The Fine Print Matters In Insurance Coverage Disputes

Many insurance disputes revolve around the fine print of the policy.  Unfortunately, the policy’s specific language may define important terms differently from what the insured understood or was led to believe.  This was the case in the Seventh Circuit Court of Appeals’ recent decision in Fiorentini v. Paul Revere Life Insurance Company.

In Fiorentini, the plaintiff became disabled during aggressive cancer treatment.  The insurer affirmed coverage and paid disability benefits while the plaintiff remained unable to work.  But a dispute arose after the plaintiff went back to work.  The insurer argued the plaintiff was no longer disabled since he had returned to work, but the plaintiff argued he remained disabled because, despite being back at work, he still could not perform all of his job duties.  Specifically, the plaintiff argued that while he could perform most job duties, aftereffects of his cancer treatment left him unable to meet face-to-face with potential clients.

The plaintiff relied on the policy’s definition of “total disability” which provided the plaintiff was disabled if he was “unable to perform the important duties” of his job.  The plaintiff argued that meeting in person with potential client was an important duty.  Hence, the plaintiff claimed that being unable to meet in person with potential clients rendered him disabled even admitting he could do all the other functions of his job.

The court read the policy differently.  The court interpreted the definition of disability to cover only the “inability” to do important job duties, not merely a “diminished” ability to perform.  The court concluded that even assuming the plaintiff’s ability to meet face-to-face with potential clients was diminished by the aftereffects of his cancer treatment, the client was not totally unable to perform his job duties.  Since the court decided that meeting in person with new clients was not essential to the plaintiff’s job, being unable to meet with new clients only diminished the plaintiff’s ability to perform his duties – it did not render the plaintiff unable to perform his duties.

In short, the court parsed the policy fine print in a way that undercut the insured’s expectations about what would be covered.  The Fiorentini decision illustrates the importance that policyholders carefully scrutinize policy language to learn their rights.