UNUM misapplied the definition of occupation for an interventional radiologist in New Jersey which resulted in his benefits being terminated. He brought a lawsuit against UNUM alleging that he is disabled from his own occupation because UNUM failed to properly consider his specialty.
Dr. McCann was insured by UNUM through a policy he obtained at work. According to his policy, he is totally disabled if he cannot work in his own occupation. The Court in this case looked closely at how occupation was defined in his policy.
Occupation was defined as the occupation he was regularly engaged in when he became disabled. It further stated that if his occupation is limited to a recognized specialty, then that specialty is his occupation. Thus, under the policy, Dr. McCann’s occupation was his specialty - interventional radiologist.
During the time just before he stopped working, his billing codes showed he was doing more diagnostic radiology work. The court analyzed his work as an interventional radiologist versus a diagnostic radiologist. It was noted that interventional radiologists do diagnostic work. So the fact that he was doing diagnostic work does not take away from his specialty as an interventional radiologist.
Dr. McCann trained to be an interventional radiologist. His specialty requires more training, longer hours, night and weekend calls, and is generally more stressful. More importantly, the Court highlighted that interventional radiologists do diagnostic work, but a diagnostic radiologist cannot do interventional work. That is an important distinction. Many specialties in medicine overlap.
The court found that UNUM got his occupation wrong. His specialty was not undermined by the fact that he was doing diagnostic work. The court concluded his occupation was an interventional radiologist.
The definition of occupation is crucial for a physician applying for disability benefits. Since a physician's occupation is not always black and white, insurance companies tend to get it wrong for its own gain.
It is important to understand the definition of occupation for a physician. Physician's undergo years of training to become specialized in a specific area of medicine. The fact that some specialties overlap should not change or reduce a physician's specialty.
Having an Experienced Disability Attorney Matters
If you are a physician who has been denied benefits based on your insurance company's misapplication of the definition of your own occupation, you need an experienced attorney on your side. We have successfully handled several cases involving physicians and the definition of occupation.
Because disability insurance law is complicated, it is important to get legal help from a lawyer who focuses on disability law. As a law firm built to focus on disability insurance, all our lawyers spend every day working to get our clients disability benefits from insurance companies. Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.If your claim for long term disability benefits was denied or being delayed by an insurance company, call us to speak with a disability insurance attorney.
We represent clients everywhere with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.
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