Insurer Says Orthopedic Surgeon Not Totally Disabled

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Claimant, an Orthopedic Surgeon suffered from disabling diabetes, neuropathies in his hands, and charcofoot (severe diabetic complications to his feet). He could no longer perform fine manipulations due to numbness in his hands and fingers and was unable to stand for long periods or perform rounds due to the neuropathy in his feet. When the Claimant applied for total disability benefits, the insurer informed him that they did not believe he was totally disabled. In part this was because Claimant had modified his practice to include a physical rehabilitation and other components, and he was therefore earning more money than he had been prior to the onset of his disability.

In his lawsuit against the insurer for bad faith denial of his Total Disability claim the insurance company made a motion seeking a Ruling supporting its interpretation of the policy language to the effect that because the insured was still working and was, in fact, earning more money than he had before the onset of his disability, that its decision to deny the claim was proper. The court ruled to the contrary and although it left some factual issues to be determined by the ultimate jury, if the case went to trial, the amount he was earning had nothing to do with whether or not he was entitled to receive Total Disability benefits based on his “own occupation” coverage.

Result: Settlement in the amount of $5,000,000.

Orthopedic Surgeon