What are “Material and Substantial Duties”? A Case Study
Most “own occupation” disability insurance policies will address “material and substantial duties” in their definitions of total and partial disability. The exact definition (and whether or not you need to be disabled from one or all material and substantial duties) will depend on the language of your specific policy. However, what is and is not a material and substantial duty is not always clear-cut.
One example of this is the case of Vossberg v. Northwestern Mutual.[1] Dr. Vossberg was a physiatrist with a speech disorder (diagnosed as dysarthria). Dr. Vossberg filed a claim for partial disability with Northwestern Mutual, claiming that he could no longer make medical records because he was required to use electronic transcription software at his long-time hospital employer.
Under Dr. Vossberg’s policy, he would be considered partially disabled if he was “unable to perform one or more but not all of the principal duties of his occupation.” In this instance, both parties agreed that one of Dr. Vossberg’s principal duties was to “make medical records that document his interaction with patients.”
In reviewing the case, the Court found that “using electronic transcription software is not required to be a physiatrist.” The Court found that Dr. Vossberg had not presented evidence that his hospital employer had required the use of transcription software and pointed to the fact that he was currently working in private practice where he made his records by dictating patient notes into a tape record and having a person transcribe them. Further, other employers that Dr. Vossberg considered applying to testified that there was no requirement for him to use electronic transcription software. Thus, the Court concluded that Dr. Vossberg was not partially disabled under the terms of his policy.
Often, policies will even go so far to say that what is and is not a material and substantial duty is not based on what is done for any one employer, but for the national economy as a whole. So, even if Dr. Vossberg’s employer had actually required him to use transcription software, he may still not be considered disabled, depending on the exact language in his policy.
This case highlights the importance of carefully reading and understanding the terms of your specific policy and how it addresses material and substantial duties. If you fee that you are unable to do the material and substantial duties of your occupation, and are considering filing a disability insurance claim, 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] Vossberg v. Northwestern Mutual Life Ins. Co., No. 1:22-cv-00364-JRS-KMB, 2023 WL 167460 (S.D. Ind. Jan. 12, 2023).
