Disability Benefits Based on Work Performed, Not Job Title

More and more, disability carriers have been faced with claims by maturing professionals, such as doctors, dentists and podiatrists, whose day-to-day functions have evolved to administration and management, rather than principally treating patients. These professionals manage practices staffed by employees and/or independent contractors and then claim to be disabled from performing patient services which no longer constitute the major part of their workday.

These claims often present difficult issues to resolve. On the one hand, the professionals believe that they have paid premiums for years to protect themselves from financial loss due to disabling illnesses or accidents, not fully appreciating that the policys definition of total disability usually speaks in terms of “being unable to perform the material and substantial duties” of the insureds occupation at the time of the disabling illness or accident. While the definition is designed to have the coverage move with the insureds career changes, it also has the effect of limiting the coverage where the insured shifts to a less physically demanding occupation. The converse is also true. Coverage continues when the insured changes careers to one which is physically more demanding. When a claim is made, the insurer must determine just what the insureds occupation was at the time of the disability.

See also…

Labor and Employment Law

Healthcare Law – Forum

Insurance Issues – Forum