Physician who cannot perform one material and substantial duty of his occupation is totally disabled

Dowdle v. National Life Ins. Co., 407 F.3d 967 (8th Cir. 2005) Minnesota

Dr. Dowdle was an orthopedic surgeon who spent half his time performing surgeries and the other half in office consultations. Outside of his surgical practice, Dr. Dowdle performed approximately 7 Independent Medical Examinations per week. However, surgery and surgery-related care comprised 85% of Dr. Dowdle’s orthopedic practice.

As the result of an accident in a private aircraft he was piloting, Dr. Dowdle suffered a closed head injury and a heel bone fracture. His injuries prevented him from standing at an operating table for an extended period of time, and thus, he was no longer able to perform orthopedic surgery. Pursuant to the terms of his disability income policy and Business Overhead Expense policy with National Life Insurance, Dr. Dowdle filed a disability claim. His claim was reviewed and he began receiving his maximum monthly total disability benefit.

Both disability policies defined total disability as the inability to perform the substantial and material duties of the Insured’s occupation. Residual disability is defined as the inability to perform one or more of the important daily duties of the Insured’s occupation or the inability to engage in the Insured’s occupation for as much time as was usual prior to the start of disability.

Within the next year, Dr. Dowdle began to perform office visits and some IMEs. Because Dr. Dowdle resumed duties he performed before his disability, National Life determined that he was now only partially disabled. Dr. Dowdle disagreed with this determination on the basis that his inability to perform orthopedic surgery, the most important part of his occupation, rendered him totally disabled.

Under Minnesota law (as well as Florida law and the law of many other jurisdictions), if the insurance policy language is ambiguous, it must be interpreted in favor of coverage. The Court’s review of the disputed policy language led it to conclude that an ambiguity exists, as the policies’ definition of “total disability” are susceptible to differing interpretations because they do not speak in terms of “any”, “all”, or “the most important part” of Dr. Dowdle’s duties. Accordingly, the 8th Circuit Court of Appeals found that the previous court’s holding, that the policies are to be construed in favor of Dr. Dowdle, was correct.

More specifically, the Court found that at the time he incurred his disability, Dr. Dowdle was engaged predominantly in the occupation of an orthopedic surgeon. The IME practice was separate and distinct from his surgery practice. Therefore, the fact that Dr. Dowdle performed IMEs both before and after the accident has no bearing on whether he can perform the “material and substantial” duties of being an orthopedic surgeon. Because Dr. Dowdle can no longer perform orthopedic surgery, which both parties concede is the most important substantial and material duty of Dr. Dowdle’s occupation as an orthopedic surgeon, he is entitled to disability benefits under Minnesota law.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Ralph R.

My experience working with Dell & Schaefer exceeded my expectations. This firm treated me professionally and help me resolve my case. I had peace of mind working with this firm because they listened to my cased and took care of me.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us