Harbin v. Continental Casualty Company

Full title: Albert S. Harbin, Plaintiff, vs. Continental Casualty Company, et al.…

Court: United States District Court, S.D. Alabama, Southern Division

Date published: Oct 26, 2000

Civil Action 99-1026-M (S.D. Ala. Oct. 26, 2000)

Opinion

Civil Action 99-1026-M.

October 26, 2000.

JUDGMENT

BERT W. MILLING, JR., United States Magistrate Judge.

It is ORDERED, ADJUDGED, and DECREED that JUDGMENT be entered in favor of Defendants Continental Casualty Company, ST Mobile Aerospace Engineering, Inc., and ST Mobile Aerospace Engineering, Inc., Disability Plan and against Plaintiff Albert S. Harbin on all claims. Each party shall bear its own costs.

MEMORANDUM OPINION AND ORDER

This action is before the Court on Defendants' Motion for Summary Judgment (Docs. 18-20). Plaintiff has responded to the Motion (Doc. 33) and Defendants have replied (Doc. 39). After consideration of all evidence of record, the Motion is GRANTED.¹

1 Pursuant to the written consent executed by all parties and filed with the Court on January 13, 2000 (Doc. 10), this action was referred to the undersigned Magistrate Judge to conduct all proceedings and order the entry of judgment in accordance with 28 U.S.C. § 636(c) and Fed.R.Civ.P. 73 (Doc. 10).

The facts, very briefly, are that Plaintiff Albert Harbin worked for Defendant ST Mobile Aerospace Engineering, Inc. (hereinafter ST Mobile) as a benefits coordinator. While employed, Plaintiff participated in the ST Mobile Aerospace Engineering, Inc., Disability Plan (hereinafter the Plan)² which provided long-term disability insurance through a contract with Defendant Continental Casualty Company (hereinafter CNA). Plaintiff submitted a claim for disability insurance, but was denied coverage by CNA.

2 The Plan is also a Defendant in this action.

These facts form the basis of this action. Harbin asserts an understanding of the insurance coverage in which he would receive disability benefits; specifically, because he can no longer perform his job at ST Mobile, Plaintiff argues that he is entitled to receive long-term disability benefits. Defendants, however, reached another conclusion, based on a different interpretation of the Plan language; more specifically, Defendants argue that the disability coverage is available only if Harbin becomes unable to perform the job of benefits coordinator as it is generally performed in the workplace.

The standard of review used in analyzing the respective arguments depends on CNA's responsibilities in the administration of the Plan. Brown v. Blue Cross Blue Shield of Alabama, 898 F.2d 1556 (11^th Cir. 1990), cert. denied, 498 U.S. 1040 (1991). However, "[i]t is fundamental that the fiduciary's interpretation first must be `wrong' from the perspective of de novo review before a reviewing court is concerned with the self-interest of the fiduciary." Brown, 898 F.2d at 1566 n. 12 (citing Denton v. First Nat'l Bank of Waco, 765 F.2d 1295, 1305 (5^th Cir. 1985)).³ So, the Court's first order of business is to determine if Plaintiff's reading of the insurance coverage contract was "wrong."

3 Because the Court ultimately concludes that CNA's decision was not wrong, it will be unnecessary for the Court to determine which standard of review is required to review the decision.

According to Dahl-Eimers v. Mutual of Omaha Life Insurance Co., 986 F.2d 1379, 1381 (11^th Cir. 1993), it is the Court's responsibility, as a matter of law, to interpret insurance contract language. In determining the meaning of the specific language, the Court must "assess the natural or plain meaning of the policy language." Dahl-Eimers, 986 F.2d at 1382 (citing Landress Auto Wrecking Co., Inc. v. United States Fidelity Guaranty Co., 696 F.2d 1290, 1292 (11^th Cir. 1983))

The Plan defines total disability as follows:

"Total Disability" means that, during the Elimination Period and Your Occupation Period shown in the Schedule of Benefits, You, because of Injury of Sickness, are:

(1) continuously unable to perform the substantial and material duties of Your regular occupation;

(2) under the regular care of a licensed physician other than Yourself; and

(3) not gainfully employed in any occupation for which You are or become qualified by education, training or experience.

Doc. 20, Exhibit 1, p. 4 (emphasis added). The Court understands the above provision to mean that a claimant must be unable to perform the job as it is regularly and normally performed in the workplace. The Court does not understand the provision to mean that a claimant is unable to perform the specific job for which the employee is employed. By its plain meaning, the Plan language requires a claimant to show that he can not perform his occupation; there is no ambiguity here. The Court finds that CNA's interpretation of the Plan was not "wrong."

The Court notes that this understanding is consistent with Social Security disability regulations which inquire as to whether a claimant can perform a past kind of work — not whether the claimant can perform a past specific job. See 20 C.F.R. § 404.1520(e)(2000); see also Social Security Ruling 82-61.⁴ Though social security law is not directly applicable to this action, the Court, nevertheless, finds it instructive here. Because the Court has reached this determination, no further analysis is added.

4 "Three possible tests for determining whether or not a claimant retains the capacity to perform his or her past relevant work are as follows:
* * *

3. Whether the claimant retains the capacity to perform the functional demands and job duties of the job as ordinarily required by employers throughout the national economy. (The Dictionary of Occupational Title (DOT) descriptions can be relied upon — for jobs that are listed in the DOT — to define the job as it is usually performed in the national economy.) It is understood that some individual jobs may require somewhat more or less exertion than the DOT description.

A former job performed by the claimant may have involved functional demands and job duties significantly in excess of those generally required for the job by other employers throughout the national economy. Under this test, if the claimant cannot perform the excessive functional demands and/or job duties actually required in the former job but can perform the functional demands and job duties as generally required by employers throughout the economy, the claimant should be found to be `not disabled.'"

For the reasons set out above, Defendants' Motion for Summary Judgment is GRANTED. Granting this motion disposes of all claims and issues raised in this action. Judgment will be entered by separate order.