A Georgia Court ruled in favor of a gynecologist and found Provident Life and Accident Insurance Company (“Provident”) incorrectly applied its policy terms.
Background
Dr. Gladstone was a board certified gynecologist. Before his disability, Dr. Gladstone was responsible for both office-based gynecological services and hospital-based gynecological surgeries. He estimates that he spent about 60% of his work week in the office and 40% of his work week devoted to hospital surgeries.
In 2001, Dr. Gladstone was diagnosed with carpal tunnel syndrome, making it impossible for him to perform surgeries. However, he was able to continue performing his office duties. Unable to perform surgery, one of the material and substantial duties of his occupation, Dr. Gladstone filed a claim for total disability benefits with Provident.
Dr. Gladstone’s Claim for Disability Benefits
The Provident policy provided for total disability benefits and residual (or partial) disability benefits. The definitions of total and residual disability are as follows:
- Total disability: the insured not able to perform the substantial and material duties of his or her occupation
- Residual Disability: the insured is unable to perform one or more of his his or her substantial daily business duties
Provident decided that Dr. Gladstone was not totally disabled because he was able to perform some of his occupation duties (i.e. the office visits). Accordingly, Provident argued he was only residually disabled. Believing he was entitled total disability benefits, Dr. Gladstone filed a lawsuit against Provident.
Court’s Review of Dr. Gladstone’s Case
The dispute before the court was whether the definition of total disability required Dr. Gladstone be unable to perform all or most of his occupational duties.
Provident argued that in order for Dr. Gladstone to be eligible for total disability benefits, he must prove that he is unable to perform all of his occupational duties. Dr. Gladstone argued that to meet the definition of his total disability unable to perform most of his occupational duties.
The court ultimately ruled in favor of Dr. Gladstone and agreed that to be totally disabled he must be unable to perform most or the vast majority of the substantial duties of occupation. Importantly, the court was not persuaded by Provident’s argument that the existence of a partial disability benefit meant that total disability benefits would only be available to those who are incapable of performing all of one’s material and substantial duties.
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.
Why Us?
- Our lawyers specialize in disability insurance;
- Our lawyers have experience with nearly every insurance company;
- Our lawyers have won tough disability insurance lawsuits;
- Our lawyers have recovered millions in disability benefits for clients who were wrongly denied.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- Submitting a disability insurance claim;
- Appealing a short-term or long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Call to speak with a disability insurance attorney. No fees are costs unless clients are paid.
