In a recent case from the Court of Appeals for the Third Circuit, the court determined that Unum had improperly classified the claimant, Dr. Kevin McCann as a diagnostic radiologist when he was an interventional radiologist. While this issue may seem minute, it highlights an important aspect of disability insurance cases.
All long-term disability insurance policies have a provision describing how the insurance company will determine whether you are disabled. Most policies state that you must be disabled from your own occupation or any occupation. In some, own occupation is further defined as the specialty area you were working in just prior to your last day worked.
These types of policies are particularly popular among doctors and lawyers. Importantly, policies that cover you from your specialty and not just your occupation are usually more expensive. It’s important to understand how to be sure you are getting the most value out of your policy.
In McCann v. Unum Provident, 907 F.3d 130 (3rd Cir. 2018), the claimant, Dr. Kevin McCann, argued that Unum has improperly classified him as a diagnostic radiologist when he was actually an interventional radiologist. Because he was unable to perform the more difficult and technical procedures of an interventional radiologist due to his medical condition, he argued he was entitled to long-term disability benefits.
Unum looked at Dr. McCann’s Current Procedure Terminology (“CPT”) codes and billing information and determined that 91% of the procedures he performed each week were diagnostic and not interventional radiology procedures. Furthermore, approximately 82% - 90% of his income was generated from diagnostic procedures.
The court rejected this “purely mechanical comparison” of billing codes and procedures and noted that he may have performed more diagnostic procedures, interventional procedures generally take much longer than diagnostic procedures. Thus, the amount of time he actually spent on interventional radiology procedures was not properly reflected in the numbers Unum relied on.
Furthermore, the court observed that interventional radiologists perform both diagnostic procedures and interventional procedures. So, the mere existence of diagnostic procedures in Dr. McCann’s day-to-day work was not determinative. The court noted that Dr. McCann was hired because of his ability to perform interventional procedures and but for that ability, he would not have been hired at all. Ultimately, the court reversed Unum’s categorization of Dr. McCann’s specialty occupation.
This is a fairly common issue in long-term disability disputes, particularly among professionals who have a policy designating that disability is based on the specialty you are performing just prior to leaving work. These policies are sold as premier long-term disability policies (often with a premier price tag), but often when it’s time to file a claim, the insurance company is suddenly less eager to recognize the specialty field.
It is important to consult with an attorney experienced in long-term disability claims (and this issue in particular) if you are facing this problem. As was made clear in McCann, a simple look at CPT codes and money earned from certain procedures is not determinative. The insurance company must look at the quality and quantity of your work to make a full and fair determination as to your proper specialty.
Dabdoub Law Firm was built to be a disability insurance law firm. Because all our disability lawyers focus on disability insurance claims, the firm has significant experience with every major disability insurance company and has won important disability lawsuits. We have handled many cases of occupation misclassification similar to McCann.
The firm can help at any stage of your long-term disability claim, including:
submitting a disability insurance claim;
appealing a long-term disability denial; or
filing a lawsuit against your disability insurance company.
Hiring an experienced disability attorney is important. Because federal law applies to most disability insurance claims, our lawyers do not have to be located in your state.