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.
The factual history presented in Dr. Giddens' case was this - Dr. Giddens practiced regular dentistry from 1983 until 1994. In 1994, he sold his practice to another dentist, and also cancelled his dental malpractice insurance. However, it was also Dr. Giddens intention to open another dental office in 1994, in a building he had already previously acquired. Unfortunately, his health did not permit him to do so as he became very ill in 1994. Nonetheless, he remained a licensed dentist until December 31, 1999, and continued to have subscriptions to certain professional dental journals. Dr. Giddens had even applied for a position as a dentist with the State Merit System. Additionally, Dr. Giddens advised that he had always and continued to perceive his primary profession as dentistry, and that it remained his intention to open the new dental practice in his building up until the point in time that he became disabled under his policy in 1999.
While practicing dentistry prior to 1994, and also following the sale of his dental practice in 1994, Dr. Giddens also engaged in for profit real estate development and investment with his wife. This involved his joint ownership in two companies with his wife, which involved substantial development of real estate on Dr. Giddens part, including purchases of real estate, development and sale of forty-three residential lots by Dr. Giddens' companies, development of commercial property, as well as involvement with residential rental properties. Dr. Giddens' primary duties in his real estate businesses were entrepreneurial, financial, planning, coordinating and other administrative duties. Though Dr. Giddens had a construction company and developed projects, he did not perform any physical labor on the job sites. Unfortunately, in 1998, Dr. Giddens also became unable to engage in the real estate business with his wife's assistance due to continued decline in his health.
In October 1998, Dr. Giddens began suffering from symptoms including significant fatigue and abdominal pain, for which he sought treatment at the Mayo Clinic in Jacksonville, Florida. Dr. Giddens was diagnosed with cryogenic cirrhosis, a condition of the liver which necessitated a liver transplant.
Dr. Giddens submitted his disability claim to the Equitable insurance company in 1999, asserting that he was on the waiting list for a liver transplant and that he was disabled as he was unable to pursue his professions of dentistry and real estate development. In May 1999, Dr. Giddens underwent liver transplant surgery, and despite his liver test and renal functions returning to normal following the transplant, Dr. Giddens continued to have numerous health problems. Dr. Giddens' health conditions and medications interfered with cognitive functioning, as well as stamina and physical capabilities, all of which prevented him from being able to perform most of the occupational duties required in both dentistry and real estate development. Dr. Giddens testified that "While I am not totally helpless, I am unable to resume either of these occupations, or any work of which I am aware approximating the same livelihood, in keeping with my background, circumstances, and physical and mental capabilities."
Equitable began paying Dr. Gidden total disability benefits under his disability income policy in 1999, while it was investigating his claim. However, following a medical review conducted by Equitable in August 2000, it concluded that there was "no current significant impairment that would preclude [Dr. Giddens] from performing most of the duties of his occupational description[,]," and continued to make benefit payments only under a reservation of rights. According to Equitable, in September 2001 it learned that Dr. Gidden had not actively practiced dentistry for four years before he became disabled and that his real estate endeavors were only "passive" in nature, and ultimately in March 2002 Equitable terminated all benefit payments to Dr. Gidden.
While the Eleventh Circuit Court of Appeals Court agreed that Dr. Gidden was disabled from his occupation in real estate development, it determined that at the time Dr. Giddens became disabled in 1999, he had not practice dentistry in over four years and thus "readily concluded] that Giddens was not 'regularly' engaged in dentistry at the time he became disabled, even if he intended to return to dentistry at some point if his health permitted."
A major lesson learned by the Giddens case is that if a disability from dentistry or any regular occupation occurs, it is critical to file the disability claim at the time the disability occurs, so that the insured's regular occupation is not changed from what was truly intended to be insured under the disability income policy.
Our boutique law firm exclusively represents individuals at all stages of the disability insurance claims process, providing representation to dentists and dental professionals throughout Florida and nationwide. We represent all types of individuals in their disability benefit claims, and have successfully dealt with "dual occupation" issues, advising clients on the appropriate timing for filing a disability insurance claim, and cases similar to Dr. Giddens. Though Dr. Giddens' case was handled by another law firm and his result in court was only partially favorable to him, if these complicated disability claims are not handled by skilled and experienced attorneys from the start the results are simply unlikely to be as favorable for the insured individual. If you are dealing with claim denial or delay, or would simply like to consult with one of our experienced attorneys about the timing for filing a claim for benefits under your disability income policy, contact us today for a free initial consultation.