Disability carrier denies disability benefits to chiropractor after paying for 8 years, yet Attorneys Dell & Schaefer file lawsuit and obtain lump-sum buyout
Author: Attorney Cesar Gavidia
Dr. Z, a chiropractor, suffered an injury to both of his wrists while performing work in his backyard. As a result, Dr. Z was forced to discontinue his profession as a chiropractor and file disability claims under his three long-term disability insurance policies. Wanting to insure his financial future in the event that he became disabled, Dr. Z maintained three individual disability policies with three different insurance companies. Initially, the disability carriers approved Dr. ‘s claims and began paying him monthly disability benefits.
Over the years, Dr. Z’s hands and wrists continued to degenerate, developing arthritis and becoming deformed. He also developed osteoarthritis, rheumatoid arthritis, herniated discs and multiple lumbar and compression fractures of the spine. There was no question that Dr. Z was totally disabled from the practice of chiropractic and that his health was only getting worse. This was evidenced further by the fact that all of his disability carriers paid and accepted liability for his claims.
Shortly after stopping the treatment of patients, Dr. Z began working part time providing consulting services approximately 4-6 hours per week and began working part time doing billing and public relations earning $7.00 per hour. At no time did he return to the practice of chiropractic.
Despite being provided with volumes of medical documentation supporting Dr. Z’s total disability, one of Dr. Z’s disability insurance carriers decided to terminate Dr. Z’s claim for benefits after paying him for several years. The insurance company also alleged that Dr. Z committed fraud by allegedly working during the period of time which he claimed he was totally disabled and unable to treat patients. The disability carrier further claimed an overpayment of disability benefits. Dr. Z maintained that he never treated patients after he became totally disabled and that the insurance company was merely taking advantage of the fact that bad times had befallen Dr. Z.
Dr. Z retained Dell & Schaefer to represent him against his disability insurance company. Dr. Z’s attorneys, Gregory Dell and Cesar Gavidia began by sending a letter to the insurance company demanding that they recommence the payment of total disability benefits and threatening suit if benefits within a specific time frame. After several communications, the parties agreed to sit down and informally attempt to resolve the dispute through mediation prior to the commencement of a lawsuit. Although neither side conceded any arguments, the parties agreed that it was best to settle the matter as opposed to initiating a lengthy and contentious lawsuit. To this day, Dr. Z’s remaining two disability carriers have continued to pay disability benefits without interruption.