Own Occupation Disability Insurance for Physicians
Own occupation disability insurance for physicians is often difficult to analyze. The insurance company will try to claim the doctor can still perform their duties even with a disability. However, some doctors have duties that make it impossible to perform if disabled.
Our disability law firm represented an emergency room physician with an own occupation disability plan. Northwestern Mutual, her insurance company, terminated her total disability benefits.
Our client suffered a serious leg injury. She could not easily move about the emergency room of a hospital. Pain and limited mobility caused her not to be able to safely treat patients. Northwestern Mutual agreed she was disabled from working as an ER doctor and approved her total disability claim.
She continued having pain and limited ability to move around after having medical treatment. When she did not return to work, Northwestern Mutual terminated her disability benefits. Northwestern Mutual stated she must be unable to perform “all” her job duties to be considered totally disabled. It decided she was able to perform duties that did not require her standing on her feet.
However, the disability insurance policy did not define total disability to mean she cannot do “all” duties. Total disability in the policy means she cannot do the “important duties” of her own occupation.
Our law firm argued that Northwestern Mutual was misapplying the definition of total disability. An emergency room doctor that could not move around the ER room or respond to a code blue emergency cannot do the important duties of her occupation. She is totally disabled under the disability insurance policy. We argued that the safety of patients would also be at risk. We gave examples of how patients might actually die if she is the ER room doctor on a shift at the hospital.
To support her total disability, our law firm got the medical opinions of our client’s doctors. Her doctors explained that she would experience more pain if she had to stand on her feet at the hospital. Their opinion was she could not work as an emergency room doctor.
After reviewing our arguments, Northwestern Mutual approved her total disability benefits again. We were successful in avoiding a lawsuit by convincing Northwestern Mutual that the termination of her disability benefits was unlawful.
Because each client’s case is unique and has different facts, results similar to those in other clients’ cases are not guaranteed.