Opinion ID: 786763
Heading Depth: 4
Heading Rank: 3

Heading: you are under the regular and personal care of a physician.

Text: 17 This means, according to the law in California, that plaintiff is eligible for benefits if she is unable to perform the substantial and material duties of her own occupation in the usual and customary way with reasonable continuity. 18 The district court's jury instruction was based upon the California Supreme Court's holding in Erreca v. Western States Life Ins. Co., 19 Cal.2d 388, 121 P.2d 689 (1942), that the term `total disability' does not signify an absolute state of helplessness but means such a disability as renders the insured unable to perform the substantial and material acts necessary to the prosecution of a business or occupation in the usual or customary way. Id. at 695. 19 Defendants argue that because the total disability provision of Paul Revere policy was unambiguous, the district court's imposition of Erreca's definition of total disability was unwarranted under California law. Contrary to Defendants' position, California law requires courts to deviate from the explicit policy definition of total disability in the occupational policy context 2 where it is necessary to offer protection to the insured when he is no longer able to carry out the substantial and material functions of his occupation. Austero v. Nat'l Cas. Co., 84 Cal.App.3d 1, 148 Cal.Rptr. 653, 667 (1978) (emphasis added), overruled on other grounds by Egan v. Mut. of Omaha Ins. Co., 24 Cal.3d 809, 169 Cal.Rptr. 691, 699 n. 7, 620 P.2d 141 (1979). Indeed, California courts oppose strict adherence to a highly limited definition of `total disability' in both non-occupational and general occupational disability policies. Id.; see also Moore v. American United Life Ins. Co., 150 Cal.App.3d 610, 197 Cal.Rptr. 878, 882-83 (1984) (stating that the unambiguous policy language misstated California law as it has existed since [ Erreca ]. When coverage provisions in general disability policies require total inability to perform `any occupation,' the courts have assigned a common sense interpretation to the term `total disability' (emphasis added)). 20 The policy in this case defined total disability as being unable to perform the important duties of one's occupation and to not be engaged in any other gainful occupation. As Defendants concede, Hangarter's policy was an occupational policy that insured Hangarter against the loss of her ability to perform her occupation as a chiropractor, not any other occupation. Given the occupational nature of the policy, the district court appropriately formulated a jury instruction that only referred to Hangarter's ability to perform the important duties of her own occupation. California courts have specifically upheld jury instructions in the occupational policy context that defined total disability as the inability to perform the substantial and material duties of one's own occupation. See Austero, 148 Cal.Rptr. at 665 (upholding the instruction if the plaintiff was `rendered unable to perform the substantial and material duties of his occupation in the usual and customary way,' that he was totally disabled (emphasis added)). Additionally, for all practical purposes there is no difference between Erreca's use of the phrase substantial and material duties and the policy's use of the phrase important duties. 3 21 Defendants also contend that the imposition of Erreca's definition of total disability in this case obviated the policy's partial or residual disability provision. 4 This argument also disregards California law. In Wright v. Prudential Ins. Co. of America, 27 Cal.App.2d 195, 80 P.2d 752 (1938), cited approvingly by the California Supreme Court in Erreca, the California District Court of Appeal specifically rejected the defendant's contention that the California judicial rule [regarding `total disability'] does not apply where the policy provides for `various degrees of disability': 22 No logical reason appears, however, why the same rule should not be applied where the policy provides for both total and partial disability in order to make the total disability clause `operative and to prevent a forfeiture' of the indemnity provided by that clause. In either case a literal interpretation of the total disability clause would defeat the very purpose of insurance against total disability, because it rarely happens that an insured is so completely disabled that he can transact no business duty whatever. The rule quoted has been applied in many cases where the policy in suit provided for both total and partial disability .... The fact that the insured may do some work or transact some business duties during the time for which he claims indemnity for total disability or even the fact that he may be physically able to do so is not conclusive evidence that his disability is not total, if reasonable care and prudence require that he desist. 23 Id. at 761-62 (citations omitted) (emphasis added). The fact that the policy in this case contained a residual or partial disability clause does not make the district court's jury instruction inconsistent with California law. 5 24 The district court therefore did not erroneously misstate California law in its jury instruction.