Category Archives: Disability Claim Denials

Provident Life Says Disabled Doctor Must Undergo Surgery or Lose Benefits

A disability insurance policy may condition a doctor’s disability benefits upon his consent to receive “appropriate” medical treatment, which may include surgery, according to the California court in Provident Life & Accident Ins. Co. v. Henry. In Henry, a disability … Continue reading

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Surgeon Who Can’t Perform Surgeries May Not be “Totally Disabled,” Says Court

In our previous post, we looked how one California court analyzed the interpretation of “total disability” as applied to a gynecologist’s claim for disability benefits.  In this post, we look at another California case, Gross v. UnumProvident Life Ins. Co., … Continue reading

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Court Says Doctor Still Performing Minor Surgeries Not Disabled

Under California law, an insured claiming coverage under an insurance policy has the burden of proving entitlement to such coverage.  See Royal Globe Ins. Co. v. Whitaker, 181 Cal.App.3d 532, 537, 226 Cal.Rptr. 435, 437 (1986).  Therefore, in the disability … Continue reading

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Insurance Bad Faith: Distinguishing Accident From Sickness

Disability insurance plans include different policy provisions that determine benefit payments based on whether your disability was caused by sickness or accidental injury.  As  we have previously discussed, the difference in benefits payments under the sickness and accident provisions is substantial.  … Continue reading

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Provident Life Tries to Short-End Disabled Doctor

Disability insurance companies may try to classify your disability claim as one resulting from “sickness” rather than “accident” or “injury.”  The difference matters because most disability insurance policies include separate sickness and accident provisions that affect limits of disability payment. … Continue reading

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Once ERISA, Always ERISA: How and why to avoid having your disability insurance policy controlled by The Employee Retirement Income Security Act of 1974

Disability insurance carriers have increasingly used The Employee Retirement Income Security Act of 1974 (ERISA) to their advantage.  While ERISA was supposed to be for the protection of employees, it is actually being used to protect insurance companies and employers. … Continue reading

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Disability Insurance and the Specialized Anesthesiologist: Understanding and Protecting Your Investment

By Edward O. Comitz, Esq. and Patrick T. Stanley; Published in Anesthesiology News As the practice of medicine has evolved and become increasingly more complex and specialized, many physicians no longer describe themselves as simply doctors or surgeons, or even … Continue reading

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Arizona Disability Insurance Bad Faith and Delegation of Administrative Duties

Under the law in Arizona, the relationship between insurer and insured is a special relationship, giving rise to duties not usually found in other contractual agreements. Rawlings v. Apodaca, 151 Ariz. 149, 163, 726 P.2d 565, 579 (1986); Dodge v. Fidelity … Continue reading

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DISABILITY INSURANCE AND THE PHYSICIAN: CAN YOU COLLECT ON YOUR POLICY?

You have worked as a physician for your entire career.  Your spouse and children rely on you, and you have numerous financial obligations both at home and at the office.  The stress and trauma of a disability can cause you … Continue reading

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Which Type of Disability Insurance Policy Do You Own?

Disability insurance policies come in several types. The type of policy you purchase affects your legal rights and the benefits you may receive. Here is an overview of the basic types of disability insurance policies. Individual Disability Insurance: As the … Continue reading

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