A federal court in Massachusetts rules in favor of a chiropractor seeking total disability benefits from Continental Assurance Company (“CNA”) after an injury caused him to be unable to treat patients.
In 1994, Dr. Giampa injured his back while treating a patient. Before then, he spent over 85% of his work time treating patients. Treatment of patients included conducting examinations and performing manipulations/adjustments. The remainder of his time was spent managing his two chiropractic facilities.
A back injury left Dr. Giampa unable to treat patients. However, he was able to expand his management duties and began managing sixteen chiropractic facilities. His income increased from $200,000 per year to over $1,000,000 per year.
Unable to continue treating patients, Dr. Giampa filed a claim for total disability benefits with CNA.
The Disability Policy
The disability policy defined total disability as follows:
Total Disability means that because of Injury or Sickness:
- The insured cannot perform the substantial and material duties of his regular occupation; and
- The insured is receiving care by a physician which is appropriate for the condition causing [his] disability
CNA’s Claim Review
Initially, CNA recognized Dr. Giampa’s total disability and awarded total disability payments. A few months later it terminated his benefits. Therefore, Dr. Giampa filed a lawsuit against CNA for his total disability benefits.
The Court’s Review of Dr. Giampa’s Claim
The court stated that this case turned on the meaning of “regular occupation.” CNA argued that Dr. Giampa’s occupation was that of an entrepreneurial chiropractor. Thus, it argued because Dr. Giampa continued to perform the managerial duties of his occupation, he was able to perform the material duties of his regular occupation and was not disabled.
Dr. Giampa contended that his occupation was a practicing chiropractor with the sole material duty being to manipulate or adjust patients. Because he could no longer do so, he argued he should receive total disability benefits.
The court focused on how Dr. Giampa earned his primary living before his injury and found that it was reasonable to conclude that Dr. Giampa’s core duty was to manipulate patients. Therefore, he was totally disabled.
The court was unpersuaded by the following arguments set forth by CNA in support of its position that Dr. Giampa:
- Dr. Giampa was still licensed as a chiropractor
- Dr. Giampa was earning more income now than before his injury
- Dr. Giampa maintained malpractice insurance
The simple fact was Dr. Giampa could no longer treat patients, which accounted for more than 85% of his practice prior to his injury. Thus, he was totally disabled.
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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