posted in: Case Studies | 0

The claimant was an Otolaryngologist who began suffering from tachycardia which impacted his ability to perform his surgical responsibilities. His condition was exacerbated by stress.  The client stopped performing surgeries but continued working in his ear, nose, and throat practice where he would see and treat patients in his office while working full time.

The insurance carrier disputed the claimants’ claim  on two grounds; first that the claimant had waited nearly three years before notifying the carrier of his disability and second that because the claimant was continuing to work in his office practice fulltime, he was residually disabled.  RBA responded that the delay in reporting the disability caused no prejudice in this case and that the significant change in the claimant’s occupation (from a surgeon to an office practitioner) constituted the discontinuation of the client’s regular occupation. The claimants treating physicians were in agreement that to continue performing surgeries would place both the claimant and his patients at risk. Payment of the claim on the basis of Residual rather than Total Disability would have resulted in a bad faith action triggering extra-contractual damages.

Result: Total Disability approved. Buyout negotiated.