Heller v. Equitable Life Assurance Society of the United States

Dr. Stanley Heller (plaintiff) is a doctor specializing in invasive cardiology. In April 1983, Heller was issued a disability-income policy from Equitable Life Assurance Society of the United States (Equitable) (defendant). Under that policy, if Heller became totally disabled, he would receive $7,000 per month. Total disability was defined by the policy as “the complete inability of the Insured, because of injury or sickness, to engage in the Insured's regular occupation, . . . provided, however, the total disability will not be considered to exist for any period during which the Insured is not under the regular care and attendance of a physician.” In 1983, Heller developed carpel tunnel syndrome. Thus, by March 1984, Heller could not practice invasive cardiology. Heller applied for benefits under his policy with Equitable. Equitable paid Heller monthly until May 1985. Equitable stopped paying Heller, because Heller refused to undergo recommended carpel tunnel syndrome surgery. Therefore, according to Equitable, Heller was not under a physician’s care and was therefore no longer totally disabled under the policy. Heller sued Equitable, seeking a declaratory judgment that Equitable breached the insurance contract. The trial court determined that Heller was entitled to receive monthly disability-income payments under his insurance contract. Equitable appealed.