A New York chiropractor ran a successful practice for more than 25 years and was a pillar of his community. Because his burgeoning practice was so physically demanding, the chiropractor worked hard to stay in shape. He boxed, trained regularly at the gym, bicycled and ran marathons. Unfortunately, while training for the New York City Marathon, he injured his back and subsequently needed surgery, after which his back was never the same. But the chiropractor pushed through the pain and continued with his busy practice.
Eventually, he realized that he could only continue in his practice if he rested every other day. He began working on Mondays, Wednesdays and Fridays and rested his back on Tuesdays and Thursdays. On the days he worked, he took a long lunch break to apply a heating pad to his back and lie flat on a floor. After several years of this reduced schedule – during which the chiropractor used rehabilitation and pain management services to get himself in a position to go to work every day – he realized he couldn’t physically do it anymore.
The Challenge
When the chiropractor’s reduction in schedule due to his disability caused a drop in his income, he filed a partial disability claim with his long-term disability insurance company, Paul Revere Life Insurance Company. Paul Revere paid his partial disability claim for more than five years, beginning in September 2013. Unfortunately for the policyholder, his continued work only exacerbated his back condition. MRI images showed that his moderate degenerative back condition in 2010 had escalated to severe degenerative changes by 2018, including permanent nerve damage to his left leg that caused him to limp when he walked.
Despite these significant and objectively verified degenerative changes, Paul Revere terminated the policyholder’s residual benefits in May 2019, claiming that he had gotten better. To support its position, Paul Revere stated that the chiropractor’s attending physician had previously indicated that he could never lift 50 lbs., but, on a more recent, check-a-box claim form, the physician stated that he could lift 50 lbs. 1% of the time.
The chiropractor continued to work for 10 more months before his worsening disability forced him to cease working altogether. He applied for full disability benefits in March 2020, and Paul Revere denied the claim. Even though the insurance company recognized that the chiropractor was injured, it insisted that he could still work because he had worked part-time for a number of years until the pandemic.
The Solution
On behalf of the chiropractor, we brought a lawsuit against Paul Revere for improperly denying the plaintiff’s claim for total disability benefits and for willfully and wrongfully terminating his claim for partial disability benefits.
Because of our deep experience representing healthcare providers in insurance disputes, our firm understood the chiropractor’s world and his practice. We recognized the amount of work he had gone through to get himself in a position to go to work every day, despite limits to the scale and scope of the work he was able to perform. We were able to effectively convey to the jury the chiropractor’s efforts to work through the pain, including his use of rehabilitation and pain management services. We were also able to present compelling evidence to show how the progression of his disability rendered him fully disabled under the definition of his policy.
The Result
The jury delivered a unanimous decision in favor of the chiropractor 45 minutes after closing arguments. Because of our thorough legal arguments supported by convincing evidence, the jury did not buy into Paul Revere’s flimsy excuses for its claim denial. Instead, jurors determined the chiropractor was disabled and entitled to benefits for total disability dating back to March 2020. They also concluded the chiropractor was partially disabled from May 2019 to March 2020 and awarded him back benefits.
If you are involved in a dispute with your disability insurance company, contact Schwartz, Conroy & Hack PC. We have the expertise, experience and tenacity to make insurance companies keep their promises to policyholders like you.
