Statute of Limitations: A Case Study
As we’ve written about before, whether a disability is caused by sickness or injury can be critical in determining the duration of benefits that will be paid out under a disability insurance policy. Another component to this calculation is knowing when to sue, if your insurance company decides to classify a disabling condition as sickness versus injury.
One such example is that of Bennett v. Ohio National Life Assurance Corp[1]. Dr. Mark Bennett, an oral and maxillofacial surgeon, was injured when he was thrown from a horse in 2006, where he sustained injuries to his left shoulder and collarbone. He subsequently underwent surgery; however, he had ongoing numbness and tingling in his left hand. He was able to continue working for a while by changing operating techniques and using different tools. However, despite these changes and treatment (medications and physical therapy), he eventually developed chronic pain in his left hand. He cut down on his patient load, but then had to quit working entirely in 2014. He filed a claim with Ohio National, stating that he was unable to work as an oral surgeon because of the physical issues he developed as a result of his 2006 accident.
Ohio National approved his benefits, but noted that it would continue to evaluate whether the cause of the disability was due to sickness or injury. In this case, the distinction was important. Because he was over 55 at the age of filing, he would only be eligible to receive benefits up to age 65 if his condition was caused by sickness. However, if it was caused by injury, he would be eligible for lifetime benefits.
Eventually, on June 8, 2015, Ohio National notified Dr. Bennett that they had determined that his disability was caused by sickness, specifically degenerative disc disease, which was causing compression of nerve roots (leading to the tingling and numbness in his left hand). The letter indicated that benefits would terminate when Dr. Bennett reached age 65.
In September 2018, Dr. Bennett’s benefits stopped. Dr. Bennett sued for breach of contract and breach of the implied covenant of good faith and fair dealing in August 2019. Under the law, Dr. Bennett had four years to file a breach of contact claim and two years to file a claim for breach of implied covenant of good faith and fair dealing. Ohio National argued that the statute of limitations had passed. In other words, they alleged that Dr. Bennett had had waited too long after their initial determination (in 2015) that his disability was caused by sickness to bring a lawsuit. Dr. Bennett argued that the clock did not start running until the date his benefits stopped (in 2018).
The Court reviewed both sides’ arguments and decided in favor of Dr. Bennett. Whether Dr. Bennett is eligible for lifetime benefits remains pending before the Court at the time of this writing.
This case highlights the importance of understanding the terms and requirements of your individual policy. If you have questions about whether your disabling condition is being handled as an illness versus an injury, please feel free to reach out to one of our attorneys directly.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1] Bennett v. Ohio Nat’l Life Assurance Corp., No. A166049, 2023 WL 4069794 (Cal. Ct. App. June 20, 2023)
