West Case Update

Disability Due to Surgery Is Injury, Not Illness

Description Appeals court affirmed that a disability suffered from complications in surgery is classified as a bodily injury, not a sickness. That meant a different classification for purposes of disability insurance.

Topic Insurance

Key Words Disability; Accidental Bodily Injury; Sickness

C A S E S U M M A R Y

Facts Paul Revere Life Insurance issued Dr. Kolb disability income policy that provided Kolb monthly sums for the rest of his life if he suffered total disability caused by “accidental bodily injury.” The policy paid him until age 65 if a disability was due to “sickness.” Kolb underwent two elective surgeries on his right eye. He suffered substantial vision loss in this eye as a result of the surgery and could no longer work as an orthopedic surgeon. Revere paid Kolb total disability benefits until he reached age 65 and then ceased payments. Kolb sued, contending he was due payments for the rest of his life and the trial court agreed. Revere appealed.

Decision
Affirmed. Whenever there is unclear language in a policy, it will be strictly construed against the insurer. The vision loss was a result of complications from eye surgery; that constitutes an accidental bodily injury, not a sickness.

Citation Kolb v. The Paul Revere Life Insurance Co., 355 F.3d 1132 (8th Cir., 2004)

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Disability Due to Surgery Is Injury, Not Illness
Description	Appeals court affirmed that a disability suffered from complications in surgery is classified as a bodily injury, not a sickness. That meant a different classification for purposes of disability insurance.
Topic	Insurance
Key Words	Disability; Accidental Bodily Injury; Sickness
C A S E S U M M A R Y
Facts	Paul Revere Life Insurance issued Dr. Kolb disability income policy that provided Kolb monthly sums for the rest of his life if he suffered total disability caused by “accidental bodily injury.” The policy paid him until age 65 if a disability was due to “sickness.” Kolb underwent two elective surgeries on his right eye. He suffered substantial vision loss in this eye as a result of the surgery and could no longer work as an orthopedic surgeon. Revere paid Kolb total disability benefits until he reached age 65 and then ceased payments. Kolb sued, contending he was due payments for the rest of his life and the trial court agreed. Revere appealed.
Decision	Affirmed. Whenever there is unclear language in a policy, it will be strictly construed against the insurer. The vision loss was a result of complications from eye surgery; that constitutes an accidental bodily injury, not a sickness.
Citation	Kolb v. The Paul Revere Life Insurance Co., 355 F.3d 1132 (8th Cir., 2004)