The Arkansas Supreme Court awarded total disability benefits to a cardiologist who filed a lawsuit against Provident Life & Accident Insurance Company (“Provident”) for total disability benefits. The Court found that despite the cardiologist being able to perform the majority of his pre-disability duties, he still qualified for total disability benefits.
Todd Gammill purchased two disability insurance policies from Provident: a business overhead expense policy and individual disability income policy. On his applications, he listed his occupation as “invasive cardiologist.” In the event Dr. Gammill became disabled under the terms of the policies, Provident would make monthly payments. Dr. Gammill worked as a solo practitioner in the field of cardiology until he was severely injured in a car accident on December 22, 1995.
Within hours of the crash, Dr. Gammill suffered a cerebral stroke during surgery and experienced significant impairment in his motor skills, loss of sensitivity in his right hand, and exacerbated a prior back injury. As a result, Dr. Gammill stopped practicing invasive cardiology but maintained his non-invasive cardiology practice with the assistance of other doctors and medical staff upon joining a cardiology clinic as a salaried employee.
Dr. Gammill filed a claim with Provident, which began making disability payments as of April 1, 1996. In February 1997, Provident had Dr. Gammill examined by its consulting neurologist who determined that Dr. Gammill could not perform any invasive procedures and his motor and sensory impairments were permanent. Nonetheless, Provident determined that Dr. Gammill continued to work in his profession and stopped making disability payments in April and then began payments again under reservation of rights.
The Court Decisions
In December 1997, Provident filed for declaratory judgment claiming that Dr. Gammill continued performing the substantial and material duties of his occupation and was not totally disabled under the policy. The trial court ruled in Provident’s favor, determining that Dr. Gammill was still able to perform the majority of the duties as a cardiologist and was working as one. Dr. Gammill appealed.
The dispute before the Supreme Court of Arkansas was whether Dr. Gammill was entitled to total disability benefits due to his undisputed inability to perform many of the duties of his occupation.
The court found that Provident was wrong in denying Dr. Gammill’s total disability benefits because:
- The definition of total disability under the policy did not speak in terms of “any,” “all,” “some,” or “a majority” of Dr. Gammill’s duties;
- Since different reasonable interpretations could be given to the policy’s definition of total disability, the policy must be constructed in favor of Dr. Gammill.
Accordingly, the court ruled in Dr. Gammill’s favor.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for 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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