A federal court in Minnesota found in favor of a former surgeon who had filed a lawsuit against National Life Insurance Company (“National Life”) for total disability benefits.
Background
Before his disability, Dr. John Dowdle practiced orthopedic surgery for 21 years and was a part-owner of Summit Orthopedics, Ltd., in St. Paul, Minnesota. In 1987 Dr. Dowdle obtained disability insurance coverage from National Life. The disability policy provided monthly disability benefits if Dr. Dowdle was totally disabled or partially disabled.
Total and Partial Disability were defined under the policy as follows:
- Total Disability: Dr. Dowdle would be entitled to benefits if he became unable to perform the material and substantial duties of the occupation he had at the time his disability began.
- Partial Disability: Dr. Dowdle would be entitled to benefits if he became unable to perform one or more of the important daily activities of the occupation he had at the time his disability began.
In his application for disability coverage, Dr. Dowdle identified his occupation as an orthopedic surgeon and estimated that about 85% of his practice involved surgery or surgery-related tasks. He included the following as “specific duties” of his occupation:
- Seeing patients
- Surgery
- Interpretation of data
- Reading x-rays
- Promotion of referrals
Dr. Dowdle’s Disability
On September 09, 2000, Dr. Dowdle was injured in an airplane crash and suffered significant head and foot injuries. The injuries to his right foot and ankle made it impossible for him to perform surgery as he was incapable of sitting or standing for prolonged periods of time. He was never able to perform surgery after the accident.
Several months after the accident, Dr. Dowdle return to work in a limited fashion, handling office visits and consultations. For this reason, National Life terminated his disability benefits claiming he was no longer totally disabled.
The Court’s Review of Dr. Dowdle’s Claim
The dispute before the court was whether Dr. Dowdle was entitled to benefits due to his undisputed inability to perform surgery.
The court found National Life was wrong in terminating Dr. Dowdle’s benefits for the following reasons:
- The most substantial and material part of Dr. Dowdle’s occupation was conducting surgery.
- The other tasks identified by Dr. Dowdle in his application for coverage are secondary to surgery.
- The income disparity between Dr. Dowdle’s pre-accident and post-accident income is evidence of the importance of his ability to perform surgery.
- Before his accident, Dr. Dowdle earned $85,915 per month. After his accident, Dr. Dowdle earned $10,000 per month.
- Dr. Dowdle’s ability to earn significant income in his diminished role is irrelevant to whether he is totally disabled.
- The existence of the partial disability provision does not preclude a finding of total disability.
Ultimately, the court concluded that since Dr. Dowdle is unable to perform surgery, he cannot perform the substantial and material duties of his occupation. Thus, the court held Dr. Dowdle is entitled to total disability benefits.
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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Dabdoub Law Firm represents clients nationwide with:
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Call to speak with a disability insurance attorney. No fees are costs unless clients are paid.
