Fedesna v. Canada Life Assurance ( 2022 )

Case: 21-50884 Document: 00516409252 Page: 1 Date Filed: 07/27/2022
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
FILED
July 27, 2022
No. 21-50884
Lyle W. Cayce
Clerk
Thomas Fedesna,
Plaintiff—Appellant,
versus
The Canada Life Assurance Company,
Defendant—Appellee.
Appeal from the United States District Court
for the Western District of Texas
USDC No. 1:18-CV-546
Before Davis, Jones, and Elrod, Circuit Judges.
Per Curiam:*
This court has carefully considered the briefs and pertinent portions
of the record in the above-styled appeal. Having done so, we find no
reversible error of law or fact in the comprehensive district court opinion and
therefore AFFIRM for the following reasons.
*
Pursuant to 5th Circuit Rule 47.5, the court has determined that this
opinion should not be published and is not precedent except under the limited
circumstances set forth in 5th Circuit Rule 47.5.4.
Case: 21-50884 Document: 00516409252 Page: 2 Date Filed: 07/27/2022
No. 21-50884
Thomas Fedesna, who began practice as a chiropractor in the 1970s,
bought an individual total disability insurance contract in 1985. In 2011 he
fell off a ladder and injured his back, neck, and arms. Fedesna made a claim
on his disability insurance contract and Canada Life Assurance (CLA) paid
him $4,500 a month for five years. At the five-year mark, however, the terms
of the contract triggered a shift in Fedesna’s coverage, and the $4,500
payments were stopped because Fedesna was not totally disabled under the
terms of the contract.
Here are the relevant terms from the contract:
“Total Disability means that you are unable, due to injury or sickness,
to engage in your regular occupation. This definition changes after benefits
have been payable during any one continuous disability for the longer of
(a) 60 months (b) to your age 55. Total disability will then mean that you are
unable, due to injury or sickness, to engage in any gainful occupation. Any
gainful occupation means work for which you are reasonably suited by your
education, training[,] and experience.”
In other words, Fedesna’s insurance coverage shifted from a policy
covering an inability to “engage in [his] regular occupation,” i.e. chiropractic
medicine, to covering an inability “to engage in any gainful occupation.”
Fedesna argues that any attempt at distinguishing the initial coverage
language from the time-triggered coverage language is futile, and that in the
time-triggered language the words “any gainful occupation” refer to
whatever gainful occupation Fedesna was capable of obtaining at the time of
his disability, not five years post-injury. He contends his interpretation is
reasonable but also that CLA’s contrary interpretation is also reasonable,
therefore an ambiguity exists as well as a fact issue over the contract terms,
and a trial is necessary to sort it all out. See Wells v. Minn. Life Ins. Co.,
885 F.3d 885, 890 (5th Cir. 2018) (if, after applying the rules of construction
a policy provision is “subject to two or more reasonable interpretations, that
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Case: 21-50884 Document: 00516409252 Page: 3 Date Filed: 07/27/2022
No. 21-50884
provision is ambiguous”). CLA replies that Fedesna’s interpretation is
unreasonable, and the only reasonable interpretation is that “any gainful
occupation” means exactly what it says with no requirement to ignore the
present circumstances of the insured. To read the clause as Fedesna does
would, according to CLA, make the clause largely superfluous.
“If a policy provision is ambiguous, the court must adopt the insured's
construction of the provision, ‘as long as that construction is not
unreasonable, even if the construction urged by the insurer appears more
reasonable or a more accurate reflection of the parties’ intent.’ National
Union Fire Ins. Co. of Pittsburgh, Pennsylvania v. Hudson Energy Co.,
811 S.W. 2d 552, 555 (Tex.1991). If, however, the policy provision is
susceptible of only one reasonable interpretation, the court must enforce the
provision as written. Id.” Lubbock Cnty. Hosp. Dist. v. Nat’l Union Fire Ins.
Co., 143 F.3d 239, 242 (5th Cir. 1998).
The CLA’s interpretation is correct. There is no cabining phrase
within the post-60-month-coverage-clause that would indicate that “any
gainful occupation” means only occupations Fedesna could undertake prior
to his injury. The deletion of the word “regular” and inclusion of the word
“any” are dispositive, and Fedesna’s alternative interpretation cannot carry
his burden to show ambiguity. Further, Fedesna’s arguments about how the
employment he qualifies for nonetheless does not constitute “any gainful
employment” falls short. For example, he argues that he cannot sell medical
devices to chiropractors, even though all it requires is an undergraduate
degree and 1-2 years of experience. Fedesna holds a doctorate and has over
30 years of experience. Therefore, because there is only one reasonable
interpretation of the policy language, under the guiding principle expressed
in Lubbock, the judgment is AFFIRMED.
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