Donaldson v. Pilot Life Ins. Co.
| Decision Date | 10 February 1986 |
| Docket Number | Nos. 71491,71499,s. 71491 |
| Citation | 341 S.E.2d 279,177 Ga.App. 748 |
| Parties | DONALDSON v. PILOT LIFE INSURANCE COMPANY; PILOT LIFE INSURANCE COMPANY v. DONALDSON. |
| Court | Georgia Court of Appeals |
O.L. Crumbley, Jr., Charles R. Free, Macon, for appellant.
William C. Harris, John B. Harris III, Macon, for appellee.
On March 13, 1980 Cecil R. Donaldson fell down some stairs while at work. At the time of the accident, Donaldson had a policy of insurance with Pilot Life Insurance Company (Pilot Life) which provided disability benefits in the event of injury or sickness. Donaldson missed work for approximately one week after his fall, but then returned to limited duty at the behest of his employer. Although unable to perform many of his normal duties, and though he missed a great deal of time, Donaldson continued to work until August 11, 1980. At that time Donaldson was fired because he could not perform all the duties inherent in his job. After his termination Donaldson filed a claim with Pilot Life seeking total disability benefits due to injury.
The pertinent parts of the Pilot Life policy held by Donaldson provide for total disability in the following manner. Total disability is defined in the policy as "the continuous complete inability of the Insured due to injury or sickness to perform any and every duty pertaining to his occupation until Monthly Indemnity has been payable under this Policy during any period of such disability for 24 months or for the period for which Monthly Indemnity is payable, if less ... provided that in no event shall 'total disability' exist for any purpose of this Policy during any period in which the Insured is engaged in his or any other gainful occupation." The policy recognizes two different types of total disability, one due to injury and one due to sickness. If the insured is totally disabled due to injury, he receives benefits for five years; if the disability is due to sickness, benefits are paid only for one year. The policy also provides: "If a period of total disability of the Insured due to injury commences while this Policy is in force but more than 60 days after such injury is sustained, such total disability shall, for the purpose of this Policy, be deemed to have been due to sickness."
After consideration of Donaldson's claim, Pilot Life found that the disability resulted more than 60 days after the injury, and began to pay Donaldson under the policy provisions for total disability due to sickness. It refused Donaldson's demand that it pay him the four additional years of benefits provided if the total disability is deemed to be due to injury as defined by the policy. Donaldson then brought this action seeking payment of the additional benefits. Each party moved for summary judgment, and in each case the motion was denied by the trial court. Each ...
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