The Eighth Circuit has sided with Sun Life Assurance Co. of Canada in a lawsuit alleging that the insurance company improperly denied the plaintiff longterm disability benefits for taking vitamin A supplements at the direction of his doctor to slow the progression of his retinitis pigmentosa, which the company said qualified as medical treatment under its pre-existing condition clause. Kutten v. Sun Life Assurance Co. of Can., No. 13-2559 (8th Cir., order entered July 21, 2014).
Sun Life’s long-term disability policy specifically excluded coverage for preexisting conditions, which it defined as receiving “medical treatment, care or services, including diagnostic measures” or taking “prescribed drugs or medications.” Under the direction of his doctor, the plaintiff took 15,000 units each day of a non-prescribed, over-the-counter vitamin A palmitate supplement, and, when Sun Life denied his request for benefits, he sued. The district court held that Sun Life abused its discretion in construing the clause to apply to the use of supplements, finding that the company’s broad interpretation of “medical treatment” rendered portions of the clause meaningless and internally inconsistent.
The Eighth Circuit disagreed, dismissing the plaintiff’s close reading of the pre-existing condition clause to differentiate between supplements and medical treatment because “[f]ocusing on such semantics misses the larger purpose of the clause.” The court found that “[t]he supplements are ‘medical’ in the sense that they prevented or alleviated the progression of [the plaintiff’s] retinitis pigmentosa. Further, [the plaintiff’s] daily supplement regimen constituted a ‘treatment’ because it was the ‘manner,’ in fact the only manner, by which [the plaintiff ] could ‘care for’ his condition.”
A dissenting judge argued that vitamin supplement use does not constitute medical treatment because supplements are over-the-counter, and Sun Life’s expansive interpretation of the clause could be dangerous. “Any time a medical official gave advice it would be considered medical treatment,” he wrote. “Even simple things such as getting eight hours of sleep a night, brushing one’s teeth, exercising thirty minutes a day, or taking an aspirin for a headache would be encompassed by this interpretation.” He also said that “Sun Life’s pre-existing condition clause was poorly drafted—which is its own fault—and thus should not be allowed to change the clause by argument in court.”