A federal court in Louisiana held that Standard Insurance Company (“Standard”) wrongly denied a urologic surgeon’s claim for total disability benefits after it determined that he had more than one occupation and was only residually, or partially, disabled.
Dr. Pittman and his Disability Income Policy
The plaintiff, Dr. Pittman, purchased a professional disability income policy from Standard in 1994, stating that his occupation was a urologist on the application. The policy provided a maximum monthly benefit of $11,250.00 for life in the event of “Total Disability” and a reduced monthly benefit for “Residual Disability” through age 65.
Dr. Pittman notified Standard that he had become disabled due to a back injury he suffered in a car crash four months earlier that now prevented him from being able to perform surgery. Standard began paying Dr. Pittman monthly benefits for his “Total Disability.” In June 2007, the Social Security Administration also found that Dr. Pittman was disabled.
However, in April 2007, Standard decided that Dr. Pittman’s claim was more appropriately classified as a “Residual Disability” because it was convinced that he was still performing the duties of a urologic surgeon in a reduced capacity while also operating a medical imaging center in an increased capacity.
Dr. Pittman filed a lawsuit seeking to recover past due disability payments.
“Total Disability” from “Your Occupation” under Standard’s Policy
Pursuant to Standard’s policy, “Total Disability” means, in part, that because of an injury or sickness, you are 1) unable to perform the important duties of your occupation; and 2) receiving care from a physician. While the policy defines “Your Occupation” as “the occupation or occupations in which you are regularly engaged at the time Disability begins”, it does not define the term “occupation” itself.
In holding that Dr. Pitman was entitled to Total Disability benefits under his policy with Standard, the Court made the following findings:
- The ability to perform surgery is an “important duty” of being a urologic surgeon, and it would be arbitrary for Standard to also consider tasks such as seeing patients, performing consultations, ordering lab tests, and administering medications as equally important.
- Dr. Pittman was a urologic surgeon, not a nurse practitioner.
- Total Disability under the policy does not require that the insured be unable to perform all of the duties of his occupation..
- Dr. Pittman’s ownership of a medical center does not constitute a second occupation considering his involvement was mainly limited to attending one meeting per week.
In the end, the Court found that Dr. Pittman was Totally Disabled within the meaning of the policy and that he was entitled to all benefits due under the Lifetime Total Disability Rider, including past due benefits, and the refund of premiums paid after the onset of his disability.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
Because this law firm was created to focus on disability insurance, we have developed an expertise in this complex area of the law.
Our expertise in long-term disability claims means our clients have the backing of a law firm that has attorneys who:
- Are experts in disability claims;
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All our lawyers commit every day of their legal career to helping people get disability benefits from Standard, UNUM, MetLife, Prudential, Northwestern Mutual, Hartford, CIGNA, and others. Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.
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