[PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FILED
U.S. COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT ELEVENTH CIRCUIT
________________________ APRIL 12, 2006
THOMAS K. KAHN
No. 05-10816 CLERK
________________________
D. C. Docket No. 02-02094-CV-RWS-1
DR. ALLEN GIDDENS,
Plaintiff-
Counter-Defendant-
Appellee,
versus
THE EQUITABLE LIFE ASSURANCE
SOCIETY OF THE UNITED STATES,
Defendant-
Counter-Claimant-
Appellant,
STANLEY HOWELL,
Defendant.
________________________
Appeal from the United States District Court
for the Northern District of Georgia
_________________________
(April 12, 2006)
Before CARNES, HULL and PRYOR, Circuit Judges.
HULL, Circuit Judge:
In this diversity case, plaintiff Dr. Allen Giddens (“Giddens”) sued
defendant The Equitable Life Assurance Society of the United States (“Equitable”)
for disability benefits under two policies. The district court granted partial
summary judgment in favor of Equitable and partial summary judgment in favor of
Giddens, concluding that Giddens was entitled to payment under the policies for
one of his claims. Equitable appeals the grant of summary judgment to Giddens
and the denial of its summary judgment motion.
I. BACKGROUND
In 1986 and 1988, Equitable issued two disability income insurance policies
(the “Policies”) to Giddens. The Policies did not require Giddens to be disabled
from any occupation but only from his “regular occupation.” Specifically, the
Policies defined the term “your regular occupation” as “the occupation (or
occupations, if more than one) in which you are regularly engaged for gain or
profit at the time you become disabled.”
The Policies provided for certain benefits to be paid to Giddens in the event
of “Total Disability,” defined as follows:
TOTAL DISABILITY means your inability due to injury or sickness
to engage in the substantial and material duties of your regular
2
occupation. It will not be considered to exist for any time you are not
under the regular care and attendance of a doctor.
The Policies each also contained a rider providing additional coverage for
“Residual Disability” defined as follows:
RESIDUAL DISABILITY means your inability due to injury or
sickness to perform:
(1) one or more of the substantial and material duties of your
occupation; or
(2) the substantial and material duties of your occupation for as much
time as is usually required to perform them. . . .
This appeal primarily concerns whether Giddens is totally or only partially
disabled from his regular occupation. We first review the undisputed evidence.
A. Giddens’s Dental Practice
Giddens practiced general dentistry from 1983 until 1994 in Hawkinsville,
Georgia. In 1994, he sold his practice to another dentist and cancelled his dental
malpractice liability insurance policies. According to Giddens, it was his intention
to open another dental office in Macon, Georgia in a building he had previously
acquired. However, Giddens became ill in 1994, and his health did not permit him
to open the practice in Macon. Nevertheless, he remained a licensed dentist until
December 31, 1999, and continued to subscribe to certain professional journals in
the field of dentistry. At some point following the sale of his practice, Giddens
applied for a position as a dentist with the State Merit System. Furthermore, Dr.
3
Giddens testified that he continues to perceive his primary profession as that of
dentistry, and that it was his intention to open a dental office in Macon until the
time he became disabled in 1998.
B. Giddens’s Real Estate Development/Investment
While practicing dentistry and following the sale of his dental practice,
Giddens also engaged for profit in real estate development and investment.
Giddens and his wife owned two companies, Giddens Construction Co., Inc. and
Oak Land & Development Inc., through which Giddens participated in the
development of real estate. Through these companies, Giddens bought real estate
and developed a subdivision. The record shows that forty-three residential lots
were developed and sold by Giddens’s companies, and indicates the address of
each lot and when each lot was sold. Giddens also developed commercial property
and was involved with residential rental properties.
Giddens’s principal duties in his real estate business were entrepreneurial,
financial, planning, coordinating, and other administrative duties. Although
Giddens had a construction company and developed projects, he performed no
physical labor on the job sites, but subcontracted out all the physical labor to
independent subcontractors. Giddens was able to engage in the real estate business
4
with his wife’s assistance until 1998, when his health no longer permitted his doing
so.
In an affidavit, Giddens described the “functional requirements and tasks for
the occupation of construction management and real estate development” as
follows:
entrepreneurial vision and energy; planning real estate projects;
selection of house plans and materials; selection of contractors;
supervision of construction superintendent(s); periodic inspection of
contractors' work quality; financial management of development and
construction projects; supervise compliance with building and other
regulatory codes; project scheduling; pay bills; pay contractors; work
with banks, government agencies, and financial consultants as needed;
calculating the feasibility of projects, reviewing sites, and planning for
contingencies; and coordination [of] dealings with realtors and agents.
C. Giddens’s Two Claims
Giddens submitted two claims to Equitable under the Policies, one in
February 1995 (the “1995 claim”) and one in February 1999 (the “1999 claim”).
Giddens’s 1995 claim asserted that he was disabled due to pain in his left hip;
however, he failed to respond to Equitable’s requests for information pursuant to
the Policies. As a result, the district court granted Equitable summary judgment as
to the 1995 claim. Giddens does not challenge the district court’s conclusions on
this issue on appeal. Thus, this appeal concerns only his 1999 claim.
5
In October 1998, Dr. Giddens began suffering from symptoms such as
fatigue and abdominal pain. He sought treatment at the Mayo Clinic in
Jacksonville, Florida, where Dr. Rolland C. Dickson diagnosed him with cryogenic
cirrhosis, a condition of the liver. After being diagnosed, Giddens submitted the
1999 claim, asserting that he was on a waiting list for a liver transplant, was
disabled, and was unable to pursue his professions of dentistry and real estate
development. In May 1999, Dr. Giddens underwent liver-transplant surgery.
Since the transplant, his liver test and renal functions have returned to normal, but
Giddens still has numerous health problems.
As to his health problems, Giddens produced testimony and Rule 26 reports
of two treating physicians, who both supported Giddens’s disability claims.1 Dr.
James Richard Spivey, a gastroenterologist, treated Giddens during his post-
transplant recovery at the Mayo Clinic. Dr. Spivey testified that notwithstanding
Dr. Giddens’s initially positive liver function following the implantation of the
allograft, Giddens continues to experience numerous adverse symptoms, including
numbness in his fingers, hand tremors, gastrointestinal difficulties, chronic sleep
1
Rule 26 requires that a party provide to other parties the identity of any expert witness
who may be used to present evidence at trial. Rule 26 further requires that the party submit a
report prepared and signed by the expert witness and containing, among other things, “a
complete statement of all opinions to be expressed and the basis and reasons therefor.”
Fed.R.Civ.P. 26(a)(2)(B).
6
disturbances and fatigue, anxiety, depression, and short-term memory loss. Dr.
Spivey opined that those symptoms were the result of both Giddens’s disorder and
the effects of his medication. Based on his review of the enumerated “functional
requirements and tasks” of dentistry and real estate development discussed above,
Dr. Spivey further opined that Giddens “is unable to perform substantial portions
of the duties of” a dentist or real estate developer, “or any other employment
known to [Dr. Spivey] approximating the same livelihood as [those professions],
given his personal circumstances, including his experience, education, and physical
and mental capabilities.” In his deposition, Dr. Spivey clarified that by
“substantial portions” of the duties, he meant most of the duties. Dr. Spivey also
explained how Giddens’s health conditions and medications could affect cognitive
functioning, including entrepreneurial vision, as well as energy and physical
capabilities.
Giddens also presented testimony of a second treating physician, Dr. Mary
Patrice Webster, who has served as Giddens’s psychiatrist since 2000, treating his
depression associated with his liver failure, transplant, and complications. Dr.
Webster’s affidavit presents essentially the same conclusions as that of Dr. Spivey
with regard to Giddens’s disability. In her deposition, Dr. Webster further testified
that, in her opinion, Giddens could not perform the duties of either dentistry or real
7
estate development on a consistent basis. Dr. Webster clarified that in her
affidavit, when she said Giddens was unable to perform “substantial portions” of
his duties, she meant the “vast majority” of the duties. She further stated: “It could
potentially mean all the duties, but my — I tend not to speak in absolutes.” Dr.
Webster noted that Giddens’s primary problems, in her view, were his depression
and cognitive problems.
In addition to his doctors’ reports and testimony, Giddens also submitted his
affidavit stating that he continues to be unable to work as a dentist or real estate
developer, as follows:
Since my liver failure and liver transplant, I have been unable to
perform most of the duties of either of my occupations, as a dentist or
in residential real estate development. While I am not totally helpless,
I am unable to resume either of these occupations, or any work of
which I am aware approximating the same livelihood, in keeping with
my background, circumstances, and physical and mental capabilities.
D. Equitable’s Payments
When it received the 1999 claim, Equitable began paying total disability
benefits while investigating the claim. After an in-house medical review in August
2000, however, Equitable concluded that there was “no current significant
impairment that would preclude [Giddens] from performing most of the duties of
his occupational description[,]” and Equitable continued to make benefit payments
8
only pursuant to a reservation of rights.2 Equitable disbursed a total of $60,790.98
in benefits to Giddens under the reservation of rights.
In September 2001, Equitable reportedly learned that Giddens had not
actively practiced dentistry for four years before he became disabled and that his
real estate pursuit was essentially “passive” in nature. Equitable requested
clarification from Giddens. In March 2002, Equitable terminated the payment of
benefits to Giddens.
E. Litigation
In June 2002, Giddens filed suit in state court seeking benefits under the
Policies, plus interest and enhanced damages for bad faith failure to pay pursuant
to O.C.G.A. § 33-4-6. Equitable filed a counterclaim seeking recovery of the
$60,790.98 paid to Giddens under a reservation of rights. In July 2002, Equitable
removed the case to federal district court. After the discovery period expired,
Giddens filed a motion for partial summary judgment and Equitable filed a cross-
motion for summary judgment as to all claims.3
2
Equitable never requested nor performed any independent medical evaluation of
Giddens. Rather, it simply reviewed the medical information.
3
Equitable also filed a motion to exclude the testimony of Giddens’s treating physicians,
Drs. Spivey and Webster, which the district court denied. We reject Equitable’s arguments on
appeal that the district court abused its discretion in admitting his doctors’ testimony. Gen. Elec.
Co. v. Joiner, 522 U.S. 136, 143, 118 S. Ct. 512, 517 (1997) (stating that the district court’s
evidentiary rulings, including Daubert rulings, are reviewed for an abuse of discretion). Both
treating doctors had conducted extensive reviews of Giddens’s medical history and interacted
9
On November 1, 2004, the district court entered an order (1) granting
summary judgment to Equitable as to all claims except the 1999 claim, and (2)
granting Giddens’s motion for summary judgment as to the 1999 claim based on
his being totally disabled from his real estate occupation. Giddens v. The
Equitable Life Assurance Soc’y of United States, 356 F.Supp.2d 1313 (N.D. Ga.
2004). The district court determined that Giddens was engaged in the “regular
occupation” of real estate developer at the time he became disabled in 1998 and
that Giddens was totally disabled with regard to that occupation. Id. at 1331.
As to dentistry, the district court agreed with Giddens that dentistry could
also be considered his “regular occupation,” but that fact issues existed as to
whether Giddens had permanently abandoned dentistry or only temporarily ceased
dentistry due to circumstances beyond his control. Id. at 1327-28. The district
court determined that those fact issues, however, did not preclude summary
judgment on Giddens’s dentistry claim because if Giddens was engaged in his
dentistry occupation at the time of his disability, the evidence shows he is unable to
perform the substantial and material duties of a dentist and is disabled from that
occupation as well. Id. at 1331 n.9.
with him and concluded that he was unable to perform various activities as a result of his
medical conditions. While certain other tests were available, the particular evidence in this case
shows that the doctors’ opinions were sufficiently reliable, without further testing, not only as to
Giddens’s medical condition but also as to which job tasks he could not perform.
10
Giddens then filed a motion for summary judgment as to damages, which the
district court granted in part and denied in part. The district court entered
judgment for Giddens in the amount of $442,604.82 for unpaid benefits and
interest and $16,165.96 as a refund of premium payments, for a total judgment of
$458,770.78. The district court denied relief on Giddens’s bad faith claim.
Equitable now appeals the district court’s grant of partial summary judgment
to Giddens on the 1999 claim and denial of its summary judgment motion as to that
claim.4
II. DISCUSSION
We address the issues Equitable raises about Giddens’s dentistry occupation
and then his real estate occupation.
A. Giddens’s Dentistry Practice
In the district court and on appeal, Giddens claims he had dual occupations –
dentistry and real estate development – and is totally disabled from both. Equitable
contends that Giddens had abandoned his dentistry practice years prior to his liver
transplant, that as a matter of law dentistry was not his “regular occupation” at the
4
“We review the district court’s grant of summary judgment de novo, applying the same
legal standards that bound the district court, and viewing all facts and reasonable inferences in
the light most favorable to the nonmoving party. Summary judgment is appropriate when ‘there
is no genuine issue as to any material fact and . . . the moving party is entitled to a judgment as a
matter of law.’” Cruz v. Publix Super Mkts., Inc., 428 F.3d 1379, 1382 (11th Cir. 2005)
(quoting Fed.R.Civ.P. 56(c)) (other quotation marks and citation omitted).
11
time of his disability, and that thus the district court erred in denying Equitable
summary judgment on his dentistry claim.
The Policies define “regular occupation” as “the occupation (or occupations,
if more than one) in which you are regularly engaged for gain or profit at the time
you become disabled,” not over the course of the insured’s life. (Emphasis added.)
The ordinary meaning of “regular,” as used in this context, is “[c]ustomary, usual,
or normal.” American Heritage Dictionary of the English Language (Fourth Ed.
2000) at p.1471.5 At the time Giddens became disabled, he had not practiced
dentistry in over four years. We thus readily conclude that Giddens was not
“regularly” engaged in dentistry at the time he became disabled, even if he
intended to return to dentistry at some point if his health permitted. Accordingly,
the district court erred in denying Equitable summary judgment on the dentistry
issue.
B. Real Estate Occupation
This conclusion, however, does not prevent Giddens from recovering
benefits if he was totally disabled from his real estate occupation. In the district
court, Equitable asserted that Giddens’s real estate endeavor was merely a “passive
5
Under Georgia law, “[t]he words used in the policy are to be given their usual and
common significance and are to be construed in their ordinary meaning.” Larson v. Georgia
Farm Bureau Mut. Ins. Co., 520 S.E.2d 45, 46 (Ga. Ct. App. 1999) (citation omitted).
12
investment” and not an occupation. The district court rejected that argument, and
concluded that Giddens had a real estate occupation, stating that
the only evidence now in the record as it relates to Dr. Giddens’
involvement in real estate development shows that his activities went
well beyond that of a casual investor who simply places money in a
given commodity with hopes of an appreciation in value. Rather, it
shows that he had significant administrative duties in connection with
that enterprise.
Giddens, 356 F.Supp.2d at 1328. The district court also explained that Equitable
had failed to cite any authority holding that “an enterprise engaged in for profit
cannot constitute one’s ‘regular occupation’ when it is subjectively perceived by
the insured (or his agents) as an ‘investment.’” Id.
On appeal Equitable does not challenge the district court’s determination
that Giddens had a real estate occupation and was involved in that occupation at
the time of his disability. Rather, in the district court and on appeal Equitable
argues (1) that issues of fact exist as to what the substantial and material duties of
Giddens’s real estate occupation actually were, (2) that the Policies require that
Giddens must be unable to perform all of those substantial and material duties in
order to be totally disabled, and (3) that Giddens failed to prove he was disabled
from all such duties. We turn to those issues.
C. Substantial and Material Duties of Real Estate Occupation
13
As noted above, the Policies provide that “total disability” means the
insured’s “inability due to injury or sickness to engage in the substantial and
material duties of [the insured’s] regular occupation.” In his affidavit, Giddens
described the “functional requirements and tasks for the occupation of construction
management and real estate development” as follows:
entrepreneurial vision and energy; planning real estate projects;
selection of house plans and materials; selection of contractors;
supervision of construction superintendent(s); periodic inspection of
contractors' work quality; financial management of development and
construction projects; supervise compliance with building and other
regulatory codes; project scheduling; pay bills; pay contractors; work
with banks, government agencies, and financial consultants as needed;
calculating the feasibility of projects, reviewing sites, and planning for
contingencies; and coordination [of] dealings with realtors and agents.
Giddens, 356 F.Supp.2d at 1318-19. The duties listed in Giddens’s affidavit are
basically entrepreneurial, financial, planning, coordinating, and administrative
duties. Thus, the record showed what Giddens’s substantial and material duties
were in his real estate occupation.6
6
Equitable stresses that Giddens testified only to the “functional requirements and tasks,”
and not the substantial and material duties, of his real estate occupation. Equitable in essence
argues that Giddens failed to use the correct terminology.
We reject Equitable’s argument that there is a factual issue simply because Giddens
failed to use the magic words “substantial and material” in his affidavit. The use of the term
“functional requirements and tasks” was perhaps inartful; however, it is clear that the point of
Giddens’s testimony was that the elements listed as “functional requirements and tasks” were in
fact the substantial and material duties of his occupation. His testimony, regardless of the terms
used, is evidence of the substantial and material duties involved, and Equitable did not introduce
any evidence to undermine Giddens’s testimony on this point.
14
Because Equitable does not now dispute that Giddens was engaged in the
occupation of real estate development, the question we must answer for summary
judgment purposes is whether, viewing the evidence in the light most favorable to
Equitable, any genuine issue of material fact precludes a finding that Giddens was
unable to perform the substantial and material duties of his real estate development
occupation. Equitable did not present expert evidence about the substantial and
material duties of Giddens’s real estate venture. Rather, Equitable primarily
asserts that two items in the record contradict Giddens’s testimony and create fact
issues as to what his real estate duties were. Equitable’s brief points to (1)
Giddens’s representation to the Social Security Administration in his May 1999
Work History Report that the “development work was all ‘[s]ubcontracted to . . .
independent contractors’ rather than performed by Giddens himself,” and (2) his
attorney’s representation in a letter, dated September 5, 2001, that the real estate
business was “a passive investment . . . managed primarily by his wife.” The
district court properly rejected this argument.
As for Giddens’s representations, in the Social Security report he identified
his job title as “Real Estate Development” and listed his rate of pay as $30,000 per
15
year and his hours as two to five per day, five days per week.7 Giddens described
his development job by completing the Social Security report as follows:
Rate of Pay Per (Circle One) Hours per day Days per week
$30,000 Hour W eek Month (Year) 2-5 hrs a day 5
In this job, did you: Use machines, tools or equipment? Yes (explain below) 9 No T
9
Use technical knowledge or skills? Yes (explain below) T
9 No 9
W rite reports or complete forms? Yes (explain below) T
9 No 9
Describe this job. W hat did you do all day? (If you need more space, write in the “Remarks” section.) Developed
Land for Commercial and Residential use. Subcontracted out all work to independent contractors.
In this job, how many total hours each day did you:
W alk? 1 hr. Kneel? (Bend legs to rest on knees.) 0
Stand? 0 Crouch? (Bend legs and back down & forward.) 0
Sit? 1 hr. Crawl? (Move on hands & knees.) 0
Climb? 0 Handle, grab or grasp big objects? 0
Stoop? (Bend down and forward at waist.) 0 W rite, type or handle small objects? 2 hrs.
Lifting and Carrying (Explain what you lifted, how far you carried it, and how often you did this.)
did not really lift or carry anything.
On the next page under “Remarks,” Giddens stated: “Real Estate
Development was mainly an investment. We had no employees all work was
subcontracted out.” Giddens also responded “no” to the question of whether he
supervised people in the development job.
7
The record indicates that Giddens’s wife actually filled out at least part of the report, but
Giddens signed the form and attested to its truth.
16
As for the representations of Giddens’s former attorney, Randall P. Harrison,
this is what he stated in a September 5, 2001, letter to Equitable:
The real estate development was a passive investment for [Giddens]
that was managed primarily by his wife. It required little physical
activity as he did none of the physical work. The real estate
development consisted of rental property and development of a
subdivision. These investment activities occurred during a period
from June, 1985 until October, 1998. As a result of the family
relocating, his wife was not able to continue with the management of
these investments which resulted in the sale of many of the assets.
During his deposition, Harrison explained that the phrase “passive investment,” as
used in that letter, means “a real estate investment where you own property but
you’re not managing it actively from day to day . . . . An example of that is when
you have . . . acreage real estate that you’re holding for investment purposes.”
Harrison relied on Giddens’s 1999 Social Security report as well as other
communications from Giddens in devising the term “passive investment.”
Harrison referenced that 1999 report and attached a copy of it to the September 5,
2001, letter. As we have already shown, in the report, Giddens indicated that he
did not perform physical work, and he also characterized the occupation as “mainly
an investment.” Giddens stated in the report, however, that he “developed land for
commercial and residential use,” and he indicated that he “use[d] technical
knowledge or skills” to do so. Giddens also said that he had to “write reports or
complete forms” as part of his occupation.
17
Viewing the evidence in the light most favorable to Equitable, there is no
evidentiary basis for concluding that the substantial and material duties of
Giddens’s real estate development occupation included any active management or
physical work. Harrison’s letter and the 1999 report to the Social Security
Administration, however, show that his duties in this “passive investment”
required him to use “technical knowledge or skills.” Thus, the type of passive
investment in real estate development that had been his occupation requires
expertise and knowledge in investing. It requires, at a minimum, the business
savvy, brain power, and research skills to be able to distinguish a good investment
from a bad one. Giddens owned his own real estate company, Oak Land &
Development, Inc., and Equitable does not dispute that he was the brain, although
not the brawn, behind that operation.
This definition of passive investment is consistent with Giddens’s
description during his deposition of his duties as including, in part:
“entrepreneurial vision and energy; planning real estate projects; selection of house
plans and materials; selection of contractors; . . . supervis[ing] compliance with
building and other regulatory codes; project scheduling; . . . work[ing] with banks,
government agencies, and financial consultants as needed; calculating the
18
feasibility of projects, reviewing sites, and planning for contingencies; and
coordinat[ing] dealings with realtors and agents.”
Giddens’s uncontroverted medical evidence shows that he suffers from a
host of physical conditions as well as mental impairments. Dr. Spivey identified
Giddens’s impairments as including “chronic sleep disturbances which lead to
chronic fatigue, poor coping abilities, chronic anxiety and depression, [and] short
term memory loss.” His medications cause “cognitive problems including short-
term memory loss, inability to concentrate or function, inability to sleep, and
ongoing depression.” Dr. Webster testified in her deposition that in addition to
depression, Giddens “has auditory and visual hallucinations” and side effects to his
medicine including “forgetfulness and confusion.” Equitable did not perform an
independent medical evaluation of Giddens. The testimony of Drs. Spivey and
Webster stands unrefuted.
The heart of Giddens’s claim is that given his cognitive problems and
physical ailments, he cannot perform the entrepreneurial, financial, planning,
coordinating, and administrative duties of his real estate occupation. Giddens’s
medical evidence and his doctors’ testimony established that he cannot perform
most or the majority of those duties and thus cannot engage in his real estate
19
occupation. We also agree with the district court’s following assessment of
Equitable’s position:
. . . while placing inordinate emphasis on testimony that Dr. Giddens’
engagement in real estate development did not involve physical labor,
Equitable fails to appreciate the uncontradicted testimony of Dr.
Giddens’ physicians that his chronic fatigue, depression, anxiety, and
short-term memory loss preclude Dr. Giddens from performing even
the administrative duties attendant to that enterprise.
Giddens, 356 F.Supp.2d at 1329. The doctors testified that Giddens suffers from
hallucinations, memory loss, forgetfulness, inability to concentrate and confusion,
and Equitable did not present any medical evidence to the contrary. These
symptoms obviously result in a diminished intellectual capacity, greatly hindering
Giddens’s ability to think and reason on a daily basis. As a result, he is no longer
able to exercise the “technical knowledge” and “skills” that he identified as job
duties in his sworn statement to the Social Security Administration. Accordingly,
the district court did not err in this regard.
D. Total Disability From Real Estate Occupation
While there is a lot of discussion in the briefs about Giddens’s duties, it is
but a prelude to Equitable’s main defense, which is based on the policy language.
Equitable argues the Policies require that Giddens be unable to perform all of the
substantial and material duties of his real estate occupation in order to be totally
disabled. Equitable stresses that Giddens is unable to perform only most or a
20
majority of his substantial, material duties. Equitable contends that if Giddens is
able to perform even one of his substantial, material duties, he is not totally
disabled, but only partially or residually disabled. Equitable thus contends the
district court erred in granting summary judgment in favor of Giddens.8
Because this defense is based on the policy language, we first review the
Georgia law regarding construction of insurance contracts and then the Policies.9
1. Georgia Law
Under Georgia law, the rights of the parties to an insurance policy should
not be expanded beyond the terms of the policy. Baldwin v. State Farm Fire &
Cas. Co., 590 S.E.2d 206, 208 (Ga. Ct. App. 2003). “In applying the rules of
construction to an insurance contract, the test is not what the insurer intended its
8
The district court concluded that this argument was raised for the first time in a reply
brief and thus need not be considered. Giddens, 356 F.Supp.2d at 1325 n.7. In any event, the
district court rejected the argument on the merits, noting that the evidence established Giddens
was unable to perform “substantial portions” of the occupational duties and thus was totally
disabled under the Policies. Id. On appeal, Equitable points out that, in fact, it first raised the
argument in opposition to Giddens’s cross-motion for partial summary judgment, and thus the
issue was properly before the district court. Equitable’s opposition brief does state that Giddens
incorrectly “contends that the policies should be read to mean that he is totally disabled if he is
unable to perform ‘most,’ but not all, of the substantial and material duties of his regular
occupation,” and that Giddens’s “interpretation would render nugatory the terms of the Residual
Disability Income riders”and is inconsistent with Georgia case law. (Opposition Brief, R-4-64
pp. 12-17.) Thus, Equitable timely raised the issue.
9
In diversity cases, the Court is bound by the applicable state law governing the contract,
in this case Georgia law. See Clanton v. Inter.Net Global, L.L.C., 435 F.3d 1319, 1323 (11th
Cir. 2006).
21
words to mean, but rather what a reasonable person in the insured’s position would
understand them to mean.” W. Pac. Mut. Ins. Co. v. Davies, 601 S.E.2d 363, 368-
69 (Ga. Ct. App. 2004) (quotation marks and citation omitted).
Where the language of the contract is unambiguous and only one reasonable
interpretation is possible, the contract must be enforced as written. Sapp v. State
Farm Fire & Cas. Co., 486 S.E.2d 71, 73 (Ga. Ct. App. 1997). However, when a
policy is ambiguous, or is capable of two reasonable interpretations, it is construed
in the light most favorable to the insured and against the insurer. Davies, 601
S.E.2d at 369; Erie Indem. Co. v. Lascala, 424 S.E.2d 820, 821-22 (Ga. Ct. App.
1992). Indeed, “[p]olicies of insurance will be liberally construed in favor of the
object to [be] accomplished, and conditions and provisions therein will be strictly
construed against the insurer, as they are issued upon printed forms, prepared by
experts at the insurer’s instance, in the preparation of which the insured has no
voice.” Davis v. United Am. Life Ins. Co., 111 S.E.2d 488, 492 (Ga. 1959)
(quotation marks and citation omitted). Georgia courts instruct that disability
provisions should be given a “practical and reasonable” construction and not a
“strict and literal” one. John Hancock Mut. Life Ins. Co. v. Poss, 267 S.E.2d 877,
881 (Ga. Ct. App. 1980) (citation omitted).
22
In addition, the interpretation of an insurance policy, including the
determination and resolution of ambiguities, is a question of law for the court to
decide. O.C.G.A. § 13-2-1; Claussen v. Aetna Cas. & Sur. Co., 888 F.2d 747, 749
(11th Cir. 1989). We now turn to the Policies.
2. The Policy Language
As noted earlier, the Policies define “Total Disability” as the inability to
“engage in the substantial and material duties of your regular occupation.”
Giddens’s Policies protect him against disability from his own “regular
occupation” and do not require that Giddens be disabled from “any” occupation or
“comparable” occupations. Thus, we look to the duties of his real estate
occupation.
Further, we agree with Equitable that Giddens did not prove that he could
not perform all substantial, material duties but rather proved that he could not
perform most or the majority of such duties. For example, Giddens testified that he
cannot perform “most of the duties” of his real estate occupation and is unable to
resume that occupation. Further, Drs. Spivey and Webster testified that he was
unable to perform “substantial portions of the duties of” his real estate
development. By “substantial portions,” Dr. Spivey meant “most” and Dr.
Webster meant “the vast majority.” Among Giddens’s substantial, material duties
23
that he is unable to perform are his application of entrepreneurial vision and
energy, higher-level planning of real estate development projects, financial
management of development and construction projects, and determining the
feasibility of projects. Although Giddens, according to the evidence, perhaps
remains able to perform a few duties – including selecting house plans, materials,
and contractors – the testimony of Giddens and Drs. Spivey and Webster indicate
that he is unable to perform most or the vast majority of the substantial, material
duties of real estate development, and thus is totally disabled from his real estate
occupation.
Equitable’s main argument on appeal is that Giddens must be unable to
perform all substantial and material duties of his occupation in order to be totally
disabled. The problem for Equitable is that the Total Disability clause in its
Policies does not identify what percentage of “the” duties the insured must be
unable to perform. The clause does not say “all” substantial and material duties or
“most” or any percentage.
Further, the parties have not cited, and we cannot locate, any decision by a
Georgia appellate court construing the same language in a disability policy.
However, the Eighth Circuit has construed the same language in a disability policy
and determined that it is ambiguous. Dowdle v. Nat’l Life Ins. Co., 407 F.3d 967,
24
970 (8th Cir. 2005) (applying Minnesota law to policy defining total disability as
inability “to perform the material and substantial duties of an occupation”and
concluding that ambiguity existed because “[t]he policies’ definitions of ‘total
disability’ are susceptible to differing interpretations, because the policies do not
speak in terms of ‘any,’ ‘all,’ ‘some,’ or ‘the most important part’ of [the insured’s]
duties”).10 We agree with the Eighth Circuit that the policy language here is
ambiguous. We do not suggest that “all” is an unreasonable interpretation of the
policy language, but we do say that “most” or the “majority” of the substantial and
material duties is also a reasonable interpretation if an insured is unable to engage
in his regular occupation as a result of his inability to perform most or the majority
of those duties.
Construing the Policies in favor of Giddens and against Equitable, we
conclude Giddens may establish total disability if he cannot engage in his real
estate occupation because he is unable to perform most or the vast majority of the
substantial and material duties of his occupation. As outlined above, Giddens’s
10
In Dowdle, the insured paid an additional premium to obtain an “own occupation” rider
to the disability policy, which expanded his protection by defining “occupation” as the
occupation of the insured at the time of disability. 407 F.3d at 968. Thus, Dowdle’s policy was
effectively the same as Giddens’s. Further, the Residual Disability definition in Dowdle’s policy
defined “partial disability” as inability to perform “one or more” of the important daily duties of
his occupation, which is similar to Giddens’s Policies.
25
evidence established inability to perform most of his important duties and an
inability to engage in his real estate occupation.
That Giddens may be able to perform one or more of the substantial and
material duties associated with that occupation simply does not preclude a showing
of total disability under the terms of the Policies, as Equitable claims. Even if
Giddens can perform a few substantial and material duties – including, for
example, selecting house plans, materials, and subcontractors – his ability to
perform those tasks in isolation still would not allow Giddens to continue in his
real estate development occupation because he is unable to perform his
entrepreneurial, financial, planning, coordinating, and administrative duties, which
were the heart of his real estate occupation. See Dowdle, 407 F.3d at 972
(concluding that surgeon who could no longer stand long enough to perform
orthopedic surgery but could conduct office visits, see patients, read x-rays,
perform IMEs, interpret data, and promote referrals was totally – not residually –
disabled because he could not perform “the most important substantial and material
duty”).11
11
We recognize that Giddens argues that summary judgment should be upheld in his
favor because Equitable failed to present evidence that he could perform even one of the
substantial and material duties of his real estate occupation. However, Equitable’s position is
that the Policies require that Giddens show he is unable to perform all substantial and material
duties and that he has not done so because his doctors testified only that he cannot perform the
vast majority of his duties and did not say all duties. Equitable did not need to controvert the
doctors’ testimony because its position is their testimony did not establish total disability under
26
3. Equitable’s Arguments
Equitable argues that Georgia law compels the interpretation that total
disability exists only where the insured is unable to perform all of the substantial,
material duties of his occupation. Equitable cites several Georgia cases that it
claims compel this definition of “total disability.” See, e.g., Cloer v. Life & Cas.
Ins. Co. of Tennessee, 152 S.E.2d 857 (Ga. 1966); Mut. Life Ins. Co. of New York
v. Barron, 30 S.E.2d 879 (Ga. 1944); Metro. Life Ins. Co. v. Johnson, 20 S.E.2d
761, 762 (Ga. 1942); Prudential Ins. Co. of Am. v. South, 177 S.E. 499, 502 (Ga.
1934); Cato v. Aetna Life Ins. Co., 138 S.E. 787 (Ga. 1927).
These cases fail to support Equitable’s position because the policy language
interpreted in those cases was substantially different from the relevant language in
this case. In those cases, the policies defined “total disability” as the inability to
perform “any occupation” or “any work.” 12 Here, by contrast, the Policies define
the terms of the Policies.
12
See, e.g., South, 177 S.E. at 500 (“The policy provided that total disability . . . existed
whenever the insured was ‘rendered wholly, continuously, and permanently unable to engage in
any occupation or perform any work for any kind of compensation of financial value during the
remainder of his life.’”); Johnson, 20 S.E.2d at 762 (stating that policy provided for benefits
when the insured became “totally and permanently disabled . . . from engaging in any occupation
and performing any work for compensation or profit”); Barron, 30 S.E.2d at 880 (stating that
insurance policy defined total disability as “any impairment of mind or body which continuously
renders it impossible for the insured to follow a gainful occupation”); Cato, 138 S.E. at 790
(stating that disability would be deemed total and permanent if “such disability presumably will
during lifetime prevent such employee from pursuing any occupation for wages or profit”);
Cloer, 152 S.E.2d at 858 (“The clause in the disability rider . . . reads that the insurer would
waive the premiums should the insured ‘become totally disabled as the result of bodily injury or
27
total disability as the inability to perform “the substantial and material duties of
your regular occupation,” without regard to whether the insured could do other
kinds of work.13 More importantly, none of the policies in these Georgia cases
contained the language at issue here – “the substantial and material duties.”
If anything, Equitable’s cases show how Georgia courts liberally construe
disability policies in favor of insureds and strictly against insurers. In the cases
Equitable cites, the Georgia courts rejected the insurers’ claims that the
requirement of inability to perform “any occupation” or “any work” meant any
gainful employment. See Barron, 30 S.E.2d at 883; Johnson, 20 S.E.2d at 762;
South, 177 S.E. at 501. Instead, the Georgia courts construed the language of
inability to perform “any work” or “any occupation,” in favor of the insured, to
mean inability to perform substantial portions of the insured’s ordinary
employment or any other employment approximating the insured’s same livelihood
as he might fairly be expected to follow given his personal circumstances,
including his experience, education, physical and mental capacities. See Barron,
disease so as to be wholly prevented thereby from engaging in any occupation or employment
for wage or profit.’”).
13
Georgia courts recognize a distinction between “occupational” policies, which provide
benefits of the insured is disabled from a particular occupation, versus “non-occupational”
disability insurance policies, which provide benefits only if the insured is disabled from any
occupation or gainful activity. See Parker v. Prudential Ins. Co. of Am., 482 S.E.2d 483, 485-86
(Ga. Ct. App. 1997). The Policies in this case are occupational, but the policies in the cases cited
by Equitable are non-occupational.
28
30 S.E.2d at 883; Johnson, 20 S.E.2d at 762; South, 177 S.E. at 501. In doing so,
the Georgia courts stressed that the word “occupation” must “be construed
according to the facts and circumstances of the execution of the contract, including
the objects to be effectuated thereby.” South, 177 S.E. at 501; see also Cato, 138
S.E. at 791 (construing total disability language and stating that “[p]olicies of
insurance will be liberally construed in favor of the object to be accomplished, and
provisions therein will be strictly construed against the insurer”). Thus, in these
cases the Georgia courts construed “any” occupation as occupations approximating
the insured’s livelihood.14 The object to be accomplished in Giddens’s Policies is
14
Even Equitable’s any-occupation cases have language suggesting that total disability
does not require that all duties are closed to the insured, but only that “substantially all” of the
material duties are closed to the insured. See, e.g., South, 177 S.E. at 502 (“If the insured is so
incapacitated that substantially all of the material activities of any [employment approximating
the same livelihood as the insured’s ordinary employment] are reasonably closed to him, he is
totally disabled within the meaning of the policy.” (emphasis added)); Johnson, 20 S.E.2d at 764
(stating that “total disability under the policy exists only when the insured is incapacitated to
perform substantially all of the duties of his employment”); Barron, 30 S.E.2d at 883 (“Total
disability is inability to do substantially all of the material acts necessary to the transaction of the
insured’s occupation, in substantially his customary and usual manner.”) (quoting Cato, 138 S.E.
787); Cloer, 152 S.E.2d at 859 (concluding that the jury charge was correct because it was in line
with Johnson, where “this court in a full bench decision clarified the meaning of total disability
by stating that ‘total disability under the policy exists only when the insured is incapacitated to
perform substantially all of the duties of his employment’”); Equicor, Inc. v. Stamey, 454 S.E.2d
550, 552 (Ga. Ct. App. 1995) (stating that under Barron and other precedent, “‘total disability’
requires only that the insured be unable to perform substantial portions of his ordinary
employment or any other employment approximating the same livelihood . . . .”); Travelers Ins.
Co. v. Stanley, 160 S.E.2d 876, 878 (Ga. Ct. App. 1968) (“As summarized in the first headnote
of the Johnson case, the insured is totally disabled when ‘he is so incapacitated that substantially
all of the material activities of his employment, or any similar employment, approximating the
same livelihood, are reasonably closed to him. Inability of the insured to perform one or more of
the substantial duties of such employment, if this be less than substantially all such duties, does
not constitute total disability under such a policy.’”).
29
total disability coverage if he is unable to perform so many substantial and material
duties that his regular occupation is reasonably closed to him. That point is clearly
reached in Giddens’s case.
Equitable finally argues that total disability must mean the inability to
perform all of the material and substantial duties because to interpret the term
otherwise would nullify the “Residual Disability” clause. The Policies define
“residual” disability as the inability “to perform . . . one or more of the substantial
and material duties of [the insured’s] occupation.” This argument is unpersuasive.
Quite obviously, there is a continuum of disability. If the insured is unable to
perform only “one or more” of many material occupational duties, then the insured
would not be totally disabled. Where the insured, such as Giddens, is unable to
perform most or the majority (but not all) of the material duties and thus cannot
engage in his regular occupation, the insured nevertheless is totally disabled from
his regular occupation, and this interpretation does not nullify the Residual
Disability clause.15 At some point, a line must be drawn where the disability
becomes so severe, and affects such a large percentage of the insured’s material
and substantial duties, that the disability is total rather than residual. The language
15
Indeed, taking Equitable’s argument to the logical extreme would nullify the Total
Disability clause. Residual Disability, by its definition, includes the inability to perform one or
more of the material duties; a literal reading would include a total inability to perform all duties,
since all duties are clearly “one or more” duties.
30
of the Residual Disability clause does not suggest where that line should be drawn
and certainly does not require that it be drawn only where Equitable suggests. If
Equitable means “all” in its Total Disability clause, then Equitable may make that
simple change to its policy forms.16
III. CONCLUSION
For the foregoing reasons, we affirm the district court’s grant of summary
judgment in favor of Giddens as to his 1999 disability claim regarding his real
estate occupation. We reverse the denial of summary judgment in favor of
Equitable as to his 1999 disability claim as to his dentistry occupation.
16
Because Equitable relies so heavily on Metro. Life Ins. Co. v. Johnson, 20 S.E.2d 761
(Ga. 1942), we discuss that case in more detail. In Johnson, the policy provided for benefits
when the insured became “totally and permanently disabled . . . from engaging in any occupation
and performing any work for compensation or profit.” Id. at 762. Johnson concerned different
policy terms than Giddens’s Policies and does not control. In any event, as noted in footnote 18
supra, Georgia courts read Johnson as we do, and Johnson, if anything, supports Giddens’s
recovery because the Johnson court twice stated that total disability exists when the insured is
unable “to perform substantially all of the duties of his employment.” Id. at 764-65.
Equitable nonetheless argues that other language in Johnson establishes the rule that total
disability requires inability to perform all duties. We disagree. Johnson does go on to state that
“although [the insured] is unable to perform some or even many of the substantially material
activities of his employment,” he is not totally disabled “so long as [he] has capacity to perform
any substantial part of his duties.” Id. (emphasis added). At other points, the Johnson court
stated that an insured was not totally disabled “if any substantially material activities of the
employment remain open to the insured,” and that a case of total disability is presented if the
insured is unable to perform “any substantial part of his ordinary duties.” Id. (emphasis added).
However, Johnson did not indicate that no single duty (even a material and substantial
one) could remain open to the insured. That an insured must be unable to perform “any
substantial part” of his duties as a whole is significantly different than Equitable’s suggested
requirement that he be unable to perform each and every substantial duty. Here, Giddens’s
evidence shows that he is unable to perform “the vast majority” of his substantial and material
duties, including the most important duties, and thus he has shown that he is unable to perform
“any substantial part of his duties.”
31
AFFIRMED in part, REVERSED in part.
32