You thought you were sold and bought a policy that protected your specialized occupation. When claim time comes, however, the insurance company doesn’t want to honor its promise. Cases like this one are, unfortunately for claimants, being fought around the country.
Kevin McCann, a radiologist by profession, submitted a claim to his disability insurer, Provident Life and Accident Insurance Company, a subsidiary of UNUM. After approving and paying the claim, Provident Life terminated Dr. McCann’s benefits, giving rise to a lawsuit in New Jersey Federal Court governed by the law of ERISA, the Employee Retirement Income Security Act of 1974. After Dr. McCann lost at the trial court level, he appealed to the Third Circuit Court of Appeals. The decision is McCann v. Unum Provident, 2018 WL 5117113 (3rd Cir. Oct. 5, 2018).
The United States Court of Appeals, Third Circuit, reversed the trial court’s decision and ruled in favor of Dr. McCann. The major issue for the court to decide was to determine Dr. McCann’s “own occupation.”
Dr. McCann worked as an interventional radiologist, but also performed diagnostic radiology. Interventional radiology is surgical and more physically demanding than diagnostic radiology. Dr. McCann’s weekly work activities included both interventional and diagnostic radiology.
Pointing to Dr. McCann’s billing records, which showed that he spent far more time taking and interpreting diagnostic readings than he did performing interventional procedures, Provident Life urged the appellate court to affirm the district court’s conclusion that his occupation was that of a diagnostic radiologist.
The appellate court rejected that approach, however, deeming that the argument was misplaced for the simple reason that interventional radiologists perform diagnostic readings and are required to do so as part of their job. In other words, the court held that, given that Dr. McCann performed tasks exclusive to interventional radiology, the fact that he also engaged in diagnostic radiology in no way altered the conclusion that interventional radiology was his occupation.
This is an important decision for those with specific occupational duties or recognized specialties. Disability insurers often try to water down the occupation or occupational duties of a specialist in a sneaky, often illegal, effort to deny, terminate or otherwise limit benefits.
Feel free to contact us for assistance in stopping your insurance company from engaging in this abusive practice.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack