Insurance Company Tactics:
Misidentifying Claims

Insurers sometimes go to great lengths to avoid paying out on professionals’ claims for benefits under their disability insurance policies. This can include improperly designating a claim as a residual (or partial) disability when it is really a total disability claim.

One such example of this is the case of Morgan v. Unum Life Ins. Co. of America.[1]  Dr. Morgan, a general surgeon, had an own occupation policy, which was targeted to physicians and specialty-specific. After purchasing the policy, Dr. Morgan injured his hand was unable to continue practicing as a surgeon.

When Dr. Morgan filed for disability, Unum told him he did not qualify for total disability because he had performed some in-office procedures (what he termed “lumps and bumps”) and had performed a single major surgery in March 2007 (done prior to his own hand surgery, and before Unum considered Dr. Morgan’s disability on its merits).

Dr. Morgan sued to challenge Unum’s determination and, upon review, Utah District Court Judge David Nuffer found that “a reasonable jury could conclude that these minor office procedures were not part of Morgan’s surgical specialty.” The Utah Court further held that “the single major surgery . . . does not prove that Morgan could continue performing major surgeries on an ongoing basis.” The Court then went on to conclude that there was sufficient evidence to suggest that Unum did not conduct a proper total disability analysis and “instead decided to treat the claim as one for residual disability for purposes of convenience and to reduce its potential exposure.”

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] Morgan v. Unum Life Insurance Co. of America, No. 2:10-cv-957 DN., 2012 WL 3156569 (D. Utah Aug. 3, 2012)

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