Louis P. River, III v. Commercial Life Insurance Company

160 F.3d 1164, 1998 WL 809615
CourtCourt of Appeals for the Seventh Circuit
DecidedFebruary 2, 1999
Docket97-3581
StatusPublished
Cited by36 cases

This text of 160 F.3d 1164 (Louis P. River, III v. Commercial Life Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Louis P. River, III v. Commercial Life Insurance Company, 160 F.3d 1164, 1998 WL 809615 (7th Cir. 1999).

Opinion

COFFEY, Circuit Judge.

In 1980, the plaintiff-appellant, Louis P. River (“River”), a surgeon licensed and practicing in the state of Illinois, was diagnosed with a manic depressive psychiatric problem. River continued to carry out his duties as a surgeon until 1985, when he was forced to terminate his surgical practice due to his psychiatric problem. In 1986, River’s insurer, ’ Commercial Life Insurance Company (“Commercial”), the defendant-appellee, began providing River with “sickness” disability benefits amounting to $1,800 per month.

After having exhausted his “sickness” benefits in late 1992, River filed suit against Commercial on July 2, 1996, seeking declaratory judgment alleging that his psychiatric illness, which allegedly stemmed from an accident that occurred in 1980, should be covered as an “injury” under the language of the policy, thereby obligating the defendant to pay disability benefits to the plaintiff for the remainder of his life. The defendant insurance company filed a motion for summary judgment on July 31, 1997, arguing that the plaintiffs manic depressive illness was not the result of the alleged accident of 1980, but was more properly classified as a “sickness,” for which insurance benefits had previously been paid. Thé United States District Court for the Northern District of Illinois granted the defendant’s (Commercial’s) motion for summary judgment, ruling that the plaintiff had failed to satisfy conditions precedent to receiving “injury” benefits under the terms of the insurance policy. We affirm.

BACKGROUND

River alleges that on August 2, 1980, he bumped his head on a metal doorframe while demonstrating ballet maneuvers for his son in his home in Chicago, Illinois. Although the plaintiff allegedly lost consciousness for several minutes, the record reflects that it never was considered serious enough for him to seek medical attention for the alleged injury to his head, and that he instead ingested two Tylenol tablets and slept through the night. River returned to the operating room the following day and carried out his surgical duties at Oak Park Hospital in Oak Park, Illinois.

On September 15,1980, the plaintiff began to exhibit severe manic psychiatric symptoms 1 necessitating hospitalization in Mercy-ville Hospital’s psychiatric ward in Aurora, Illinois. Shortly thereafter, on October 3, 1980, Dr. Lee Gladstone (“Gladstone”), a psychiatrist at Northwestern University Memorial Hospital, examined River and directed that he be transferred from Mereyville to the psychiatric ward at Northwestern. Gladstone noted in his history that River informed him that for the past fifteen years, River had consumed between ten and twenty-five ounces of alcohol each evening to help him sleep. River also told Gladstone that he had also ingested one or two Meprobamates, an oral sedative used for the relief of anxiety and tension, each evening for the past ten years. Gladstone also noted in River’s medical record that in his opinion, River had abused alcohol for years prior to his hospitalization in order to self-medicate a pre-exist-ing manic condition. Gladstone also noted that prior to October of 1980, River had no history of past physical injuries that one could identify as contributing to his illness. During this period of inpatient confinement, Gladstone officially diagnosed River as suffering from manic depression. River’s condition subsequently improved and he returned to his surgical practice at Oak Park Hospital in February of 1981.

In June of 1985, River’s psychiatric problems took a turn for the worse, severe enough to necessitate the termination of his surgical practice. Six months later, in January of 1986, he submitted a claim for disability benefits to one of his insurers, the *1167 defendant Commercial. Commercial’s policy provided for the payment of monthly benefits totaling $1,800 if the insured became disabled while the policy was in force. The policy distinguished between disability benefits for “sickness” and disability benefits for “injury.” Specifically, the “sickness” provision provided benefits for “loss or disability commencing during any term of this Policy, resulting from sickness or disease” for a maximum of seven years. On the other hand, the “injury” provision of the policy provided lifelong benefits for “loss or disability, resulting directly and independently of all other causes from accidental bodily injury occurring during any term of this Policy.” (Emphasis added). Written notice of a claim for benefits had to be filed within twenty days of a particular loss or disability, or as soon as reasonably possible. Furthermore, the coverage provision for “injury” benefits provided that the insurer was obligated to make monthly benefit payments only “for total disability which results from ‘injury’ and occurs uñthin one year from the date of the accident.” (Emphasis added). The policy defined “total disability” as a condition in which the insured was “wholly and continuously unable to perform all of the substantial and material duties of [the insured’s] occupation.” In order to qualify to receive either “sickness” or “injury ” benefits, the insured needed to be totally disabled for a minimum of six months. River did not claim any “sickness” benefits during his hospitalization in 1980 because he returned to his duties as a surgeon within five months after the original onset of his psychotic episode. By contrast, River’s 1985 episode caused him to stop working for a period of more than six months, and in January of 1986, River filed a claim for “sickness” benefits. Commercial approved River’s application or “sickness” benefits, and began making monthly benefit payments of $1,800, which River exhausted seven years later, as dictated under the terms of the policy. During the seven-year span, commercial paid River total benefits in excess of $150,000.

Shortly after his benefits were exhausted, River had an accident while riding his bicycle in Florida. To avoid hitting a pedestrian, River was forced off a path, lost control of his bicycle, and was catapulted to the ground sustaining a head injury. His mental health deteriorated, necessitating hospitalization once again in 1993. According to River, at this time he and his wife began to speculate about a connection between the bicycle accident and the recurrence of River’s psychiatric illness. River reviewed an old diary kept by his wife and realized that his initial hospitalization in 1980 came two months after the 1980 accident in his home in Chicago. River and Dr. Gladstone concluded in 1994 that there was a link between the 1980 head trauma and the onset of River’s psychiatric episodes in 1980 and 1985.

In September of 1994, River retained an attorney to contact each of his disability insurers to assert claims under the “injury” provisions of his various policies. But River failed to contact Commercial until October 17, 1995, ten years after the full manifestation of his disorder, when he sent a letter requesting that Commercial reinstate his disability benefits for life. River specifically contended that his manic depressive illness should not be classified as a “sickness,” but rather as an “injury” resulting from his doorway accident in 1980. The letter to Commercial was mailed more than a year after River had contacted his other disability insurers and approximately three years after his sickness benefits from Commercial had been exhausted.

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Cite This Page — Counsel Stack

Bluebook (online)
160 F.3d 1164, 1998 WL 809615, Counsel Stack Legal Research, https://law.counselstack.com/opinion/louis-p-river-iii-v-commercial-life-insurance-company-ca7-1999.