A federal court in Florida denied a motion by The Paul Revere Life Insurance Company (“Paul Revere”) seeking a judge’s decision that a Miami ear, nose, and throat surgeon was not totally disabled.
Dr. Groff and his Disability Insurance Policies
The plaintiff, Dr. Groff, purchased three disability policies from Paul Revere. Each policy defined “Total Disability” to mean that “as a result of such injury or sickness, the insured is unable to perform the duties of his regular occupation.”
While skiing in Vail, Colorado, Dr. Groff suffered significant injuries to his shoulder and surrounding areas of his body. Though he was able to return to his practice within weeks of the injury, Dr. Groff was forced to hire an associate surgeon to assist him with the more complex and physically demanding surgeries. In addition, procedures he could previously do in his office now had to be done at a hospital facility with the use of anesthesia to accommodate Dr. Groff’s weakened condition.
Based upon his inability to perform many of his occupational tasks, Dr. Groff filed a claim for “Total Disability” under each of his three policies. In response, Paul Revere denied Dr. Groff’s claims and asserted that he was not totally disabled under the policies because he still had the ability to perform surgical procedures (with assistance) and his practice had not suffered any economic loss since his accident.
The Court’s Decision
In holding that the application of the term “total disability” under the policies to Dr. Groff’s physical condition was a question of fact for a jury to decide, the Court made the following additional findings:
- Total disability does not mean absolute helplessness, but rather the inability to perform all the substantial and material acts necessary to one’s usual occupation in a customary and usual manner.
- Since genuine issues of material fact existed regarding Dr. Groff’s ability to perform certain occupational duties, Paul Revere could not win the case by filing a motion for summary judgment.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for long term 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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