Mossa v. Provident Life and Casualty Insurance Company

Patrick Mossa (plaintiff) had a degree in economics. After college, Mossa co-owned and operated a store that sold fruits and vegetables. Mossa then worked for and co-owned a plumbing, heating, and air-conditioning contractor. Provident Life and Casualty Insurance Company (Provident) (defendant) issued a Disability Income Policy to Mossa. Under it, if Mossa became disabled, this policy provided for insurance benefit payments of $5,000 per month. Disabled, within the meaning of the policy, meant “not able to perform the substantial and material duties of your occupation.” If after receiving two years of insurance-benefit payments Mossa was totally disabled, Mossa would be entitled to continued monthly insurance benefit payments of $5,000 until he turned 65. Totally disabled, under the policy, meant “not able to engage in any gainful occupation” in which Mossa would engage because of education, training, or experience. Later, Mossa was injured and submitted a claim to Provident. Provident paid Mossa’s monthly disability payments until September 1995. Provident then notified Mossa that it would stop making disability payments, because based on its records, Mossa was able to work in a gainful occupation. Mossa sued Provident to recover his total disability benefits. Provident moved for summary judgment, claiming that Mossa was not totally disabled under the policy, because he could work.