A New York Surgeon wins his lawsuit for total disability benefits against Pacific Mutual Life Insurance Company (“Pacific Life”).
Background
Dr. George Graves purchased disability insurance from Pacific Mutual Life Insurance Company. The insurance policy would allow for monthly disability payments should Dr. Graves become disabled from his occupation as a physician and surgeon.
Before his disability, Dr. Graves was a member of the American College of Surgeons. To qualify for this group, Dr. Graves needed to provide that 70 percent of his practice was surgical. It follows that Dr. Graves spent most of his time in the operating room.
In 1949, Dr. Graves developed dermatitis of the hands. He managed to continue practicing surgery for another three years with his condition. However, Dr. Graves experienced flares caused by necessary surgical sterilization procedures, like rubbing his hands, using soaps, and wearing rubber gloves.
By October 1952, Dr. Graves could no longer perform surgery and gave up his practice. He then sought additional employment. He was hired as a Director of Professional Services and Administrative Chairman of the Research Committee for the Veteran’s Administration Hospital. He no longer engaged in any surgery and no longer examined or treated patients.
Dr. Graves’ Claim for Benefits
In 1953, Dr. Graves filed his claim for disability benefits. His claim representative at Pacific Life notified him he was not entitled to total disability benefits because he continued to be employed as a physician. The claim representative offered Dr. Graves a settlement instead of his monthly benefits. Dr. Graves accepted the settlement based on the recommendations of the representative.
The Court Case
Dr. Graves argued he only agreed to the settlement because he believed his claim representative when he was told he could not receive benefits while working. He further argued that the suggestion he could not total disability benefits while working was incorrect. Thus, he brought a lawsuit against Pacific Life seeking reinstatement of his benefits.
The court ultimately ruled in Dr. Graves’ favor. It did not care that Dr. Graves continued to work as a physician for the Veteran’s Hospital. The court recognized that Dr. Graves was a specialist in surgery. That was his occupation and his condition made it impossible for him to perform surgery. Therefore, he was totally disabled and could no longer pursue his real occupation.
Help from an Attorney with Expertise in Disability Insurance
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