Pennsylvania Court Rules Against Equitable Life Assurance in Applying Material and Substantial Duties of a Trial Attorney

A Pennsylvania court rules against Equitable Life Assurance (“Equitable”) in applying the material and substantial duties of a trial attorney.

Prior to being hospitalized for labile hypertension, John Krisa practiced law as a trial attorney in Pennsylvania. After being told by his doctors he could not continue in his occupation as a trial attorney, he filed for disability benefits under his policies with Equitable.

Material and Substantial Duties of A Trial Attorney

Mr. Krisa’s policies defined total disability as the inability to engage in the material and substantial duties of your regular occupation. After Mr. Krisa filed his claim for disability benefits, he continued work but with a reduced caseload and no trials. During this time, he negotiated settlements without trial, represented a client at arbitration, acted as aribator in another case, and participated in a hearing.

Because of his continued work, Equitable argued that Mr. Krisa was not totally disalbed. It claimed that he continued work in some capacity in his regular occupation. As a result, Equitable offered that Mr. Krisa may be residually disabled as opposed to totally disabled.

The Pennsylvania Court held that while some of the work Mr. Krisa did after filing for disability could be litigation oriented, a jury could reasonably conclude that it was not material or substantial to his work pre-disability, as a trial attorney.

This case represents an issue we see often with individual disability insurance policies. Insurance companies make every effort to blur the occupational duty lines. When the policy defines disability as the inability to perform the material and subntail duties of an occupation, it is important to define what those duties are.

We work hard to clearly and definitively outline the subantail and material duties of our client’s occupation. We want to avoid an opportunity for the insurance company to allege the ability to do some work means the claimant is not disalbed.

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