A Hawaiian court found a urologist is disabled under his UNUM disability insurance policy. Dr. Lawrence Raithaus suffered from low back pain for many years, which was aggravated by his job as a urologist. As a result, he was forced to file for disability benefits under his group policy with UNUM.
UNUM inaccurately defined the material and substantial duties of a urological surgeon
One of the main issues in this case was whether Dr. Raithaus was disabled from performing the material and substantial duties of his own occupation. UNUM argued that 80% of his practice was made up of seeing and treating patients in the clinic and only 20% of his occupation was performing surgery.
UNUM attempted to argue that surgery was not a substantial part of Dr. Raithaus’ occupational duties when he became disabled.
The Court finds surgery is required to be a urologist
The Court rejected the defense’s argument for the following reasons:
- Surgery was normally required for the performance of his occupation
- Surgery cannot be reasonably omitted or modified from his occupation
The court appropriately concluded that a urologist is expected to perform some surgery. In other words, one cannot be a urologist without performing surgery. It was so clear that the court went so far as to cite surveys which showed non-surgical urologist jobs did not exist.
The material and substantial duties of a claimant's occupation play a major role in disability insurance cases. Insurance companies try to complicate occupations to avoid paying benefits. In this case it is clear - a surgeon who cannot perform surgery is disabled from his occupation.
The experienced attorneys at Dabdoub Law Firm have handled many physician, own occupation claims. We know what kind of information they look for in an attempt to convolute the occupational duties. Our goal is to keep the focus on what the claimant did and what they cannot do now.
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