Louis Leonor v. Provident Life & Accident Co.

790 F.3d 682, 2015 FED App. 0129P, 2015 U.S. App. LEXIS 10647, 2015 WL 3874808
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 24, 2015
Docket14-2120, 14-2152
StatusPublished
Cited by17 cases

This text of 790 F.3d 682 (Louis Leonor v. Provident Life & Accident Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Louis Leonor v. Provident Life & Accident Co., 790 F.3d 682, 2015 FED App. 0129P, 2015 U.S. App. LEXIS 10647, 2015 WL 3874808 (6th Cir. 2015).

Opinion

OPINION

ROGERS, Circuit Judge.

This case arises from a dispute over three disability income insurance policies issued to Louis Leonor, a dentist licensed in Michigan. Each policy provided “total disability benefits” in the event that Leonor became unable to perform “the important duties of [his] Occupation,” or words to this effect. This appeal turns entirely on the question of whether the words “the important duties” necessarily mean “all the important duties.” Whether use of the definite article before a plural noun implies the meaning of “all,” however, depends on context, and the context of the policy language in this case permits a reading of “the important duties” that is not necessarily “all the important duties.” Given this permissible reading, the district court properly ruled in favor of the insured.

*684 Leonor suffered an injury that prevented him from performing dental procedures. At the time of his injury, he spent approximately two-thirds of his time performing dental procedures and approximately one third managing his dental practices and other businesses that he owned. After initially granting coverage, his insurers denied total disability benefits after they discovered the extent of his managerial duties. They argued that, because his occupation at the time of his injury included his managerial duties and because he could still perform those duties after his injury, he was not totally disabled under the policies. .Leonor sued, alleging contract and fraud claims. The district court granted summary judgment to Leonor on his contract claim, holding that “the important duties” could plausibly be read to mean “most of the important duties” and resolving the ambiguity in favor of Leonor under Michigan law. The insurers appeal, arguing that “the important duties” neces sarily and unambiguously means “all the important duties.” The district court was correct that “the important duties” could plausibly mean something like “the major portion of the important duties” and that therefore - Leonor was entitled to total disability benefits. The other issues raised on appeal and cross-appeal are either controlled by this determination or no longer contested.

Paul Revere Life Insurance Company issued policy number 0102450113 (“the 0113 policy”) to Leonor on April 24, 1990. The policy provided benefits in the event that Leonor became totally disabled, defining “total disability” as follows:

“Total Disability” means that because of Injury or Sickness:
You are unable to perform the important duties of Your Occupation; and
You are under the regular and personal care of a physician.

‘Tour Occupation” is defined as “the occupation in which You are regularly engaged at the time You become Disabled.” The policy provides reduced benefits in the event of “residual disability,” defined as follows:

“Residual Disability,” prior to the Commencement Date, means that due to Injury or Sickness:
(1) You are unable to perform one or more of the important duties of Your Occupation; or
(2) You are unable to perform the important duties of Your Occupation for more than 80% of the time normally required to perform them; and
Your loss of Earnings is equal to at least 20% of your prior earnings while You are engaged in Your Occupation or another occupation; and You are under the regular and personal care of a Physician.
As of the Commencement Date, Residual Disability means that due to the continuation of that Injury or Sickness:
Your Loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your Occupation or another occupation; and You are under the regular and personal care of a Physician.
Residual Disability must follow right after a period of Total Disability that lasts at least as long as the Qualification Period, if any.

Two disability policies with similar language but less at stake (policies 8090 and 2074) are also at issue in this case. These two policies contain language that is arguably more favorable to the insurers than the 0113 policy, 1 but the insurers explicitly *685 decline to rely on language contained in those two policies but not in 0113.- Appellant Br. at 12 n. 5.

When applying for each policy, Leonor listed his occupation as “Dentist.” Leonor alleges in his complaint that the insurers’ agents stated that the policies covered his occupation — dentistry.

Prior to his injury in March 2009, Leonor worked essentially full time — 35 to 40 hours per week — performing dental procedures. He also owned a number of dental practices and other businesses as investments, and spent approximately 15 to 25 hours per week managing and overseeing them. He earned approximately half of his income from these investments.

In March 2009, after cervical spine surgery, Leonor became unable to perform dental procedures. He remained able to manage and operate the businesses he owned, and after his injury he “more aggressively” sought out “investment opportunities in terms of purchasing dental practices.” As a result of the success of these investments, his overall income increased after his 2009 injury.

Following his injury, Leonor claimed benefits for total disability under each of the three policies, and in July 2009 Provident and Paul Revere began paying Total Disability benefits under each. The insurers stopped paying Total Disability benefits under the two lesser policies in September 2010 on the ground that Leonor was engaged in another gainful occupation — managing his businesses. See n. 1, supra. In August 2011, the insurers stopped paying Total Disability benefits under the 0113 Policy on the ground that, at the time of his injury, Leonor’s occupation consisted of both his “Dental duties” and his “Owner/Operator duties.” Leonbr tried to use the insurers’ internal channels to reverse these determinations, but failed.

Leonor filed suit in federal court on the basis of diversity jurisdiction against Provident and Paul Revere, alleging breach of contract and fraud under Michigan law. Leonor sought full Total Disability benefits as well as penalty interest of 12% per year *686 under Mich. Comp. Laws § 500.2006(4). Provident and Paul Revere counterclaimed seeking reimbursement of Total Disability benefits paid before the insurers cancelled coverage. The district court dismissed Leonor’s fraud claim on the ground that the fraud claim arose solely from the insurers’ “alleged failure to fulfill a contractual obligation and not from a breach of a separate and independent duty,” and that a breach of duty separate from a breach of contract was required to sustain a fraud action.

After discovery and cross-motions for summary judgment by Leonor and the insurers, the district court granted summary judgment to Leonor on his contract claim.

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Cite This Page — Counsel Stack

Bluebook (online)
790 F.3d 682, 2015 FED App. 0129P, 2015 U.S. App. LEXIS 10647, 2015 WL 3874808, Counsel Stack Legal Research, https://law.counselstack.com/opinion/louis-leonor-v-provident-life-accident-co-ca6-2015.