By John Joseph (J.J.) Conway
Law, it seems, is changing rapidly at the state and federal level. It can be difficult to keep up with the transformation of entire areas of substantive law.
There is a kind of reordering of things, which includes revisiting established precedents to correct perceived legal errors in prior rulings.
The Michigan Supreme Court has distinguished itself nationally by taking a measured approach. Although the justices are popularly elected, the Court doesn’t appear to be actively looking for ways to take up controversial issues. The Court has shown a willingness to reexamine precedent, however. One case the Court should look at is Nehra v. Provident Life and Accident Company, 454 Mich. 110 (1997) involving the interpretation of disability insurance contracts for professionals like surgeons.
If the case sounds unfamiliar, it is.
Even seasoned Supreme Court advocates hadn’t heard of it. Nehra is rarely cited and even more rarely followed. Most cases that cite it, distinguish it. Nehra is a decision that proves again the old adage that ‘bad facts can make bad law.’ The problem with Nehra – in addition to being a bad decision – is that it serves to undermine the long-term financial security of professionals in certain industries, particularly medicine.
In Nehra, the plaintiff, a dentist, filed an insurance claim with his long-term disability insurance carrier. His policy provided coverage in the event he could not regularly perform his specific occupation — dentist — if he became ill or he had suffered “injuries.”
The issue in Nehra centered on what constitutes an “injury” in a disability insurance contract. The contract in Nehra states that the term “injuries” means “accidental bodily injuries occurring while your policy is in force.” As contrasted with the term “sickness,” which under the contract “means sickness or disease which is first manifested while your policy is in force.” The contract did not define the term “accidental bodily injuries.” Nehra, 454 Mich. at 112.
In his application, the plaintiff listed “bilateral carpal tunnel syndrome” as being one of the causes of his disability along with “duodenal ulcer with hemorrhage.” His claim was approved, and he began collecting benefits.
The decision suggests that Nehra had not realized that his disability contract made a distinction regarding the cause of his disability. Under the contract, if his disability were a “sickness,” his monthly benefits would end at age 65. If his disability stemmed from “injuries,” on the other hand, he could receive benefits over a lifetime.
After collecting benefits for years, Nehra attempted to change the cause of his disability to “injury” from “sickness.” Nehra argued that his diagnosis of carpal tunnel syndrome was the result of a series of repetitive motion injuries that qualified him for the lifetime benefit under the “injuries” provision of his contract. The medical record on this point was seemingly underdeveloped.
Nehra’s claim was denied, and a lawsuit followed. The trial court dismissed his case, but the Michigan Court of Appeals reinstated it, finding there was an issue of fact as to the cause of Nehra’s disability. From there, the Supreme Court granted leave and reversed the Appeals Court reinstating the dismissal.
The Supreme Court reasoned that the case was governed principally by two statutes that have nothing to do with disability insurance. First, the Supreme Court looked to the provisions of the Worker’s Disability Compensation Act to determine the meaning of the word “injury.” The Court also looked to Michigan’s No-Fault Act to determine the meaning of an “injury.” The concept of a repetitive motion type injury was not supported by the Court’s reading of either statute. The Court found that an “injury” was a precipitating event that led to the claimant’s condition, not a pattern of micro-injuries over a sustained period of time.
Other courts have rejected this analysis. One federal court wrote that it had never heard of a “repetitive motion sickness.” Chapman v. Unum Life Ins. Co. of America, 555 F. Supp. 3d 713, 724 (D. Minn. 2021).
Nehra is not a particularly strong or persuasive decision, and upon closer examination, its underlying analysis is flawed.
Both the Workers Compensation Act and the Michigan No-Fault Act are statutes that regulate mandatory insurance systems. The two statutes cited mandate that individuals and businesses purchase specific forms of insurance, and the cited laws create a uniformity among huge segments of the state’s population.
A private disability contract is a contract that is voluntary and its purchase is discretionary. The terms that govern the contract are between the two contracting parties, and Michigan does not regulate the definitions that appear in a disability insurance contract.
The Nehra case is an outlier and makes little sense in our modern, professional world.
Here’s an example. Nehra is routinely cited to try to defeat the legitimate claims of surgeons who have suffered spinal injuries during the practice of their profession. Surgeons experience a significantly higher rate of spinal problems compared with the general population.
By some estimates, nearly 75% of all surgeons suffer from back problems. Some surgical specialties have a rate of spinal injuries as high as 65% of the entire occupational category. And this is a growing trend.
With the consolidation of medical practices, the specialization of surgical practices, and increased patient need, surgeons are seeing their caseloads increase. The more surgeons work, the greater the risk of injury to their own spines.
Compounding matters, surgeons work in physical positions where their bodies are contorted for long periods of time; further, they are required to wear equipment necessary to perform surgery, including magnetic loupes and heavy, protective lead aprons. Collectively, this contributes to putting pressure on the neck and back and often results in spinal injuries over time. Undoubtedly, their medical conditions are caused by “injuries,” not illnesses.
Nehra is a little known, rarely cited case; yet, it increasingly hangs out there as an impediment for legitimately disabled medical professionals within our state who entered into expensive disability contracts in the good faith understanding that their injuries (not just narrowly defined ones), would be covered.
Nehra is not good law, comparatively speaking, and serves little purpose to continue. The Michigan Supreme Court should give it another look and consider overruling it.
————————
John Joseph (J.J.) Conway is an employee benefits and ERISA attorney and litigator and founder of J.J. Conway Law in Royal Oak.
Law, it seems, is changing rapidly at the state and federal level. It can be difficult to keep up with the transformation of entire areas of substantive law.
There is a kind of reordering of things, which includes revisiting established precedents to correct perceived legal errors in prior rulings.
The Michigan Supreme Court has distinguished itself nationally by taking a measured approach. Although the justices are popularly elected, the Court doesn’t appear to be actively looking for ways to take up controversial issues. The Court has shown a willingness to reexamine precedent, however. One case the Court should look at is Nehra v. Provident Life and Accident Company, 454 Mich. 110 (1997) involving the interpretation of disability insurance contracts for professionals like surgeons.
If the case sounds unfamiliar, it is.
Even seasoned Supreme Court advocates hadn’t heard of it. Nehra is rarely cited and even more rarely followed. Most cases that cite it, distinguish it. Nehra is a decision that proves again the old adage that ‘bad facts can make bad law.’ The problem with Nehra – in addition to being a bad decision – is that it serves to undermine the long-term financial security of professionals in certain industries, particularly medicine.
In Nehra, the plaintiff, a dentist, filed an insurance claim with his long-term disability insurance carrier. His policy provided coverage in the event he could not regularly perform his specific occupation — dentist — if he became ill or he had suffered “injuries.”
The issue in Nehra centered on what constitutes an “injury” in a disability insurance contract. The contract in Nehra states that the term “injuries” means “accidental bodily injuries occurring while your policy is in force.” As contrasted with the term “sickness,” which under the contract “means sickness or disease which is first manifested while your policy is in force.” The contract did not define the term “accidental bodily injuries.” Nehra, 454 Mich. at 112.
In his application, the plaintiff listed “bilateral carpal tunnel syndrome” as being one of the causes of his disability along with “duodenal ulcer with hemorrhage.” His claim was approved, and he began collecting benefits.
The decision suggests that Nehra had not realized that his disability contract made a distinction regarding the cause of his disability. Under the contract, if his disability were a “sickness,” his monthly benefits would end at age 65. If his disability stemmed from “injuries,” on the other hand, he could receive benefits over a lifetime.
After collecting benefits for years, Nehra attempted to change the cause of his disability to “injury” from “sickness.” Nehra argued that his diagnosis of carpal tunnel syndrome was the result of a series of repetitive motion injuries that qualified him for the lifetime benefit under the “injuries” provision of his contract. The medical record on this point was seemingly underdeveloped.
Nehra’s claim was denied, and a lawsuit followed. The trial court dismissed his case, but the Michigan Court of Appeals reinstated it, finding there was an issue of fact as to the cause of Nehra’s disability. From there, the Supreme Court granted leave and reversed the Appeals Court reinstating the dismissal.
The Supreme Court reasoned that the case was governed principally by two statutes that have nothing to do with disability insurance. First, the Supreme Court looked to the provisions of the Worker’s Disability Compensation Act to determine the meaning of the word “injury.” The Court also looked to Michigan’s No-Fault Act to determine the meaning of an “injury.” The concept of a repetitive motion type injury was not supported by the Court’s reading of either statute. The Court found that an “injury” was a precipitating event that led to the claimant’s condition, not a pattern of micro-injuries over a sustained period of time.
Other courts have rejected this analysis. One federal court wrote that it had never heard of a “repetitive motion sickness.” Chapman v. Unum Life Ins. Co. of America, 555 F. Supp. 3d 713, 724 (D. Minn. 2021).
Nehra is not a particularly strong or persuasive decision, and upon closer examination, its underlying analysis is flawed.
Both the Workers Compensation Act and the Michigan No-Fault Act are statutes that regulate mandatory insurance systems. The two statutes cited mandate that individuals and businesses purchase specific forms of insurance, and the cited laws create a uniformity among huge segments of the state’s population.
A private disability contract is a contract that is voluntary and its purchase is discretionary. The terms that govern the contract are between the two contracting parties, and Michigan does not regulate the definitions that appear in a disability insurance contract.
The Nehra case is an outlier and makes little sense in our modern, professional world.
Here’s an example. Nehra is routinely cited to try to defeat the legitimate claims of surgeons who have suffered spinal injuries during the practice of their profession. Surgeons experience a significantly higher rate of spinal problems compared with the general population.
By some estimates, nearly 75% of all surgeons suffer from back problems. Some surgical specialties have a rate of spinal injuries as high as 65% of the entire occupational category. And this is a growing trend.
With the consolidation of medical practices, the specialization of surgical practices, and increased patient need, surgeons are seeing their caseloads increase. The more surgeons work, the greater the risk of injury to their own spines.
Compounding matters, surgeons work in physical positions where their bodies are contorted for long periods of time; further, they are required to wear equipment necessary to perform surgery, including magnetic loupes and heavy, protective lead aprons. Collectively, this contributes to putting pressure on the neck and back and often results in spinal injuries over time. Undoubtedly, their medical conditions are caused by “injuries,” not illnesses.
Nehra is a little known, rarely cited case; yet, it increasingly hangs out there as an impediment for legitimately disabled medical professionals within our state who entered into expensive disability contracts in the good faith understanding that their injuries (not just narrowly defined ones), would be covered.
Nehra is not good law, comparatively speaking, and serves little purpose to continue. The Michigan Supreme Court should give it another look and consider overruling it.
————————
John Joseph (J.J.) Conway is an employee benefits and ERISA attorney and litigator and founder of J.J. Conway Law in Royal Oak.
