Filed: Jul. 16, 2013
Latest Update: Mar. 28, 2017
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 13-1017 THOMAS S. LINTON, JR., Plaintiff – Appellant, v. AXA EQUITABLE LIFE INSURANCE COMPANY, f/k/a Equitable Life Assurance Society of the United States, Defendant - Appellee. Appeal from the United States District Court for the District of South Carolina, at Charleston. William O. Bertelsman, Senior District Judge for the Eastern District of Kentucky, sitting by designation. (2:11-cv-03536-WOB) Submitted: June 19, 2013 Deci
Summary: UNPUBLISHED UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT No. 13-1017 THOMAS S. LINTON, JR., Plaintiff – Appellant, v. AXA EQUITABLE LIFE INSURANCE COMPANY, f/k/a Equitable Life Assurance Society of the United States, Defendant - Appellee. Appeal from the United States District Court for the District of South Carolina, at Charleston. William O. Bertelsman, Senior District Judge for the Eastern District of Kentucky, sitting by designation. (2:11-cv-03536-WOB) Submitted: June 19, 2013 Decid..
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UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 13-1017
THOMAS S. LINTON, JR.,
Plaintiff – Appellant,
v.
AXA EQUITABLE LIFE INSURANCE COMPANY, f/k/a Equitable Life
Assurance Society of the United States,
Defendant - Appellee.
Appeal from the United States District Court for the District of
South Carolina, at Charleston. William O. Bertelsman, Senior
District Judge for the Eastern District of Kentucky, sitting by
designation. (2:11-cv-03536-WOB)
Submitted: June 19, 2013 Decided: July 16, 2013
Before WILKINSON, WYNN, and FLOYD, Circuit Judges.
Affirmed by unpublished per curiam opinion.
Robert T. Lyles, Jr., LYLES & LYLES, LLC, Charleston, South
Carolina, for Appellant. D. Larry Kristinik, William C. Wood,
Jr., NELSON MULLINS RILEY & SCARBOROUGH, LLP, Columbia, South
Carolina, for Appellee.
Unpublished opinions are not binding precedent in this circuit.
PER CURIAM:
Thomas Linton, Jr., appeals the district court’s order
granting AXA Equitable Life Insurance Company’s (“AXA”) motion
for summary judgment and dismissing his complaint. * We affirm.
Linton purchased a Disability Income Policy from AXA
in 1985. In 2010, Linton was injured from an accidental
exposure to formaldehyde during a mold remediation effort in his
home; this injury led to the claim for benefits from AXA. After
an investigation, AXA denied Linton benefits under the policy,
stating that because Linton was retired he was ineligible for
benefits.
The relevant language in the Disability Income Policy
states:
TOTAL DISABILITY INCOME. If disability (1) starts
while this policy is in force; and (2) continues
beyond the Elimination Period: we will pay the Monthly
Income for each month of the period of disability that
extends beyond the Elimination period. . . .
(J.A. 77).
*
Linton’s notice of appeal purports to appeal both the
district court’s order dismissing his complaint and the order
denying his Fed. R. Civ. P. 59(e) motion. However, because
Linton does not address the denial of the Rule 59(e) motion in
his opening brief, we consider this issued abandoned. See A
Helping Hand, LLC v. Baltimore County, 515 F.3d 356, 369 (4th
Cir. 2008) (“It is a well settled rule that contentions not
raised in the argument section of the opening brief are
abandoned.”).
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The policy contains the following definitions that are
used to determine who is eligible to receive benefits:
DISABLED or DISABILITY means Total Disability.
YOUR REGULAR OCCUPATION means the occupation (or
occupations, if more than one) in which you are
regularly engaged for gain or profit at the time you
become disabled.
TOTAL DISABILITY means your inability due to injury or
sickness to engage in the substantial and material
duties of your regular occupation. It will not be
considered to exist for any time you are not under the
regular care and attendance of a doctor.
(J.A. 76).
On appeal, Linton argues that (1) it was error for the
district court to grant summary judgment to AXA because the
language of the Disability Income Policy creates a question of
fact with respect to whether it provides benefits to a retired
policyholder; and (2) the district court erred in denying Linton
the opportunity to conduct discovery into AXA’s handling of
other similar claims.
We review de novo a district court’s order granting
summary judgment. Providence Square Assocs., L.L.C. v. G.D.F.,
Inc., 211 F.3d 846, 850 (4th Cir. 2000). Summary judgment
should be granted when “there is no genuine dispute as to any
material fact and the movant is entitled to judgment as a matter
of law.” Fed. R. Civ. P. 56(a). “[T]here is no issue for trial
unless there is sufficient evidence favoring the nonmoving party
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for a jury to return a verdict for that party. If the evidence
is merely colorable, or is not significantly probative, summary
judgment” is proper. Anderson v. Liberty Lobby, Inc., 477 U.S.
242, 249-50 (1986) (citations omitted).
Under South Carolina law, “[a]n insurance contract is
subject to the general rules of contract construction.” Hansen
ex rel. Hansen v. United Servs. Auto. Ass’n, 565 S.E.2d 114, 116
(S.C. Ct. App. 2002) (citation omitted). Moreover, “[t]he
purpose of all rules of construction is to ascertain the
intention of the parties to the contract.” Id. (citation
omitted).
“If the contract’s language is clear and unambiguous,
the language alone determines the contract’s force and effect.”
Schulmeyer v. State Farm Fire & Cas. Co., 579 S.E.2d 132, 134
(S.C. 2003) (citation omitted). “[W]hen an insurance policy
. . . is susceptible to more than one reasonable interpretation,
one of which would provide coverage, [courts] must hold as a
matter of law in favor of coverage.” Gaskins v. Blue Cross-Blue
Shield of South Carolina,
245 S.E.2d 598, 602 (S.C. 1978)
(citation omitted); see also Goldston v. State Farm Mut. Auto.
Ins. Co.,
594 S.E.2d 511, 518 (S.C. Ct. App. 2004) (“Where
language used in an insurance contract is ambiguous, or where it
is capable of two reasonable interpretations, that construction
which is most favorable to the insured will be adopted.”)
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(internal quotation marks and citation omitted). In determining
the meaning of contract terms, the court “must give policy
language its plain, ordinary, and popular meaning.” B.L.G.
Enters., Inc. v. First Fin. Ins. Co., 514 S.E.2d 327, 330 (S.C.
1999).
The rule of strict construction against an insurer
does not, however, authorize a perversion of language or the
exercise of inventive powers for the purpose of creating an
ambiguity where none exists, S.S. Newell & Co. v. American Mut.
Liab. Ins. Co., 19 S.E.2d 463, 467 (S.C. 1945), nor should
courts torture the meaning of policy language to extend or
defeat coverage that was never intended by the parties,
Torrington Co. v. Aetna Cas. & Sur. Co.,
216 S.E.2d 547, 550
(S.C. 1975). Rather, if the meaning of a particular word or
phrase cannot be determined from the language itself, a court
must read the policy as a whole and consider the context and
subject matter of the insurance contract in order to discern the
parties’ intention. See Yarborough v. Phoenix Mut. Life Ins.
Co.,
225 S.E.2d 344, 348-49 (S.C. 1976).
Here, the district court analyzed the language of the
policy, and in ruling on AXA’s motion for summary judgment,
expressly concluded that it was not ambiguous. We agree.
Linton advances a variety of dictionary definitions for terms
contained within the policy, specifically “gain,” “profit,” and
5
“occupation,” in support of his contention that the terms of the
insurance agreement should be construed in his favor. It
strains credulity to accept that “[b]roadly construing the words
‘gain’ and ‘profit,’ given their plain and ordinary meaning,
results in the conclusion that Linton’s pre-disability duties
and activities [as a retired person] were for his ‘gain’ or
‘profit’ from a monetary, social and personal standpoint.”
(Appellant’s br. at 11). The district court correctly rejected
Linton’s contention that gain or profit could have a plain
meaning other than traditional monetary compensation, and noted
that Linton’s arguments were merely “an attempt to fit his
square-shaped situation into the round hold provided by [the
policy] terms.” (J.A. 157).
Furthermore, the district court properly found that
even if it accepted Linton’s definitions of “occupation,”
“gain,” and “profit,” Linton’s argument would still fail when
the words are read within the definition as a whole, as required
by South Carolina contract law. See McGill v. Moore, 672 S.E.2d
571, 574 (S.C. 2009); (J.A. 157). When it elaborated on this
finding, the district court noted
if the policy definition of YOUR REGULAR OCCUPATION
was meant to include those individuals who were
retired, then there would be no need to include the
phrase “for gain or profit” to further explain the
term “occupation.” Even Plaintiff’s proffered
definition of the term “profit” only lends itself to a
monetary context. Thus, reading the definition of
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YOUR REGULAR OCCUPATION as a whole only allows for an
interpretation that the policy holder is required to
hold an occupation for which he receives compensation,
rather than merely the “pursuit of pleasure.”
(J.A. 158).
As the district court properly concluded, the terms are not
ambiguous, and Linton is ineligible for benefits under the
policy because he was not employed for gain or profit at the
time he became disabled.
Linton also argues that the district court erred in
refusing further discovery into how AXA handled comparable
claims. This argument is without merit. As the district court
correctly noted, Linton’s request for discovery regarding the
handling of other claims was intended to support his allegations
of bad faith on the part of AXA. However, before allegations of
bad faith can be pursued, the insured must demonstrate that he
was entitled to benefits under the policy. Because Linton was
not entitled to benefits under the policy, the district court
correctly concluded that further discovery was unnecessary.
Accordingly, we affirm the judgment of the district
court. We dispense with oral argument because the facts and
legal contentions are adequately presented in the materials
before this court and argument would not aid the decisional
process.
AFFIRMED
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