circuit
DecidedApril 12, 2006
Docket05-10816
StatusPublished
Cited by37 cases

This text of 445 F.3d 1286 (Giddens v. Equitable Life Assurance Society of the United States) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Giddens v. Equitable Life Assurance Society of the United States, 445 F.3d 1286, 2006 U.S. App. LEXIS 8970, 2006 WL 932077 (11th Cir. 2006).

Opinion

HULL, Circuit Judge:

In this diversity case, plaintiff Dr. Allen Giddens (“Giddens”) sued defendant The Equitable Life Assurance Society of the United States (“Equitable”) for disability benefits under two policies. The district court granted partial summary judgment in favor of Equitable and partial summary judgment in favor of Giddens, concluding that Giddens was entitled to payment under the policies for one of his claims. Equitable appeals the grant of summary judgment to Giddens and the denial of its summary judgment motion.

I. BACKGROUND

In 1986 and 1988, Equitable issued two disability income insurance policies (the “Policies”) to Giddens. The Policies did not require Giddens to be disabled from any occupation- but only from his “regular occupation.” Specifically, the Policies defined the term “your regular occupation” as “the occupation (or occupations, if more than one) in which you are regularly engaged for gain or profit at the time you become disabled.”

The Policies provided for certain benefits to be paid to Giddens in the event of “Total Disability,” defined as follows:

TOTAL DISABILITY means your inability due to injury or sickness to engage in the substantial and material duties of your regular occupation. It will not be considered to exist for any time you are not under the regular care and attendance of a doctor.

*1289 The Policies each also contained a rider providing additional coverage for “Residual Disability” defined as follows:

RESIDUAL DISABILITY means your inability due to injury or sickness to perform:
(1) one or more of the substantial and material duties of your occupation; or
(2) the substantial and material duties of your occupation for as much time as is usually required to perform them....

This appeal primarily concerns whether Giddens is totally or only partially disabled from his regular occupation. We first review the undisputed evidence.

A Giddens’s Dental Practice

Giddens practiced general dentistry from 1983 until 1994 in Hawkinsville, Georgia. In 1994, he sold his practice to another dentist and cancelled his dental malpractice liability insurance policies. According to Giddens, it was his intention to open another dental office in Macon, Georgia in a building he had previously acquired. However, Giddens became ill in 1994, and his health did not permit him to open the practice in Macon. Nevertheless, he remained a licensed dentist until December 31, 1999, and continued to subscribe to certain professional journals in the field of dentistry. At some point following the sale of his practice, Giddens applied for a position as a dentist with the State Merit System. Furthermore, Dr. Giddens testified that he continues to perceive his primary profession as that of dentistry, and that it was his intention to open a dental office in Macon until the time he became disabled in 1998.

B. Giddens’s Real Estate Development/Investment

While practicing dentistry and following the sale of his dental practice, Giddens also engaged for profit in real estate development and investment. Giddens and his wife owned two companies, Giddens Construction Co., Inc. and Oak Land & Development Inc., through which Giddens participated in the development of real estate. Through these companies, Giddens bought real estate and developed a subdivision. The record shows that forty-three residential lots were developed and sold by Giddens’s companies, and indicates the address of each lot and when each lot was sold. Giddens also developed commercial property and was involved with residential rental properties.

Giddens’s principal duties in his real estate business were entrepreneurial, financial, planning, coordinating, and other administrative duties. Although Giddens had a construction company and developed projects, he performed no physical labor on the job sites, but subcontracted out all the physical labor to independent subcontractors. Giddens was able to engage in the real estate business with his wife’s assistance until 1998, when his health no longer permitted his doing so.

In an affidavit, Giddens described the “functional requirements and tasks for the occupation of construction management and real estate development” as follows:

entrepreneurial vision and energy; planning real estate projects; selection of house plans and materials; selection of contractors; supervision of construction superintendent(s); periodic inspection of contractors’ work quality; financial management of development and construction projects; supervise compliance with building and other regulatory codes; project scheduling; pay bills; pay contractors; work with banks, government agencies, and financial consultants as needed; calculating the feasibility of projects, reviewing sites, and planning for contingencies; and coordination [of] dealings with realtors and agents.

*1290 C. Giddens’s Two Claims

Giddens submitted two claims to Equitable under the Policies, one in February 1995 (the “1995 claim”) and one in February 1999 (the “1999 claim”). Giddens’s 1995 claim asserted that he was disabled due to pain in his left hip; however, he failed to respond to Equitable’s requests for information pursuant to the Policies. As a result, the district court granted Equitable summary judgment as to the 1995 claim. Giddens does not challenge the district court’s conclusions on this issue on appeal. Thus, this appeal concerns only his 1999 claim.

In October 1998, Giddens began suffering from symptoms such as fatigue and abdominal pain. He sought treatment at the Mayo Clinic in Jacksonville, Florida, where Dr. Rolland C. Dickson diagnosed him with cryogenic cirrhosis, a condition of the liver. After being diagnosed, Giddens submitted the 1999 claim, asserting that he was on a waiting list for a liver transplant, was disabled, and was unable to pursue his professions of dentistry and real estate development. In May 1999, Giddens underwent liver-transplant surgery. Since the transplant, his liver test and renal functions have returned to normal, but Giddens still has numerous health problems.

As to his health problems, Giddens produced testimony and Rule 26 reports of two treating physicians, who both supported Giddens’s disability claims. 1 Dr. James Richard Spivey, a gastroenterologist, treated Giddens during his post-transplant recovery at the Mayo Clinic. Dr. Spivey testified that notwithstanding Giddens’s initially positive liver function following the implantation of the allograft, Giddens continues to experience numerous adverse symptoms, including numbness in his fingers, hand tremors, gastrointestinal difficulties, chronic sleep disturbances and fatigue, anxiety, depression, and short-term memory loss. Dr. Spivey opined that those symptoms were the result of both Giddens’s disorder and the effects of his medication. Based on his review of the enumerated “functional requirements and tasks” of dentistry and real estate development discussed above, Dr.

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Bluebook (online)
445 F.3d 1286, 2006 U.S. App. LEXIS 8970, 2006 WL 932077, Counsel Stack Legal Research, https://law.counselstack.com/opinion/giddens-v-equitable-life-assurance-society-of-the-united-states-ca11-2006.