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May 2019 Archives

What is the Meaning of "Regular Occupation" in a Disability Insurance Policy?

Most people assume that if they become unable to perform their usual work on account of sickness or injury, that they would qualify to receive benefits under their work-sponsored long-term disability insurance coverage. That may not be the case, though. In Nichols v. Reliance Standard Life Ins. Co., 2019 WL 2223614 (5th Cir. May 23, 2019), the court permitted a disability insurer to classify the work of an inspector in a poultry processing plant as that of a "sanitarian," a quite different occupation. Although the district court delivered a blistering indictment of Reliance Standard's review of Juanita Nichols's claim for disability benefits (2018 WL 3213618 (S.D. Miss. June 29, 2018)), the Court of Appeals reversed and awarded judgment to the insurance company. The lower court was so incensed by the insurer's behavior, it cited over 100 examples of Reliance Standard's arbitrary and capricious conduct in other litigation and found similar misconduct in its treatment of Nichols. The Fifth Circuit had a different view, though.

Is death resulting from autoerotic asphyxiation a self-inflicted injury?

Is death resulting from autoerotic asphyxiation gone wrong an accident or is coverage under an accidental death insurance policy precluded by the policy's "self-inflicted injury" exclusion. A recent appellate court ruling overturned a lower court's determination that the language of the exclusion is ambiguous and therefore had to be resolved in favor of the insured under the doctrine of contra proferentem. In Tran v. Minnesota Life Ins. Co., 2019 WL 1894769 (7th Cir. April 29, 2019), the insurer denied benefits, claiming the insured's unintended self-strangulation was an "intentionally self-inflicted injury," an exclusion under the policy. The court of appeals, disagreeing with the lower court and with rulings from the Second and Ninth Circuits on this issue, reversed the district court's decision holding that a reasonable person would interpret [the decedent's] cause of death, autoerotic asphyxiation, to be an "intentionally self-inflicted injury."

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