Phoenix Home Life Mutual Insurance v. Huggett

5 F. App'x 792
CourtCourt of Appeals for the Ninth Circuit
DecidedMarch 16, 2001
DocketNo. 99-16612; D.C. No. CV 97-0735-PHX-EHC
StatusPublished

This text of 5 F. App'x 792 (Phoenix Home Life Mutual Insurance v. Huggett) 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
Phoenix Home Life Mutual Insurance v. Huggett, 5 F. App'x 792 (9th Cir. 2001).

Opinion

MEMORANDUM1

Phoenix Home Life Mutual Insurance Company (Phoenix) appeals from a judgment entered against it after a two-day bench trial. The district court had jurisdiction pursuant to 28 U.S.C. § 1332(a). We have jurisdiction over this timely filed appeal pursuant to 28 U.S.C. § 1291. We affirm in part, reverse in part, and remand.

Phoenix first contends that the district court erred in determining that Huggett is “totally disabled” under the terms of her disability insurance policy and, therefore, is entitled to receive disability benefits. Phoenix argues that Huggett merely shifted duties, continuing to work as a professional nurse for the same employer, in the same location, at the same salary. Thus, she merely changed “jobs” within her “occupation,” and is not “totally disabled” and entitled to collect on her policy. The district court determined that because Huggett is “unable to perform the substantial and material duties of her regular oeeupa[794]*794tion of surgical nurse due to severe stress,” she is “totally disabled” and entitled to receive benefits under the policy.

In order to receive benefits under the Phoenix disability policy, Huggett had to establish that she was “totally disabled.” The policy sets up two “tiers” of coverage. First, the policy provides a type of coverage commonly termed “occupational disability” insurance. This coverage is available under the policy for up to sixty months or until Huggett reaches the age of fifty-five, whichever occurs later, and is triggered if Huggett is “totally disabled” such that her disability “prevents [her] from engaging in ... [her] regular occupation ... at the time the disability began .” Second, following the sixty-month period, or after Huggett reaches age fifty-five, the policy provides for “general disability” insurance, which is available to Huggett only if her disability “prevents [her] from engaging in ... any occupation for which [she] is or becomes reasonably suited by education, training, or experience.”

Thus, the threshold issue in this case is whether Huggett’s occupational disability coverage was triggered by a “total disability,” which, under the policy, requires a determination of Huggett’s “regular occupation” at the onset of her disability. Under Arizona law, when examining a claim under an occupational disability policy, “[t]he proper standard for disability ... is whether the condition ... prevents the insured from performing the substantial and material duties of his occupation in the usual or customary way.” Nystrom v. Mass. Cas. Ins. Co., 148 Ariz. 208, 713 P.2d 1266, 1270 (Ariz.Ct.App.1986). This standard is known as the “substantial performance” test. See Couch on Insurance 8d § 147:107 (1998). In applying this standard, “[t]he courts consistently have focused upon the unique and specific tasks of the insured’s occupation to determine whether he no longer can engage in his profession in the usual or customary way.” Radkowsky v. Provident Life and Accident Ins. Co., 196 Ariz. 110, 993 P.2d 1074, 1076 n. 1 (Ariz.Ct.App.1999). Thus, “under the ‘substantial performance’ test, even though the insured is able to perform some parts of his or her work, a case of total disability is presented where the insured is incapacitated from performing any substantial part of his or her ordinary duties.” Couch at § 147:107.

In this ease, the district court found:

In 1994, Huggett was working predominantly as a surgical nurse, performing surgical nursing duties. She spent about 98% of her workday in the operating room and her duties were almost exclusively surgical in nature.
... Huggett’s present duties ... are administrative tasks which are not ordinarily performed by a nurse. For the most part, Huggett’s current duties do not require any specialized training as a nurse ... This is work that would ordinarily be delegated to an executive or administrative assistant.

Accordingly, the district court determined that Huggett is no longer able to perform the “substantial and material” duties of her occupation and, therefore, is “totally disabled” under the terms of her policy.

We review the district court’s factual findings for clear error. Cariaga v. Local No. 1184, Laborers Int'l Union of N.Am., 154 F.3d 1072, 1074 (9th Cir.1998). Huggett’s pre- and post-injury job descriptions, together with letters sent to Phoenix by Huggett’s employer and the insurance agent who sold Huggett her original policy in 1982, provide evidentiary support for the district court’s findings. Based upon this evidence, Huggett’s substantial and material duties prior to her disability were [795]*795surgical, while after her disability she was unable to perform those duties in the usual or customary way. In fact, the district court found that she was not able to perform them at all as she was reduced to performing largely administrative tasks. Because we are not left with a definite and firm conviction that the district court committed a mistake, we affirm its determination that Huggett is “totally disabled” and entitled to receive benefits under her disability insurance policy. See United States v. Doe, 155 F.3d 1070, 1074 (9th Cir.1998) (en banc) (“We accept the lower court’s findings of fact unless upon review we are left with the definite and firm conviction that a mistake has been committed.”).

Phoenix next contends that the district court erred in awarding Huggett monthly income benefits for life. Phoenix argues that the district court failed to recognize that the policy at issue is a “two-tier” disability policy. By misconstruing the policy’s Schedule of Benefits, Phoenix argues, the district court erroneously read the “general disability” provision out of Huggett’s policy.

The interpretation and meaning of contract provisions are questions of law reviewed de novo. Mendler v. Winterland Prod., Ltd., 207 F.3d 1119, 1121 (9th Cir.2000). The plain meaning of the policy language is clear. When an insured is disabled from engaging in the insured’s regular occupation at the time the disability began, the first type of coverage provides compensation for five years, or until the insured reaches the age of 55, whichever occurs later. At the expiration of that time period, this “occupational disability” coverage expires. “The expectation is that, by that time, the insured will have made the necessary adjustment to another line of work or, if that is not possible because of the severity of the disability, will qualify for continued benefits under the second type of coverage ...” McFarland v. Gen. Am. Life Ins. Co., 149 F.3d 583, 587 (7th Cir.1998).

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Nystrom v. Massachusetts Casualty Insurance
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United States v. Doe
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Bluebook (online)
5 F. App'x 792, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phoenix-home-life-mutual-insurance-v-huggett-ca9-2001.