Chiropractor placed on claim despite an “any occupation” provision

Our client, a chiropractor, suffered from severe bilateral carpal tunnel syndrome, as a result of a traffic accident. Our client applied for disability insurance benefits under the terms of his contract. His disability insurance contract defined total disability for the first 24 months as the inability to perform the substantial and material duties of his occupation as a chiropractor. After 24 months the definition changed to the inability to perform the substantial and material duties of any occupation taking into consideration his education, training, experience, and pre-disability earnings. Earnings were defined as “income from work.”

Our client was paid for the first 24 months, however thereafter his insurance carrier denied further benefits, claiming that our client could engage in several other occupations and was thus, no longer disabled. His insurance carrier asserted that since our client did not withhold Social Security from the profits he obtained from his practice, the money received was deemed “dividends” rather than “income / earnings.” Therefore, the insurance carrier considered his pre-disability earnings as $0, despite the fact that he was earning upwards of $200,000 per year. As such, the insurance carrier argued that if he could engage in any job in which he could earn more than $0 per year, he was not eligible for total disability benefits.

We submitted an appeal to the insurance carrier providing ample medical documentation, a report from a vocational rehabilitation expert, and citing applicable case law. Based on our appeal, our client’s insurance carrier reversed its decision, provided all back benefits owed, including interest, commenced monthly benefits, and paid attorney’s fees and costs.

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