Mass Mutual attempts to deny disability benefits to OBGYN after ten years on claim
Our Client, an OBGYN from New York, suffered significant spinal injuries following a fall from his horse. Total Disability benefits were paid for approximately 10 years without question. As part of his physical therapy and to prevent further degeneration of his spinal cord, back muscles and leg muscles, his doctor advised him to lift weights. During one of the insurer’s regular disability surveillance observations, our client was videotaped while in the gym lifting weights. This doctor was subsequently contacted by the insurer and advised that there were some questions related to his claim and his disability.
After paying benefits for 10 years, the insurer advised my client that they believed he could return to work in some capacity, however, they never clearly established his pre-disability duties. As such, they wanted documents and information to verify the pre-disability duties, as they were not sure that he practiced as a full time OB/GYN 10 years ago. My client advised the carrier that he sold the practice 10 years ago and that any and all documents that could specifically show the procedures he performed at that time were no longer in his possession, and most likely not in the possession of the doctor to whom he sold the practice. Apparently this response was not sufficient and the insurer continued to harass my client as well as one of his former employees. At that point he hired our law firm.
We immediately advised the carrier that there actions were not only unreasonable, but the claims handling actions illustrated bad faith. Additionally, we met with the claims adjuster and one of the company’s vice presidents to further discuss the carrier’s mishandling of this claim. After agreeing to keep our client on claim, we negotiated a very lucrative, confidential lump sum buyout for him, allowing him to end the scrutiny and unforeseeable acts of his disability insurance carrier.