Provident Life and Accident Ins. Co. v. Hallum

Plaintiff's disability insurance policy covered his carpel tunnel syndrome resulting from 30 years of OBGYN work as an injury, rather than a sickness or disease.

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Alton Hallum, Jr. suffers from carpal tunnel syndrome. Provident Life and Accident Insurance Company issued Hallum a disability insurance policy that provided greater coverage for disabilities arising from injuries than those caused by sickness. Hallum sued Provident Life after it refused to categorize the cause of his condition as an injury. The United States Court of Appeals for the Eleventh Circuit certified to this Court the question of whether, under Georgia law, carpal tunnel syndrome caused by repetitive hand motion should be classified as an injury or a sickness, as those terms are used in the policy. We conclude that, under Georgia law, a person who unexpectedly suffers from carpal tunnel syndrome brought on by years of voluntary repetitive hand movements that renders him disabled has suffered an “injury,” as that term is defined in this Provident Life insurance policy.

Hallum is a retired physician, who specialized for thirty years in obstetrics and gynecology. The Provident Life insurance policy covered disabilities due to injuries or sickness that rendered Hallum unable to practice his occupation. The parties agree that Hallum’s carpal tunnel syndrome has made him incapable of continuing his medical practice, but because of Hallum’s age when he claimed total disability, the duration of his coverage depends on whether his disability is due to an injury or a sickness. If the former, then Hallum is entitled to lifetime coverage. If the latter, then Hallum’s benefits last four years. Both parties agree that there is no default designation for a total disability. Therefore, the insured must show that his disability is due to either a sickness or an injury before he receives any coverage at all.

Provident Life and Accident Ins. Co. v. Hallum

Plaintiff's disability insurance policy covered his carpel tunnel syndrome resulting from 30 years of OBGYN work as an injury, rather than a sickness or disease.

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