How Long Term Disability Physician’s Companies Use The Dual Occupation Defense to Deny Physician’s Claims| Clearwater Long Term Disability Insurance Lawyer

Are you a physician who has multiple specialties or businesses? If so, you must properly protect yourself in the event that you become disabled, because one of the common defenses to a long-term disability claim is the “dual occupation” defense. What is this defense?

The long-term disability insurance company will argue that you have two or more occupations at the time you claim to be disabled. Because you’re able to work full time in one of those occupations, a long-term disability carrier will argue that you are not entitled to ANY benefits.

Let me give you some examples.

In Giampa v. Trustmark Insurance Co., 73 F.Supp.2d 22 (D. Mass. 1999), Dr. Giampa, a chiropractor, spent 85% to 95% of his pre-injury time treating patients by conducting examinations and performing manipulations or chiropractic adjustments. He injured his back, which limited his ability to perform manipulations. He had spent incidental time managing his two other chiropractic facilities before his injury.

After his injury, Dr. Giampa devoted all of his time to administrative duties managing the other chiropractic facilities, which resulted in a dramatic increase in his income. He claimed long-term disability benefits, which were denied.

His disability insurance policy had both a total disability clause and a partial disability clause.

The Federal Court decided that the total disability clauses should not be read so literally that an insured persons ability to perform some business duty, no matter how small, would prevent the finding of total disability.

Another twist on the dual occupation issue involved a dentist who had retired and begun working in the real-estate field.  He became disabled and filed a claim asking for the payment of long-term disability benefits based on his inability to perform dentistry. The court found that regardless of whether he intended, even after the sale of his dental practice to resume dentistry, dentistry wasn’t his regular occupation at the time he became disabled. The un-controverted medical evidence show that he was unable to perform most of the substantial material duties of his regular occupation as a real estate developer. The clause in the disability policy defined total disability as the inability to perform some substantial and material duties of his regular occupation. The long term disability policy  did not unambiguously require that he be unable to perform all of the substantial maternil duties of his occupation.

Another example involves the policy of a general surgeon who had on the side, developed a second business doing cosmetic surgeries including vein striping. Needless to say, that was far less stressful and more remunerative than doing general surgery. Unfortunately, he became disabled and unable to perform general surgery. Was he entitled to long-term disability benefits?

The answer could be found in the terms of the disability policy. He had a policy that looked at the occupation he was engaged in at the time of his disability and also had a residual disability provision. The residual disability provision paid benefits even if he was working at another occupation.

The residual disability provision said that “residual disability must follow right after a period of total disability that lasts as long as the qualification period, if any.” Huh?

This would seem to say that one could never get residual disability benefits, unless there was some initial period of total disability. Another question would be whether you had to be totally disabled from work as both a general surgeon and as a cosmetic surgeon to get benefits?

Another paragraph says that “This (residual disability benefit) will begin on either the commencement date or the day after the total disability ends up later.”  You could argue that if he are unable to do general surgery, but the same day could do vein stripping, the doctor  would be entitled to residual disability benefits.

You have significant choices to make and you can inadvertently shoot yourself in the foot and screw up your eligibility for disability coverage by making the wrong decision

It is crucial that you consult with a qualified long-term disability/ERISA attorney before you file your disability application to avoid making crucial mistakes that can result in the complete denial of your claim and cost you residual disability benefits.

You must determine what your policy says about the criteria for being disabled, what occupation your policy covers, whether there is a residual claim, what percentage of your revenue comes from both occupations, how your disability impacts your ability to perform both occupations, and how you’re going to prove that disability. That determination should be made BEFORE you even file your long-term disability claim.

Nancy Cavey, a long-term disability/ERISA lawyer, can be a great resource to you before you apply for long-term disability benefits. Nancy Cavey will be able to review your policy, advise you as to the best course of action to preserve your benefits and maximize your disability income, and assist you in gathering the necessary documentation to prove your entitlement to disability benefits.

Finding a lawyer with long-term disability/ERISA experience who has a proven background in dealing with physicians committee will make the difference between obtaining your long-term disability benefits or being denied. The lawyer who helped you set up your practice, helped you write your will and helped you purchase your house does not have the experience handling disability/ERISA claims.

Contact Attorney Nancy Cavey, who represents physician’s  through out the United States for more information on the dual occupation defense and to get your free no obligation copy of “Robbed of Your Peace of Mind.”

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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FAQ – Attorney Fees in ERISA Cases | Pinellas County Long Term Disability Attorney

There are as many different fee arrangements as there are ERISA attorneys.

Some attorneys will require a flat fee for investigations and then take your case on a contingent fee basis. Contingent fee basis means that you are not required to pay any money up front and the lawyer only gets paid a fee based on what they recover for you.

Some attorneys will require you to pay for retainer up front and then bill you hourly deducting the hourly charge from the retainer.

The Law Firm of Cavey and Barrett has a flexible fee schedule designed to meet your specific financial situation. We are also flexible about advancing costs.

Our attorney’s fee contracts are in writing and explain our fees and costs in detail.

If you would like to see a copy of our basic fee agreement, contact Nancy Cavey by clicking here or by calling 727.894.3188.

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Overview of Frequently Asked Questions | Bradenton Long Term Disability Lawyer

You have many questions about your Short and Long Term Disability benefits. There is no uniform long term disability policy in the United States. Every policy is different. The answers provided to frequently asked questions are general in nature. If you would like a full explanation concerning your specific problem, consult an experienced long-term disability attorney.

Please feel free to order your free, no obligation, copy of Attorney Nancy Cavey’s book

“Robbed of your peace of mind? Important information on long-term disability insurance policies, the claims process and how to win your long-term disability benefits”

You can order a copy on the home page of this blog or by going to www.caveylaw.com.

Ms. Cavey can be reached at 727 -894-3188 for a free, no obligation, phone consultation. She handles long-term disability cases nationwide.

Frequently asked questions include:

What is ERISA?

What impact does ERISA have on my claim?

What if I asked for my plan or other documents and I can’t get them?

Okay, I got the plan. Now what does it say?

How do I file a claim?

Will my employer help me with my disability claim?

What does my doctor have to do to help me with my claim?

Are there certain medical conditions excluded from my policy?

What is the definition of disability?

How does the carrier define my occupation?

How much will my benefits be if I get approved?

Are my benefits subject to taxation?

How long will it take for an initial decision?

What if I get a notice of denial letter?

What is the disability claims appeals process?

What seven clauses you don’t want to see in your long-term disability policy?

What are the common mistakes I can make in trying to handle my own disability case?

What happens if my benefits are denied?

What is a Standard of Review and why do I care?

When should I get a disability attorney?

What type of legal services do I need?

I have a limited income. How do I pay for lawyer?

When can we sue the long-term disability carrier?

If there are other questions you’d like answered, use the comment function and send me an e-mail about your questions. I can either answer them online publicly, or we can communicate privately. Don’t be shy about asking questions!

My father became disabled when I was in middle school. He, like you, wanted to be prepared in the event that he became disabled and could not support his family. He purchased a long-term disability policy through USF&G. I remember the monthly trips he made to his doctor, asking for the appropriate long-term disability forms to be completed service benefits would continue. I remember my mother’s fear that the long-term disability benefits will be suspended.

I understand your fears and the unanswered questions you have. I have been there. So, don’t be shy about asking questions, as the purpose of this blog is to help educate you about the ERISA and short term/long-term disability process. I hope you find this information useful.

If you have any questions, please give us a call at 727.894.3188 or contact us online by clicking here.

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