A New Jersey court ruled in favor of an orthopedic surgeon against Reliance Standard over the material duties of his regular occupation. Dr. Stephen Lasser was a successful orthopedic surgeon when he suffered a heart attack. As part of his treatment plan, he was ordered to reduce his work stress which meant he had to:
- Cut back work hours
- Stop taking night call
- No longer perform emergency surgery
As a result of his reduced schedule, he earned significantly less each month. He filed for disability and was approved for benefits for about one year. After one year, however, Reliance Standard terminated his benefits. Reliance alleged that night call and emergency surgeries were not material duties of his regular occupation as an orthopedic surgeon.
Regular Occupation As It Appears in the Policy Must be Applied
Under the policy Dr. Lasser is disalbed if as a result of his illness he is only
- Capable of performing the material duties of his/her regular occupation on a part-time basis, or
- Some of the material duties on a full time basis.
In this case, Reliance attempted to rewrite the policy after it had already acknowledged Dr. Lasser’s disability from coronary artery disease and paid benefits. In doing so, it applied a broad definition of regular occupation to determine what the material duties were. However, the policy does not define regular occupation. So the usual meaning of the term must be used. Reliance cannot add language to the policy or redefine it to be broader than how it appears in the policy.
Reliance argued that the regular occupation of an orthopedic surgeon is how it is performed in the national economy. It did not consider the duties of Dr. Lasser’s four-physician practice in New Jersey to determine the material duties.
Since the words “his/her'' comes before “regular occupation,” the Court found that it was unreasonable for Reliance to apply a broader definition. It should have considered Dr. Lasser’s regular occupation. In other words, what “his regular occupation” was just before he became disabled. From there, it could determine what his material duties were.
Dr. Lasser successfully argued that Reliance was unreasonable in their analysis of his regular occupation. After examining the correct application of his regular occupation, the Court found that Dr. Lasser was disabled, due to coronary artery disease, from performing the material duties of his regular occupation as an orthopedic surgeon.
The attorneys at Dabdoub Law Firm are experts in the practice of disability insurance. We have argued against cases like this one knowing exactly how insurance companies like to play games with policy language. The terms of the policy are what they are - they cannot be re-written after the fact for the benefit of the insurance company.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
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