Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca3-15-01129/USCOURTS-ca3-15-01129-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 

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NOT PRECEDENTIAL

UNITED STATES COURT OF APPEALS

FOR THE THIRD CIRCUIT

__________

No. 15-1129

__________

DANIEL S. BOWERMAN, D.C.,

 Appellant 

v.

NATIONAL LIFE INSURANCE COMPANY

__________

On Appeal from the United States District Court

for the Eastern District of Pennsylvania

(District Court Civil No. 2-13-cv-03345)

District Judge: Honorable Ronald L. Buckwalter

Submitted Under Third Circuit LAR 34.1(a)

October 6, 2015

BEFORE: FUENTES, SMITH, and NYGAARD, Circuit Judges

(Filed: July 7, 2016)

__________

OPINION*

__________

NYGAARD, Circuit Judge.

 * This disposition is not an opinion of the full Court and pursuant to I.O.P. 5.7 does not 

constitute binding precedent.

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Daniel Bowerman appeals the District Court’s order granting summary judgment 

in favor of National Life Insurance Company. Bowerman complains that the District 

Court erred by misinterpreting a critical phrase of a disability insurance policy that 

resulted in the termination of his benefit. We will affirm.1

This opinion does not have any precedential value. Therefore our discussion of 

the case is limited to covering only what is necessary to explain our decision to the 

parties. We apply a de novo standard of review. Viera v. Life Ins. Co. of North America,

642 F.3d 407, 413 (3d Cir. 2011). Bowerman, a chiropractor, began receiving residual 

disability benefits from National Life in 1990, following a shoulder injury he suffered 

after falling off of his bike. The policy covered total disability but contained a Rider for 

Residual Disability Income Benefit. The policy contained the following language:

Until an income benefit, for any period of continuous 

disability, has been paid to the Insured’s 55th birthday, or for 

120 months, whichever is longer, occupation means the 

occupation of the Insured at the time such disability begins. 

Thereafter it means any occupation for which the Insured is 

 1 Although he does not disagree with the panel’s analysis on the merits, Judge Smith 

would vacate the District Court’s judgment with instructions to dismiss for lack of 

subject matter jurisdiction. “[A]n insurance coverage plan covering only a sole business 

owner . . . cannot qualify as an employee welfare benefit plan covered by ERISA.” 

Matincheck v. John Alden Life Ins. Co., 93 F.3d 96, 101 (3d Cir. 1996). Notwithstanding 

the allegations in Bowerman’s complaint to the contrary, evidence in the record clearly 

shows that Bowerman’s policy was an individual policy not covered by ERISA. See, 

e.g., Supplemental App. 3890 (“We have reviewed Dr. Bowerman’s policy and find it to 

be an individual [long-term disability] policy issued to a single insured: Daniel S. 

Bowerman. We therefore dispute National Life’s/Unum’s assertion that Dr. Bowerman’s 

policy and Residual Disability Income Benefits claim are governed by ERISA.”). In 

Judge Smith's view, the District Court should have dismissed for lack of subject matter 

jurisdiction. Cf. Shahmoon Indus., Inc. v. Imperato, 338 F.2d 449, 451 (3d Cir. 1964) 

(“[W]here the record creates doubt as to jurisdiction, the trial court must determine 

whether there are adequate grounds to sustain its jurisdiction over the subject matter.”).

Case: 15-1129 Document: 003112347595 Page: 2 Date Filed: 07/07/2016
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or becomes reasonably fitted by education, training or 

experience.

App. 40a.

The Rider had the following language: “This rider, while in force, and the policy 

shall be treated as one instrument. The terms of the policy shall apply to this rider unless 

the rider states otherwise.” App. 44a. It also said: “The Insured shall be deemed 

partially disabled only if, due to accidental injury or due to sickness, the Insured is not 

able: 1. to perform one or more of the important daily duties of the Insured's occupation 

as defined in this policy; or 2. to engage in the Insured's occupation as defined in this 

policy for as much time as was usual prior to the start of disability.” Id. Finally, the 

Rider stated: “The manner in which we determine: 1. periods of continuous disability 

prior to and after the Benefìt Start Date; and 2. periods of separate disability; shall be the 

same as set forth in this policy.” Id.

In the following years, Bowerman continued his chiropractic business at a reduced 

level, but also worked—full-time or nearly full-time—at Independence Healthcare 

Management-Independence Blue Cross. Additionally, he worked as a consultant. After 

paying him benefits for twenty-one years, National Life sent Bowerman a letter in 2011 

informing him that, upon its investigation and assessment of the facts in his file, it was 

terminating his partial disability benefit on his fifty-fifth birthday because he no longer 

met the definition of disability. It determined that his full-time work as Medical Director 

at Independence Healthcare Management-Independence Blue Cross was fitted to his 

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education, training or experience, making him ineligible for continued benefits. He

pursued an administrative appeal of this decision, but was not successful. 

Bowerman claimed before the District Court that National Life violated ERISA by 

terminating his residual insurance benefit.2

 The essence of Bowerman’s argument is that 

the District Court erred by failing to identify an ambiguity in the insurance policy, and 

erred by refusing to resolve the ambiguity in his favor. Specifically, Bowerman contends 

that the District Court erred by focusing only on the term “occupation” appearing in the 

policy, and not accounting for the separate term “Insured’s occupation” that appears in 

the Rider.

The District Court determined that the plain language of the Rider tied the 

definition of occupation to the Policy. It further determined that Bowerman’s attempt to 

create a distinct term in the Rider—“Insured’s occupation”—with a unique meaning is 

not supported by the language of the policy. We agree on all points.

‘“Disagreement between the parties over the proper interpretation of a contract 

does not necessarily mean that a contract is ambiguous.’” Viera, 642 F.3d at 419 

(quoting 12th Street Gym, Inc., Robert Guzzardi v. General Star Indem. Co., 93 F.3d 

1158 (3d Cir. 1996).). The language of the Rider is unequivocal. The definition of 

partial disability is “to perform one or more of the important daily duties of the Insured's 

occupation as defined in this policy,” and “to engage in the Insured's occupation as 

defined in this policy for as much time as was usual prior to the start of disability.” App. 

 2 The District Court, by stipulation, exercised de novo review over National Life’s 

decision to terminate, pursuant to 29 U.S.C. § 1132(a)(1)(B).

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44a (emphasis added). Importantly, the Rider also states that “the manner in which we 

determine: 1. periods of continuous disability prior to and after the Benefìt Start Date . . . 

shall be the same as set forth in this policy.” Id. (emphasis added). This plainly ties the 

Rider to the policy to define the term “occupation” and to understand how periods of 

continuous disability are determined.

Turning to the policy, it states that “[u]ntil an income benefit, for any period of 

continuous disability,” has been paid for ten years or to the claimant’s fifty-fifth birthday

(whichever is longer) “occupation means the occupation of the Insured at the time such 

disability begins.” App. 40a (emphasis added). We regard the use of the word “any” as

complementing the Rider’s language referring to the policy. “Thereafter it means any 

occupation for which the Insured is or becomes reasonably fitted by education, training or 

experience.” Id. (emphasis added). The District Court reasonably interpreted “it” as 

referring to the term “occupation.” 

As a result, the District Court properly determined that the Rider and policy 

provided a definition of “occupation” that used one standard (“occupation of the Insured 

at the time such disability begins”) in the period of continuous disability up to the first ten

years or to age fifty-five (whichever is later), and a second standard to define the term 

after that (“any occupation for which the Insured is or becomes reasonably fitted by 

education, training or experience”). App. 40a.3

 For this reason, we reject Bowerman’s 

contention that the policy was ambiguous on this point. Accordingly, we do not agree 

 3 Because we agree that the language of the policy is not ambiguous, we conclude that 

reference to material extraneous to the policy is not proper here.

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with his assertion that the Rider should be construed to mean that residual disability 

benefits are not subject to a changing standard in the determination of what the term 

“occupation” means.4

For these reasons, we conclude that the District Court’s interpretation of the policy

was not erroneous, and we will affirm the order granting summary judgment in favor of 

National Life.

 4

We will not address Bowerman’s argument raised for the first time on appeal that the 

Pennsylvania Code supports his definition of occupation for partial disability. 

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