The importance of defining one’s own occupation in a private disability insurance policy cannot be understated. We recently represented a surgeon who owns a private (individual) disability insurance policy, purchased from a major insurance company.
He was approaching his maximum benefit of eligibility to continue the policy with lifetime benefits still potentially available when he came to us to pursue a claim, while he wished to continue to work in some capacity.
In order to succeed with his claim, we needed to demonstrate that he was totally disabled from his “own occupation.” This situation occurs often, but most people don’t know how or if it can be resolved. Without the guidance of an experienced disability insurance attorney, hundreds of thousands of dollars may be lost.
He was referred to the firm, having friends who had prior claims and had successfully worked with our office. Knowing that every claim was different, he sought a similar result to what we had achieved for his colleagues. His claim, however, posed more challenges than his colleagues claims had.
He was performing an array of procedures that were adjunctive to his practice but would likely not be considered surgical by the disability insurance company if it were trying to find a way out of paying his benefits, which would be substantial.
Our concern was that he might be viewed as a surgeon with another potential occupation.
We carefully crafted his occupation description to address and focus upon his significant surgical practice, and the impairments that related directly thereto. His inability to continue to operate without putting patients at risk was a significant factor in proving his impairment.
Another challenge came from his age: because he was approaching 65, his claim for residual benefits, if that were the determination, would have yielded very little return for his claim.
It was mission critical to declare him totally disabled. It meant the difference between lifetime benefits and very little benefits.
Our development of the claim support, his occupation, and all of his collateral materials, including his change of malpractice insurance, were critical elements to support our contentions. His claim was successful and he is continuing to be paid by the disability insurance company.
He did two very smart things: he listened to colleagues who similarly protected their claim by working with us, and he made the decision to work with Disability Attorney Jason Newfield to guide his claim to success.