Questão jurídica principal
Whether the insurance clause on incapacity to earn requires a medico-theoretical invalidity test or a contractual assessment based on the insured’s profession and social position.
Decisão extraída
The policy is an insurance of persons, but the applicable test is the contractual one: the insurer must pay only if the insured cannot work in his profession or in another gainful activity corresponding to his social position, knowledge, and aptitudes.
Fundamentação extraída
The court held that the parties may define disability by reference to the insured’s inability to perform his profession or another suitable occupation; this differs from a general medical invalidity concept and shifts the burden to the insurer to prove suitable alternative work.