Dr. G’ s individual long-term disability insurance policy with National Life of Vermont (National Life), now owned and administered by Unum, were initially purchased shortly after his graduation from chiropractic college. Although after graduation, he initially worked and apprenticed under other chiropractors, his true desire was to one day open his own practice. With that aspiration in mind, he knew the importance of safeguarding his financial future and career from illness or injury and purchased his personal disability policy. The individual policy contained specific language, which provided that National Life would pay benefits if illness or injury prevented Dr. G from performing the substantial and material duties of his own occupation.
Torn Rotator Cuff and Arthritis Cause Total Disability from Own Occupation for Chiropractor
After a few years of apprenticing, Dr. G opened his private practice in Miami, Florida. Once he established his practice and developed his reputation as a skilled chiropractor, he found himself treating up to 40 patients a day performing manual chiropractic adjustments. Eventually, performing high velocity arm lever adjustment on over 200 patients per week took its toll, and Dr. G began experiencing pain in his right shoulder, as well as pain in his knees, wrists and hands. An MRI revealed that he had a torn rotator and x-rays revealed that he had developed degenerative osteoarthritis in his knees, wrists and hands.
Dr. G had surgery to repair his rotator cuff and did the only thing he could for his arthritis, which was to take prescribed and over the counter medication to control his pain and slow the progression. Unfortunately, despite his efforts, he continued to experience pain, stiffness and discomfort following his rotator cuff surgery, and his work adjusting patients only aggravated and worsened his arthritis.
Dr. G came to the difficult conclusion that he would have to discontinue treating patients with manual adjustments and file a claim for long-term disability benefits under his National Life policy.
Unum Pays Claim Under Reservation of Rights Without Accepting Liability Over Disability Claim
Soon after Dr. G submitted his claim application, Unum requested that he submit personal and corporate tax returns; profit and loss statements for his practice; medical records, amongst other items which he requested and submitted. While Unum reviewed the extensive documentation submitted by Dr. G, it agreed to pay several months of benefits under reservation of rights, without accepting any official liability for the claim pending its official decision. Ultimately, Unum concluded that Dr. G was not totally disabled from performing his chiropractic duties and discontinued paying monthly benefits.
Following Denial of Benefits Unum is Sued for Breach of Disability Insurance Contract
Immediately after receiving the letter from Unum informing him that his long-term disability claim was denied, Dr. G contacted the insurance agent that he purchased the policy through. Dr. G’s insurance agent was confident that he could speak with Unum and persuade the claim representative to reverse their decision. Unum agreed to review additional information pertinent to the claim, but ultimately refused to reverse its decision.
After failing to convince Unum to pay the claim, the agent recommended that Dr. G contact Cesar Gavidia with Attorneys Dell & Schaefer to discuss his legal options. Dr. G retained Cesar Gavidia and suit was filed against Unum for breach of contract. After months of litigation the parties agreed to meet to discuss settlement. Several weeks of negotiations ensued, with the parties zealously arguing their positions and points. Ultimately however, both Unum and Dr. G successfully reached a confidential settlement, where Dr. G agreed to accept a lump sum settlement in exchange for his policy, and the lawsuit against Unum was dismissed.
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