Provident Life and Accident Ins. v. Hallum
| Decision Date | 27 January 2003 |
| Docket Number | No. S02Q1307.,S02Q1307. |
| Parties | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY v. HALLUM. |
| Court | Georgia Supreme Court |
OPINION TEXT STARTS HERE
Carter & Ansley, Atlanta, H. Sanders Carter Jr., Andrea K. Cataland, for appellant.
Goldner, Sommers, Scrudder & Bass, Glenn Scott Bass, Ramsey Kazem, Atlanta, for appellee.
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.
The policy defines injuries to mean "accidental bodily injuries occurring while your policy is in force." Sickness is defined as "sickness or disease which is first manifested while your policy is in force." The evidence in the record demonstrates that Hallum does not have, and has not had, any of the diseases generally associated with carpal tunnel syndrome. Rather, the record shows that his condition was caused by thirty years of performing the hand motions required by his obstetrics/gynecological practice, hence the Eleventh Circuit's focus on carpal tunnel syndrome caused by repetitive hand motions. Georgia law distinguishes between insurance coverage for accidental injuries and coverage for injuries caused by accidental means. 1 An accidental injury is an injury that is unexpected but may arise from a conscious voluntary act.2 In contrast, an injury from accidental means is one that is the unexpected result of an unforeseen or unexpected act that was involuntarily or unintentionally done.3 For example, in Winters v. Reliance Standard Life Insurance Company,4 the insured died from voluntarily ingesting too much alcohol; her blood alcohol level was .49 grams percent at the time of death. The insurance policy covered "bodily injury... caused by accident," which the court of appeals found insured against death by accidental means, not accidental results. Although the insured's death may have been an unexpected result, the court of appeals held that the acts that caused her death were voluntary and intentional, and her policy therefore did not cover her death.
In contrast to the policy in Winters, the insurance contract here uses the words "accidental bodily injuries," which, in the context of this policy, means a bodily injury that was unexpected, but could have arisen from a conscious or voluntary act. By using "accidental"...
To continue reading
Request your trial
-
BILEZIKJIAN v. UNUM LIFE INS. CO. OF AMERICA, Case No.: SA CV 07-1438 AHS (ANX).
...not matter" because it would "pay benefits for the disability which provides the greater benefit." Provident Life & Accident Ins. Co. v. Hallum, 276 Ga. 147, 148, 576 S.E.2d 849, 851 (2003). The insurance company paid monthly benefits under the "sickness" provision of the policy for 48 mont......
-
Lawler v. State, S02P1377.
... ... [Cit.] The need to protect or preserve life or avoid serious injury is justification for what would be ... ...
-
Carney v. Paul Revere Life Ins. Co.
...here, we find that each repetitive trauma experienced by Dr. Carney was a "bodily injury." See Provident Life & Accident Insurance Co. v. Hallum, 276 Ga. 147, 576 S.E.2d 849 (2003) (where an identical provision was found to support a finding of bodily injury, "a person who unexpectedly suff......
-
Owners Ins. Co. v. James
...coverage for accidental injuries and coverage for injuries caused by accidental means. See Provident Life and Accident Ins. Co. v. Hallum, 276 Ga. 147, 147, 576 S.E.2d 849, 851 (2003). An accidental injury is an injury that is unexpected but may arise from a conscious voluntary act. Id. In ......
-
Death Penalty Law - Michael Mears and Holly Geerdes
...O.C.G.A. Sec. 17-10-35(c)(3)). 342. 275 Ga. at 56, 572 S.E.2d at 595 (citing O.C.G.A. Sec. 17-10-35(c)(3)). 343. 276 Ga. at 236, 576 S.E.2d at 849 (citing O.C.G.A. Sec. 17-10-35(c)(3)). 344. O.C.G.A. Sec. 17-10-35(c)(1). 345. Arevalo, 275 Ga. at 399, 567 S.E.2d at 309; Braley, 276 Ga. at 56......
-
American Empire Surplus Lines v. Hathaway Dev. Co.: an Important Occurrence in Georgia Insurance Law
...coverage for accidental injuries and coverage for injuries caused by accidental means. See Provident Life and Accident Ins. Co. v. Hallum, 276 Ga. 147, 147, 576 S.E.2d 849, 851 (2003). An accidental injury is an injury that is unexpected but may arise from a conscious voluntary act. Id. In ......