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June 2015 Archives

Is A Physician Who Is No Longer Able To Perform Surgery Totally Disabled Under An Own Occupation Disability Insurance Policy?

Numerous cases exist where a physician who has specialized as a surgeon becomes unable to perform surgical procedures due to injury or illness but remains able to still perform other duties as a physician. Whether or not this is considered a total or residual disability benefits claim is contingent upon the specific disability insurance coverage you have with your insurance company. Insurance companies frequently either deny these types of disability claims by physicians outright, or attempt to pay these claims only as "residual disability," which usually involves a much reduced disability income benefit when compared to the "total disability" benefit at issue. There is legal authority to support the position that a physician who is no longer able to perform surgery is totally disabled under own occupation disability insurance coverage, particularly where "specialty" own occupation disability insurance coverage is at issue. However, having a disability insurance claim approved by an insurance company as such is another story entirely.

If You are not Practicing as a Dentist on the Time of Your Disability Claim Under the Policy, Regardless of Intent, Dentistry is not Considered "Your Occupation."

In the case of Giddens v. Equitable Life Assurance Society of the United States, 445 F.3d 1286 (11th Cir. 2006), the Eleventh Circuit Court of Appeals held that regardless of his intent, if Dr. Giddens was not practicing dentistry at the time of his disability under his policy, dentistry was not his "regular occupation" for purposes of his disability claim. Under Dr. Giddens' disability income policies, in order to receive total disability benefits he was required to be unable due to injury or sickness to perform substantial and material duties of his regular occupation. The policies further defined "regular occupation" as "the occupation (or occupations, if more than one) in which you are regularly engaged for gain or profit at the time you become disabled." Dr. Giddens' position in the filing of his disability claims was that he had dual occupations - both dentistry and real estate development - and that he was disabled from both. However, Equitable contended that Dr. Giddens had abandoned his dentistry practice years prior to his disability claim filed in 1999, and thus that his dentistry disability claim should not be permitted. The Court ultimately agreed with Equitable and disallowed the dentistry disability claim on the basis that it was no longer Dr. Giddens' regular occupation at the time of his disability in 1999.

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