PHILADELPHIA, July 11 — The Third Circuit U.S. Court of Appeal found no ambiguity in a residual disability policy’s definition of the term “occupation” and as a result held that the insurer’s termination of benefits was proper.
Daniel Bowerman, a chiropractor, sued National Life Insurance Co., claiming that benefits were improperly terminated under the Employee Retirement Security Act. Bowerman suffered a bike-riding injury to his shoulder, and had been receiving benefits for twenty one years. After the accident, however, Bowerman continued his chiropractic practice and also worked as a consultant.
In 2011, National Life sent Bowerman a letter to terminate partial disability benefits as of his 55th birthday, and asserted he no longer was disabled as defined in the policy. The insurer claimed that Bowerman’s full time consulting work for Independence Blue Cross took him outside of the definition of disabled as written in the policy, as he was performing his occupation.
After Bowerman filed suit to overturn the determination, the parties filed cross-motions for summary judgment. The District Court granted summary judgment to National Life, rejecting Bowerman’s argument that the terms of “occupation,” and “insured’s occupation,” were ambiguous.
After Bowerman appealed to the Third Circuit, the Third Circuit Panel of Circuit Judges Julio M. Fuentes, D. Brooks Smith and Richard L. Nygaard affirmed the summary judgment for National life, ruling that the “plain language of the [policy] Rider tied the definition of occupation to the Policy.”
In a footnote to the opinion, Circuit Judge Smith noted he would have vacated the District Court’s judgment for subject matter jurisdiction, because Bowerman’s individual policy was not within the coverage of ERISA, therefore not presenting a federal question.
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