FI L ED U.S. COURT OF A P P E A LS E LE V EN T H C IR C U IT J ANUARY 19 , 2006 THOMAS K. KAH

N CL ERK [DO NOT PUBLISH] IN THE UN ITED STATES COURT OF APPEALS FO R T HE EL EV EN TH CIRC UI T

____ ____ ____ ____ ____ ____ N o. 05- 1061 6

____ ____ ____ ____ ____ ____ D. C. Docket N o. 03-00692 -CV -RL V- 1

STEVEN A. BLASKE, Pl ai nti ff -Appe llant, ve rs us
PROVIDENT LIFE AND A CCIDENT INSURANCE COM PANY, De fendant-Appellee.

____ ____ ____ ____ ____ ____ Appeal f rom the United State s District Court fo r the N orthe rnD istri ct

of G eo rg ia

____ ____ ____ ____ ____ ____ _ (J an ua ry19, 200 6) Be fo re E D MO N D SO N , Ch ie f Judg e, and B L A CK , and F A Y , Ci rc uit Jud ge s. PE R CU RIA M:Th e po lic ie s d e fi ne d th e fo llo wi ngte rm s: 1 Total D isa bil ity

or Totall y Disabled

means that due to injuries or sickness, you are not able to per form the substantial and material duties of your occ upation. Re sid ua l D isa bil ity or Residually Disabled means due to injuries or sickness, you are not a ble to d o o ne or

mor e of your s ub sta

nti a l and mate ri a l da ily

bu sin e ss d

uti e s o r you

are no t a ble to do y our usual daily

business for a s much time as it would normally take you. 2 This case concerns an order deny ing pl aintiff’ s long term insurance dis ab ili ty be ne fi ts unde r pol ic ie s is sue d by de fe ndant- ap pe lle e, P ro vid en t L if e an d Ac cident Insurance Com

pany (here after

ref erre d to as “ Provident”). The district co urt gr an te d sum

m ar y j udgm en t i n f

av or of P ro vid en t, hol din g th at

a s am atte r of law, the plaintiff failed to tim ely file notice of his disabilit y claim , and his injuries did not f al l i nto the de fi nit ionof

“ T ota lly D isa ble d, ” as de fi ne d inthe P ro vid en t policies. W e re verse. I. F actual Background In198 1, S te ve n A . Bl as ke ( he re af te r re fe rr ed

to as “ Bl as ke ”) start ed

his em ploym ent as in-hous e counsel for U nisy s Corporation. A fter a couple of y ears of em ploym ent, P rovident is sued four disabil ity insurance policies to Blaske. E ach o f th e s e p o l i c i e s p r o v i d e dl i f e t i me b e n e f

i t s i nth e e v e n tth a tB l a s k e b e c a me

“ T ota lly or Re sid ua lly D isa ble d” due to sic kne ss o r inj ur y be fo re a ge 60. 1 In Marc h 200 0, Blaske inj ured his back while lifting box es at his hom e. O ve r the ne xt c oupl e of

m onths B la ske c ont inu ed to w ork a t U nis y s, but

w as inAcc ordingto Blaske ’s deposition he admitted that, “I might be vie wed a s damag ed 2 g oods, as somebody

who was e x pensive a

nd could not be re lied upon health-w ise.” pg .50-51. 3 considerable pain. O n May 8, 2000, Blaske c onsu lted with Dr . C hristop her E dw ar ds, aboard

c er tif ie d ortho pe dic sur ge on who s pe ci al iz es in dis or de rs of the spi ne . O n S ep te m

be r 28, 200 0, a ft er

f our m onths o f unsu cc es sf

ul tre atm en t, Bl as ke decided to und ergo back surgery . D ue to the back surgery , B laske we nt on m edical le av e fro m

Sep te m be r 19 , 20 00 , th ro ug h F eb ru ary 28 , 20 01 . A cc or din g to the r ec or d, in la te 200 0, U nis y s announc ed that i t w as of

fe ri ng earl y r et ir em en t t o 1, 500 em

plo y ee s, and tha t anothe r 1, 500 em plo y ee s w oul d be la id o ff . Be fo re r et

ur nin g to w ork onMarc h 1, 200 1, Bl as ke te sti fi ed that he re ce ive d “ hin ts” that he m igh t be one of the e m plo y ee s th at

w oul d no t c ont inu e to w ork f or U nis y s. I n January

200 1, in pr ep ar at ionof

pos sib ly be ing la id o ff

a s in 2 hous e co unse l f

or U nis y s, Bl as ke too k and p as se d th e G eo rg iaRe al E state Com m issio n test. A lso, in January 2001 , B laske sent Provident a claim form dated O ct obe r 16, 200 0, in w hic h B la ske r ep orte d hi s ba ck inj ur y f or the pur pose s of re ce ivi ng N on- D isa

bli ng I nj ur

y be ne fi ts unde r one of

the pol ic ie s pr ovi de d by Pr ovi de nt. P ro vid en t pa id the N on- D isa bli ng I nj ur

y be ne fi ts i n F eb ru ar

y 200 1. On Mar ch 1, 2001, Blaske r eturned to work, with no apparent m edical re str ic tio ns, but

w iththe ge ne ra l a dvi ce “ to b e care fu l and n ot t o do m or e than heAcc ordingto the rec ord, B laske a lleg edly did not try

to work a f

ull day to see if he was 3 “ To ta lly Di sa ble d. ” Ins te a d, he uti lize d th e we e k o f M arc h 1 to n e g oti ate a se pa ratio n a g re e me nt, and “wrap thing s up.” Bla ske testified that he had re gular tele phone conve rsations about his situation and 4 phy sic a l c on dit ion

wi th M s. L ou ise Pon s, a

Cus tom e r C are Spe c ia lis t at Pr ov ide nt. 4 fe lt co m fo rt ab le doi ng. ” A s B la ske pr ed ic te d, on the sam e day he r et ur ne d to w ork, U nis y s pr opos ed

ase paratio n of

e m plo ym en t a gr ee m en t. O n M ar ch8, 200 1, Bl as ke f ina liz ed his se paratio n a gr ee m en t. P ur suant t o th e te rm s of the a gr ee m en t, Blaske rem ained on the pay -roll through J uly 16, 2001, but as of March 8, he w as no l onge r to r ep ort f

or w ork a t U nis y s. 3 A ft er be ing te rm inate d by

U nis y s, Bl as ke w orke d inA tlanta a s ar ea l e state agent. D uring part of April, May and June 20 01, Blaske w orked part tim e at Re /M ax G re at er

A tlanta . I n a ddi tio n, start ing in June 200 1, thr oughthe spr ing of 2003 , B laske worked f

ull-tim e as a realtor w ith Coldwell Banker. S i n c e J an u ary 2 0 0 1 , w h e n B l a s k e s e n tP r o v i d e n tth e N o n - D i s ab l i n g f o rm, th ere h adbe en no fur th er wri tt en co m m un ic at io n b et ween th es e p art ie s. On 4 N ove m be r 27, 200 1, P ro vid en t r ec ei ve d adis ab ili ty c la im sig ne d by

Bl as ke , a lon g with an A ttendin g Phy sician Statem ent signed b y Dr . E dwar ds claim ing “ Total D isa bil ity . ” O n D ec em

be r 6, 200 1, Ms . P ons co nduc te d a te le phon e int er

vie ww ith Blaske, during which tim e she inform ed him that his dis ability

claim wa s filed“Written notice of a claim must be g iven within 20 day s after a cove red loss starts or a s 5 soon as re asonably

possible.” (Emphasis adde d) 5 u n t i m el y. Ne v er th el es s , du ri n g J an u ary 2 0 0 2 , P ro v i d en tre qu es t edBl as k e’s

5 m ed ic al r ec or ds i n or de r to d et er m ine w he the r Bl as ke f

it the de fi nit ionof

“ T ota lly D isa ble d. ” I nc lud ed

the re in w as am ed ic al e va luatio n by aD r. Jos ep h R . T hom as , a board c er tif ie d ortho pe dic sur ge on. D r. T hom as c onc lud ed that B la ske c oul d st ill pe rf orm a s an a tto rn ey , that he m ad e a sa tis fa ct or y r ec ove ry f ro m his sur ge ry , and that there w as no evidence of any significant dis c herniation or neural en cr oa ch m en t. P ro vid en t the n no tif ie d B la ske that i t w as e xe rc isi ng i ts r igh t t o obtain an in dependent m edical exam ination (“ IME ”). Dr . T apan K. Da ftari co nduc te d th e IM E and c onc lud ed that B la ske ha d pe rs ist en t ne rv e ro ot p ro ble m s, and could n o long er per form all of his occupational respon sibili ties. H owever , D r. Daft ari co nc lu de d B la sk e co ul d s ti ll work3-4 ho ur s p er d ay wit h fr eque nt bre ak s. Ac cording to Blaske’s deposition , he had the following respon sibili ties w hil e em plo y ed a t U nis y s: a

ppe ar ing in co urt, giv ing ope nin g and c los ing state m en ts, c ro ss- ex am ini ng w itn es se s, a tte ndi ng a dm ini str at ive he ar ing s and appearing at depositio ns and m ediations. Blaske also contended th at his norm al w ork day w as 12- 14 h our s pe r day , and tha t he f re que ntl y ha d to tr av el a s th e inhous e lit igator

f or U nis y s.6

On April 19, 2002, Provident no tified Blaske that his claim for “ Total D isa bil ity ” be ne fi ts w as de nie d, be ca use he did

not m ee t the de fi nit ionof

“ T ota lly D isa ble d, ” as de fi ne d inthe pol ic y . P ro vid en t di d su gge st tha t he m igh t be e lig ibl e fo r “ Re sid

ua l D isa bil ity ” be ne fi ts, and r eque ste d se ve ra l f inanc ia l do cum en ts f

ro m B l a s k e . Ac c o r d i n g t o th e r e c o r d , B l a s k e n e v e r r e c e i v e dan y “ R e s i du a l Di s ab i l i ty” be ne fi ts. W e dis ag re e w iththe low er c ourt’ s de ci sio n th at

no g enuin e iss ue of m at er ia l f ac t e xis ts w ithr eg ar d to both no tic e an d di sa bil ity be ne fi ts.
II. St andard of Re view W e re vie wr

uli ngs on m oti ons fo r sum m ar y j udgm en t de novo by

appl y ing the sam e le ga l st an dard s us ed by the dis tr ic t c ourt. S ee G ranit e St at e O utd oor Advertising, Inc. v. City

of St. Peter sburg, 348 F.3d 1278 , 1281 (11th Cir. 2003 ).

III . A na lys is Bl as ke c ont en ds tha t the dis tr ic t c ourt e rr ed in gr an tin g P ro vid en t’ s m oti on fo r sum m ar y j udgm en t. Bl as ke arg ue s th at age nui ne iss ue of

m at er ia l f

ac t e xis ts re gard ing w he the r his de lay in pr ovi din g no tic e w as r ea sona ble . A cc or din g to the p o l i c i e s , B l a s k e wa s r e qu i r e dt o p r o v i d e wr i t t e nn o t i c e o f ac l a i m “ w i th i n2 0 d ays7

af te r a co ve re d lo ss s tart s or a s so on a s r ea sona

bly pos sib le . ” (E m

pha sis a dde d) U nde r G eo rg ialaw , “ tim el y not ic e to the ins ur ed

of ac la im or oc curr en ce is a conditi on precedent to the insu rer’ s dutyto defend or pay .” Equitable L ife A ssuranc e So c’ y

v. S tud en ic , 77 F . 3d 4 12, 415 ( 11th Ci r. 199 6) ( ci tin g I ns. Co . of N. Am . v. Wald ro up , 46 2 F . Sup p. 1 61 , 16 2 (M .D. Ga. 19 78 )). A cc or din g to the r ec or d, it is undi sput ed

that B la ske f

ai le d to pr ovi de w ri tte n no tic e w ith in 2 0 day s of the c om m en ce m en t of

the a lle ge d di sa

bil ity . I t i s al so undi sput ed

that B la ske did

not f ile his c la im

f or “ T ota l D isa

bil ity ” unt il Novem ber 2001. How ever, Blaske contends that he provi ded noti ce as soon as reasonably

possi ble. G eogia courts have held that su ch a notice requirem ent is m et as lon g a s no tic e is g ive n “ w ithr ea sona ble dil ige nc e an d w ith in a r ea sona ble le ng th of t im e in vi ew of

th e at te nd in g c irc um st an ces of e ach pa rti cu la r cas e.” Bi tum ino us C as ua lty

Co rp . v. J. B. F or

re st & S ons, I nc . , 132 G a. App. 714 , 719 , 209 S.E .2d 6 (1979). Blaske contends th at his delay in provid ing no tice to Provident was re as ona ble be ca use , e ve n th oughhis dis ab ili ty a ct ua lly be gan inS ep te m

be r 2000 , he did not le ar n th at he w as “ T ota lly

D isa ble d” und er

the te rm s of

the pol ic ie s, unt il O ct obe r 31, 200 1, w he n D r. E dw ar ds, his tr eatin g ph y sic ian, inf orm ed him th a th e c o u l dn o l o n g e r

w o rki n h i s o c c up a t i o na s al i t i g a t i o na t t o rn e y. A tth e t i me8

of the sur ge ry

both B la ske and D r. E dw ar ds b el ie ve d th at the pr oc ed

ur e w oul d be successful, and that Blaske w ouldbe able to perform his sub stantial and m aterial res po ns ib il it ie s as a li ti ga to r. H ow ev er , a s m en tio ne d a bove , Bl as ke c ont en ds tha t a ft er his sur ge ry , he w as una ble to re tur

n to w ork and p er fo rm

his sub stanti al and m at er ia l du tie s a s a litigato r. Ac cording to th e re cord, on O ctober 31, 2001, Blaske had a scheduled appoin tm ent with D r. Edw ards to discuss his condi tion. Blaske contends that dur ing thi s a

ppoi ntm en t he le ar

ne d f or the f ir st t im e that hi s c ondi tio n w oul d no t im pr ove , and tha t he w as “ T ota lly D isa ble d” a s de fi ne d inthe te rm s of the pol ic ie s. W ith in t

w o day s of

the O ct obe r 31 a

ppoi ntm en t, Bl as ke c ont ac te d M s. Po ns an d a dv is edhe r th athe wou ldbe m ak in g acla im for“ Tot al Dis ab il it y .” Blaske contends th at the notice requirem ent shou ld have started after Oc tober 2001 , be ca

use that i s whe n, f

or the f ir st t im e, he w as not if

ie d th at he w as “ T ota lly D isa ble d” a s de fi ne d inthe te rm s of the pol ic ie s. Provident dis agrees, and argues that even thoug h Blaske wa s told b y Dr . E dw ar ds i n O ct obe r 2001 that he w as “ T ota lly D isa ble d, ” as de fi ne d inthe pol ic ie s, Bl as ke sho uld

have be enaw ar e of

his dis ab ili tie s whe n he r et ur ne d to w ork onMarc h 1, 200 1.9

“ A s is tr ue ge ne ra lly

w ithr eg ar ds t o is sue s r el at ing to re as ona ble ne ss and suf fi ci en cy of c om pli an ce w ithstate d c ondi tio ns, que sti ons of the a de qua cy

of the notice and the m erit of [ the insured’s] claim of j ustification are ones of fac t which m ust be r es olv ed

by a j ur y . . . . ” St at e Farm

Auto . I ns. Co . , v. S loan, 150 G a. App. 464, 466, 258 S.E .2d 146, 148 (1979 ). A lth oughit

is unc le ar

if Bl as ke w ill pr ev ai l onthi s c ont en tio n, it c er ta inl y raises a genuine issue of m aterial f act, which should n ot have been extingu ished as a m atte r of

law . S ee S tud en ic , 77 F . 3d at 41 5; s ee a lso N or fo lk F ir e In s. Co . v. Cum ba a, 128 G a. App. 196 , 196 S . E . 2d 1 76 ( 1973 ) (d et er m ini ng the re as ona ble ne ss o f a 19 m onth de lay sho uld be sub m itt ed

to a j ur y ). W e fi nd tha t the que sti on o f w he the r the not ic e w as giv ena s so on a s r ea sona bly pos sib le sh ou ldbe de ci de d b y

a jury, an d n ot as am at te r of law. Ne xt, Pr ovid ent argues in the alternative, that even if the claim had been tim el y m ad e, Bl as ke w oul d no t be e nti tle d to “ T ota l D isa bil ity ” be ne fi ts s inc e he w as not “ T ota lly D isa ble d” a s de fi ne d un de r the te rm s of the pol ic ie s. B la ske ar gue s th at

the dis tr ic t c ourt e rr ed

in gr an tin g sum

m ar y j udgm en t be ca

use he pr ovi de d su ff

ic ie nt e vid en ce to cr eate age nui ne iss ue of m at er ia l f

ac t r eg ar din g h i s i n ab i l i ty t o p e r f

o rm h i s s ub s t an t i a l an dmat e r i a l du t i e s a s al i t i g a t i o na t t o rn e y.10

Th e p o l i c i e s p r o v i d e dth a tB l a s k e wo u l db e e n t i t l e dt o “ To t a l Di s ab i l i ty” be ne fi ts i f he w as “ una

ble to pe rf

orm the sub stanti al and m at er ia l du tie s of [ his ] occupation.” H owever , B laske and Provident dis agree about what occupational duties Blaske perform ed at U nisy s before inj uring his back. B laske contends th at his oc cu pa tio n a t U nis y s w as “ in- hous e lit igatio n a tto rn ey , ” w he re as P ro vid en t ch arac te riz edBla sk e’s oc cupa ti on as a“ ru n- of -th e-m il l i n- ho us e co un se l.” A lth oughthe dif

fe re nc e m ay

be aque sti on o f se m an tic s, the f ac ts s ur ro undi ng w hic h du tie s B la ske pe rf or m ed are a ll im

portant. T he te rm s of

the pol ic ie s st at e that “ T ota l D isa bil ity , ” w ith in the m eanin g of the c ontra ct s, oc curs w he n th e ins ur ed is una ble , due to inj ur

y or sic kne ss, to pe rf orm the sub stanti al and m at er ia l du tie s of the ins ur ed ’ s r eg ular oc cu pa tio n. T he re fo re it

is cr iti ca l t o de te rm ine w ha t oc cu pa tio na l du tie s B la ske ha d a t U nis y s. B l a s k e c o n t e n d s th a th i s jo b a tUn i s ys r e qu i r e dh i m t o tr a v e l e x t e n s i v e l y, atte nd tri al s, part ic ipate in adm ini str at ive he ar ing s, arg ue m oti ons, and s it thr ough lengthydepositi ons and alternative dis pute resolutio n session s. H e contends that his pr es en t c ondi tio n pr ev en ts h im f ro m pe rf orm ing a ll of

the se dut ie s. Pr ovi de nt d isa gr ee s, and arg ue s th at Bl as ke a dm itt ed

in his de posi tio n and re sum e that he ha d othe r re spon sib ili tie s, li ke dr af tin g c ontra ct s, r ev ie w ing pa pe rs , an d e va luatin g a gr ee m en ts, a ll w hic h c oul d be don e notw ith standi ng h is c ur re nt11

dis ab ili ty . P ro vid en t a lso poi nts out that B la ske c onc ed ed

in his de posi tio n th at

he c o u l ds t i l l wo rk3 - 4 h o u r s p e r d ay. Bl as ke arg ue s th at

e ve n th oughhe c ansti ll part ic ipate in a fe wli tig at ion activities for a c oupl e of hours, he c an no lon ger assum e his 10-12 h our work day as a litigator. H e contends that he is si m ply unable to perform

the required duties an d r es pons ibi lit ie s of

an a tto rn ey

li tig at or . I n a ddi tio n, Bl as ke c ont en ds tha t hi s em plo ym en t w ithCo ldw el l B an ke r, a s ar ea l e state a ge nt, c or ro bor at es thi s propos ition . T he argum ent is that sin ce he is unable to work as an attorney lit igator , he ha s tr ie d r ea l e state in ana tte m pt t o do the m ost

he is phy sic al ly

able t o d o . We c o n c l u d e th a tth i s c r e a t e s ag e n u i n e i s s u e o f f a c tf o r aju ry.
IV . C on cl us ion Our r eview of

this record convinces us th at there are genuine issues of fact as to: (1)Whether Blaske’ s claim notice was given as soon as reasonably possi ble, (2)What j ob du ties Blaske had at U nisy s, and (3) Whether Blaske’ s m edical co ndi tio n r en de re d hi m “ T ota lly D isa ble d, ” as de fi ne d inthe te rm s of the pol ic ie s. T his sum m ar y j udgm en t i s VA CA TED and the m atter REM AN DED f or tr i a l b y aju ry.