Our client, an ENT doctor injured his finger during an automobile accident. As result of the injury to his finger our client was no longer able to perform a majority of the surgeries that he was once able to do. Our client had both a personal disability policy and a business overhead policy. Our client continued to work as an ENT, but his partner handled all of the surgeries that our client was once able to perform. The revenues and profits of the practice continued to stay the same for the practice, but our client was now only generating about 30% of the income for the practice. The disability carrier attempted to argue that even though our client was claiming residual/ partial disability benefits, his business did not have a greater than 20% lost of income and therefore he was not entitled to any disability benefits.
The disability carrier did not understand that in calculating the monthly income for our client, the disability policy stated that they must only consider “the revenues generated for services performed by the insured.” In order to present the revenues earned by our client we prepared a detailed analysis of all the procedures performed by our client both before and after his disability. We then worked closely with our client’s accountant and office manager to prepare profit and loss statements for each month that specifically identified the revenues generated by our client. After several meetings with the claims examiner and their financial consultants we were successful in getting the carrier to understand the appropriate calculation of monthly benefits for our client. In addition to recovering in excess of $225,000 in past due benefits for our client, we were also successful in making the carrier pay our attorney fees plus interest on the past due disability benefits.
We continue to represent this client on a monthly basis as he continues to work as an ENT and collect almost 100% of his disability benefit on a monthly basis. This claim was handled by Attorney Gregory Dell and continues to be handled by Mr. Dell on a monthly basis.