Court Opinion

ID: 9479951
Source: CourtListenerOpinion
Date Created: 2023-08-05 07:33:41.657601+00
Date Added: 2024-06-11T17:47:23.395007
License: Public Domain

TUTTLE, Senior Circuit Judge:
This is an appeal from the dismissal by the trial court of appellant Arnold’s complaint in which he had alleged defendant Life Insurance Company of North America had refused to pay for the loss of plaintiff’s sight in one eye.
I. STATEMENT OF THE CASE
The insurance policy in question was provided to the plaintiff by his employer under an employee welfare benefit plan. His claim, therefore, fell within the purview of the Employee Retirement Insurance Security Act, 29 U.S.C. § 1001 et seq. (ERISA). The plan administrator ruled that the plaintiff was not entitled to benefits under ERISA because, as he held, plaintiff did not meet the definition of “entire and irrecoverable loss of sight” under the policy. The petitioner then sought review in the district court. The court, considering the matter de novo, affirmed the decision of *1567the plan administrator and held that the plaintiff was not entitled to recover.
II.STATEMENT OF FACTS
The facts are not disputed. The plaintiff suffered an injury to his eye while on the job. He had surgery in an effort to correct the vision which, uncorrected, gave him a vision represented by 20/400 but, by the use of corrective lenses was 20/50 minus one. The undisputed evidence was that appellant could see well enough by the use of a corrective lens for his injured eye, to permit him to perform his usual duties.
The policy provision upon which plaintiff relied reads as follows:
Coverage A — Loss of Life, Limb or Sight Indemnity. If such injuries shall result in any one of the following specific losses within one year from the date of accident, the Company will pay the benefit specified as applicable thereto, based upon the Principal Sum stated in the Policy Schedule; ... Loss of one member One-Half The Principal Sum. “Member” means hand, foot or eye. “Loss” means, with regard to hand or foot, actual severance through or above the wrist or ankle joints; with regard to eye, entire and irrecoverable loss of sight.
III.ISSUES ON APPEAL
1. By what legal standard is the language of this contract to be construed?
2. Did the trial court err in its construction of the contract under such proper standard?
IV.DISCUSSION
The parties are in agreement that the Supreme Court’s decision in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. -, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), prescribes the law that federal courts are to apply in ERISA actions. The federal courts are to develop a “federal common law of rights and obligations under ERISA-regulated plans,” 109 S.Ct. at 954, citing Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41 at 56, 107 S.Ct. 1549 at 1558, 95 L.Ed.2d 39 (1987). The Court also referred to Franchise Tax Board v. Construction Laborers Vacation Trust, 463 U.S. 1, 24 n. 26, 103 S.Ct. 2841, 2854 n. 26, 77 L.Ed.2d 420 (1983) (“ ‘a body of federal substantive law will be developed by the courts to deal with issues involving rights and obligations under private welfare and pension plans.’ ”).
We agree with the trial court that this does not mean that the federal courts attempt merely to decide what a majority of state courts have done in their interpretations of an insurance policy provision to establish the federal common law. Federal common law is that law fashioned by the federal courts through their interpretation of policy language and is not based upon any calculation of the majority of decisions from other jurisdictions.
A. Standard of Review
The appellee here contends that the district court’s review of the decision by the plan administrator should have been on a deferential basis rather than de novo. In other words, appellee claims that the court should not set aside the administrator’s decision unless it was “arbitrary and capricious”; see qenerally, Firestone, supra, 109 S.Ct. at 953.
We conclude that it is not necessary for us to determine which standard of review should be applied here, because under either standard the federal common law requires us to give effect to the unambiguous language of the policy when construed in accordance with its terms.
B. Meaning of the Policy
It is clear that the terms of this contract respecting Coverage A, under which plaintiff claims, clearly and unambiguously deal with the “entire and irrecoverable loss of sight.” This is first made clear by the first line in Coverage A, which is: “Loss of life, limb or sight indemnity.” This language indicates that any loss of sight was considered differently from a loss of life or a loss of limb, especially since in the further provision of Coverage A, it is *1568clear that the policy protected against a complete loss of the hand or foot but with respect to the eye, it “means ... with regard to eye, entire and irrecoverable loss of sight.” It did not state “irrecoverable injury to eye.”
While the eye may have been irrecoverably damaged, the sight clearly was not. The evidence is undisputed that with corrective lenses, the sight was substantially normal.
We conclude, therefore, that there is only one construction that can be made of this provision, and that construction requires that we find that the trial court did not err in dismissing the plaintiffs complaint.
We recognize that there are state court decisions holding similar contract terms in the manner contended for by the plaintiff, but there are also state court opinions, holding as we do, including the Georgia case involving this same plaintiff, claiming under a different insurance policy, Arnold v. Equitable Life Assurance Society of the U.S., 189 Ga.App. 66, 374 S.E.2d 782 (1988), citing Smith v. Great American Life Insurance Co., 125 Ga.App. 587, 188 S.E.2d 439 (1972).
V. CONCLUSION
The judgment of the trial court is therefore AFFIRMED.