Laun v. AXA Equitable Life Ins. Co.

The insured was not entitled to reclassification of his disability insurance designation from sickness to injury, since the insured's osteoarthritis admittedly contributed to his total disability, and the plain language of the policy barred reclassification of those disabilities resulting in whole or in part from sickness.

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Dr. Frederick Laun, an orthopaedic and hand surgeon, seeks a declaratory judgment against AXA Equitable Life Insurance Company “Equitable” and Disability Management Services “DMS”. Laun claims that Equitable, which provides his disability income insurance, and DMS, Equitable’s third party administrator, improperly refused to change his disability insurance designation from sickness to injury, which would result in increased benefits. The Superior Court of Fulton County granted summary judgment in favor of the defendants, and Dr. Laun appeals. Finding no error, we affirm. Summary judgment is proper when there is no genuine issue of material fact and the movant is entitled to judgment as a matter of law. OCGA § 9-11-56 c. We review a grant or denial of summary judgment de novo and construe the evidence in the light most favorable to the nonmovant. Home Builders Assn. of Savannah v. Chatham County, 276 Ga. 243, 245 1 577 SE2d 564 2003.

Dr. Laun secured a disability income insurance policy with Equitable on January 28, 1983, when he was 40 years old. The policy provides monthly benefits for Laun in the event of a “total disability” that leads to “the complete inability of the Insured, because of injury or sickness, to engage in the Insured’s regular occupation.” It defines two types of total disability, and they are treated differently. “Accident Total Disability,” defined as “total disability resulting from injury,” provides lifetime benefits. On the other hand, “Sickness Total Disability,” which includes “medical or surgical treatment of . . . any sickness or disease,” only provides benefits through age 65. The policy states that “total disability caused or contributed to by a policy-defined sickness will not be considered accident total disability.” Emphasis supplied.

Laun v. AXA Equitable Life Ins. Co.

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