Court Rules for Paul Revere/UNUM and Holds Plaintiff is not Totally Disabled
Author: Attorney Gregory Dell
In Fiorentini v. Paul Revere Life Insurance Company, Plaintiff Henry Fiorentini, CEO and owner of his own information-technology company Panatech, was granted total disability in 2009 due to problems he had when basal cell carcinoma attacked his right ear. The ear was amputated in 2008.
In 2014, Paul Revere learned Plaintiff had returned to work full-time, assuming his position as CEO, so it terminated his benefits. Plaintiff filed a lawsuit for breach of contract in the District Court for the Northern District of Illinois, Eastern Division, alleging that Paul Revere improperly terminated his total disability benefits. The District Court ruled in favor of Paul Revere and Fiorentini appealed.
Fiorentini is Not Disabled Under the Terms of the Disability Contract.
Even though Plaintiff returned to work full-time, he claimed he should still receive disability benefits because he could not do one of the four parts of his occupation. The Appellate Court disagreed, finding that the policy language was unambiguous in its definition of total disability, which said that total disability means “You are unable to perform the important duties of your occupation.”
The appellate court upheld the district court’s ruling, finding that the one part of his job that he said he could not perform was minor. He was still able to “perform all other important duties of his position and to exercise full control of the company.” The policy’s total disability provision did not cover the insured who had “diminished ability to perform his occupation.”
Policy’s “Residual Disability Benefits” Provision Could Have Helped Fiorentini
Paul Revere suggested that Plaintiff apply for residual disability benefits which would have likely helped him. It provided some benefits to those who, like Plaintiff, suffered from a reduced capacity to work, but could still work. Plaintiff refused to apply for these benefits and allowed his policy to lapse.
Facts Did Not Support Plaintiff’s Claim
Although Plaintiff claimed the one portion of his job he could not do was to meet with new clients to convince them to buy his company’s products, he was able to meet face-to-face with continuing clients, renewed his pilot’s license and often flew to meet other recreational pilots for breakfast. He conducted a 90-minute seminar for other flying enthusiasts, and played weekly in an adult hockey league. The court found this evidence did not support his allegations that he could no longer meet with new clients in order to sell them the products of his company, Panatech.
This case was not handled by our office, but we believe it may be helpful to those who can go back to work, but not perform all of their job duties. If you have any questions about this case, or any aspect of your disability claim, contact us for a free consultation.