Georgia Supreme Court Rules in Favor of Physician in Disability Claim for Lifetime Benefits Against Provident Life and Accident Insurance Company

The Georgia Supreme Court found in favor of a former physician who had filed a lawsuit against Provident Life and Accident Insurance Company (“Provident Life”) for lifetime disability benefits as a result of his injury that caused total disability.

Background

Alton Hallum, Jr. specialized for 30 years in obstetrics and gynecology in Georgia. Dr. Hallum suffered from carpal tunnel syndrome, which made him incapable of continuing to practice in his area of medicine.

Provident Life issued Dr. Hallum a disability insurance policy that covered disabilities due to injury or sickness that rendered him unable to practice in his occupation. Under Provident Life’s disability policy, the duration of benefits to which he was entitled was dependent upon whether his disability was due to an injury or sickness. If Dr. Hallum’s disability was due to a sickness, he was entitled to four years of benefits. If Dr. Hallum’s disability was due to an injury, he was entitled to benefits for his lifetime.

Dr. Hallum’s Disability

The medical evidence in the record showed that Dr. Hallum did not have, nor did he previously have, any of the diseases that are typically associated with carpal tunnel syndrome. Instead, the medical record showed that Dr. Hallum’s condition was the result of 30 years of performing the hand motions required by his practice. In other words, Dr. Hallum’s carpal tunnel syndrome was caused by repetitive hand motions.

Because Dr. Hallum’s policy was issued and delivered in Georgia, the state’s law applied to disputes regarding the disability insurance contract. Under Georgia law, there is a distinction between insurance contracts that provide coverage for accident injuries and those that provide coverage caused by accidental means. According to Georgia law:

  • Accidental injury: is an injury that is unexpected but may arise from a conscious voluntary act;
  • Injury from accidental means: is an injury that is the unexpected result of an unforeseen or unexpected act that was unintentionally or involuntarily done.

The Court’s Review of the Policy Language

The question before the court was whether Dr. Hallum’s unexpected carpal tunnel syndrome, brought on by years of intentional repetitive hand motions, that rendered him disabled is considered an “injury” under the terms of Provident Life’s disability policy.

Looking to Provident Life’s policy language, the court reasoned that “accidental bodily injuries” meant a bodily injury that was unexpected but could have arisen from a voluntary or conscious act. Provident Life, however, argued that the injury must have resulted from a specific event that happened at a certain time and place. Because Dr. Hallum could not identify a specific incident that caused his carpal tunnel syndrome, his disability did not result from an injury.

The court disagreed, reasoning that a person could suffer a series of small traumas over an extended period of time that eventually results in a bodily injury that is disabling. In such a scenario, like Dr. Hallum, the disability would be caused by an unexpected bodily injury. The court held that Provident Life’s disability insurance policy covered bodily injuries resulting from a series of actions over a prolonged period of time as well as those caused by a single event.

Help from an Attorney with Expertise in Disability Insurance

Disability insurance law is complicated. If your claim for disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.

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