Gynecologic Oncologist

posted in: Case Studies | 0

Our client, a Gynecologic Oncologist, developed psoriatic arthritis in his hands and hips which resulted in pain, lack of strength/mobility, and stiffness.  As the condition worsened it became difficult to continue performing surgeries.  As a result, the claimant was forced to hire another surgeon and to assume a minor role as an assistant. The client worked as both a primary surgeon and an assistant while training his replacement.

The carrier argued that because the client was continuing to work, as both a primary surgeon and as a surgical assistant, he was only residually disabled.  The carrier also maintained that although the claimant was assuming a diminished role he was still performing his regular occupation.  We responded that the changing roles of the client, as well as the irreversible and progressive nature of his disabling condition clearly entitled the client to Total Disability benefits.  Again, failure of the insurer to pay TD benefits would have triggered filing of an extra-contractual action with the attendant substantial increase in damages.

Result: Settled for full TD benefits in excess of $21,000 per month. Company’s buyout offer rejected due to Company’s insistence on using an inflated discount rate and unrealistic mortality calculation in its PV assessment.