Florida Ob/Gyn with Amputated Finger Defeats Reliance Standard over Definition of Regular Occupation
A Florida Ob/Gyn with an amputated finger defeated Reliance Standard over the definition of Regular Occupation in his disability insurance policy. In this case, Regular Occupation was not a defined term in the policy. This means that Reliance cannot apply a broad definition of the term not found in the policy in support of its denial of benefits.
Dr. Eric Freling was a practicing Ob/Gyn when he suffered an injury to his left (non-dominant) hand. As a result of the accident, he had one finger amputated and suffered nerve damage to his other fingers. Following the accident, Dr. Freling submitted a disability claim to his insurance company, Reliance Standard.
The Terms of the Policy Are Crucial
As is true of any contract, the terms of a disability insurance policy are key. The insurer and the insured must follow the policy definitions when applying the terms of the policy. However, if a term is not defined, we must look at the plain meaning. If it is ambiguous then it must be interpreted in a light most favorable to the claimant.
In this case, the policy defined Total Disability as the insured’s inability to perform each and every material duty of his/her regular occupation. Regular occupation is not defined in the policy. Reliance attempted to rewrite the policy by broadening the definition of regular occupation to include how it is performed in the national economy.
When reviewing Dr. Freling’s claim, Reliance conducted a review of his occupation as an Ob/Gyn. However, Reliance did not examine what Dr. Freling’s material duties were as an Ob/Gyn. Instead, to determine the material duties of an Ob/Gyn, it looked at how the occupation is performed in the national economy by using the Dictionary of Occupational Titles (“DOT”) definition of an Ob/Gyn.
The DOT’s definition outlined 7 tasks that Reliance interpreted as the material duties of an Ob/Gyn. It analyzed Dr. Freling’s disability against these 7 tasks and determined he could perform most of them. Thus, it found he was not disabled.
DOT’s Definition of Ob/Gyn versus the Insured Regular Occupation as an Ob/Gyn
Dr. Freling explained to Reliance that 80% of his hours were spent in obstetrical and gynecological surgery and the other 20% of his work hours were spent conducting office exams. Dr. Freling maintained that he could not perform surgery with one hand nor could he see patients in his office without the use of both hands. In support of this, Dr. Freling even submitted a letter from a colleague, another Ob/Gyn, who explained in great detail how and why the use of both hands were critical to their work.
Reliance ignored this evidence. It chose to focus on the DOT’s 7 tasks of an Ob/Gyn as the material duties which were not necessarily the same as Dr. Freling’s. It also relied heavily on an outdated article surveying surgeons who could perform surgery with one hand. At no point did Reliance consider how Dr. Freling performed his occupation as an Ob/Gyn.
Reliance ‘s Broad Definition of Regular Occupation was Unreasonable
No where in the policy does it say occupation is defined by the national economy or the DOT. The term regular occupation is not defined. So in analyzing the issue, the Court determined that because the term regular occupation was preceded with his/her, there is a connection between the insured and their occupation.
Accordingly, the Court found that Reliance’s broad interpretation of regular occupation to include the national economy was unreasonable.
As disability insurance attorneys, we often see insurance companies try to rewrite the policy for its own benefit. We are experts in this area and know how to spot wrong interpretations of key policy language. This type of action can be detrimental to a claim if not properly argued against.
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