A federal court in Florida found in favor of a former interventional cardiologist who had filed a lawsuit against Massachusetts Casualty Insurance Company (“Massachusetts Casualty”) for total disability benefits.
Background
Before his disability, Dr. Steven Kraft practiced invasive and interventional cardiology for more than a decade and was part-owner of Interventional Cardiologists of Gainesville, P.A. (“IVC”) in Florida. In 2001, Dr. Kraft underwent a lumbar discectomy for partial relief of degenerative disc disease that was causing him lower back pain that radiated down into his legs.
After a short recuperation, Dr. Kraft attempted to return to work as an invasive and interventional cardiologist but struggled performing invasive procedures. The need to wear a heavy protective apron, stand for long periods of time, bend over for extended periods, and rotate his body caused continuing pain and deterioration of his spine. As of July 13, 2001, Dr. Kraft stopped working as an interventional cardiologist.
The Disability Policy
Prior to his disability, Dr. Kraft had purchased disability insurance coverage from Massachusetts Casualty. The disability policy provided monthly disability benefits if Dr. Kraft became totally disabled or residually disabled.
Under the Massachusetts Casualty policy, Total and Residual Disability were defined as:
- Total Disability: Dr. Kraft would be entitled to benefits if he suffered the complete inability to engage in his regular occupation or profession.
- Residual Disability: Dr. Kraft would be entitled to benefits if he was able to perform some but not all of the important duties of his regular occupation or profession.
Shortly after issuing Dr. Kraft’s disability policy, Massachusetts Casualty sent an initial “specialty letter” to him defining his “regular occupation or profession” as “Cardiologist.” Dr. Kraft immediately sought a correction of this language. Massachusetts Casualty sent a second “specialty letter” signed by its Chief Underwriting Officer, recognizing his specialty as an “Invasive and Interventional Cardiologist.”
Dr. Kraft’s Disability
In his application for disability coverage, Dr. Kraft identified his occupation as an invasive and interventional cardiologist and estimated that about 60% of his practice involved invasive and interventional-related tasks. He included the following as “specific duties” of his occupation:
- Diagnostic catheterization - 25%
- Coronary interventions - 25%
- Pacemaker implantation - 10%
- Noninvasive diagnostics - 20%
- Patient workups - 20%
After his disability, Dr. Kraft testified that he continued to perform noninvasive diagnostics and patient workups but could not perform any of the invasive and interventional duties as he did before. Every doctor who examined Dr. Kraft, including Massachusetts CAsualty’s consulting physician, concluded that he was disabled as an invasive and interventional cardiologist.
Dr. Kraft submitted his total disability claim to Massachusetts Casualty in August 2001, which was denied a month later. Massachusetts Casualty suggested instead that Dr. Kraft qualified for residual disability because he was still working as a cardiologist, although without performing any invasive or interventional procedures.
The Court’s Review of Dr. Kraft’s Claim
The dispute before the court was whether Dr. Kraft was entitled to total disability benefits benefits due to his undisputed inability to perform invasive and interventional cardiology procedures.
The court found Massachusetts Casualty was wrong in denying Dr. Kraft’s total disability benefits for the following reasons:
- The policy terms defining “regular occupation” were clear on their face, Dr. Kraft’s usual work when total disability starts as an invasive and interventional cardiologist;
- Even if the policy terms were ambiguous, and the specialty letter were not allowed in as evidence, it would hold significant weight in favor of Dr. Kraft;
- Because it was undisputed that Dr. Kraft could perform some of the duties of a cardiologist, but none of the duties of an invasive and interventional cardiologist, he was totally disabled under the policy.
Accordingly, the court ruled in Dr. Kraft’s favor.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
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