Defining Occupation: A Case Study
When you file an individual disability insurance claim, one of the first things the insurance company will do is define your occupation, and its job duties. They’ll often look at CDT/CPT codes and financial statements in order to try to determine your job duties. In many instances, insurance companies will seek to define your occupation as broadly as possible.
One such example of this is the case of Minzter v. Providence Life Ins. Co.[1] (Unum). Dr. Minzter, a board-certified ophthalmologist, filed a total disability insurance claim in 2019, based on significant ulnar atrophy of his left hand. According to Dr. Minzter, since 1992 his practice has been focused primarily on pediatric ophthalmology, including ophthalmic surgery (many of his parties suffered from amblyopia or strabismus, which often require surgery). In fact, when he purchased his policy from Unum in 1993, Dr. Minzter indicated that his “occupation” and “exact duties” were “ophthalmic surgeon” on his policy application.
However, in evaluating his claim, Unum deemed Dr. Minzter’s occupation to be that of an ophthalmologist, and stated that his records, including CPT codes, showed that surgery had been only a limited amount of his practice, and pointed to Dr. Minzter’s answers on his Physician Questionnaire that indicated he spend only 5% of his time in the operating room. Unum argued that Dr. Minzter was still performing other duties of an ophthalmologist, except for surgery. Dr. Minzter countered that the practice of eye surgery required a significant amount of time outside of the operating room—including assessing whether patients may need surgery.
Additionally, Unum pointed to the fact that there is no recognized subspecialty of surgery in ophthalmology. Dr. Minzter argued that even if Unum chose to consider him an ophthalmologist rather than an ophthalmic surgeon, he should still be entitled to total disability of because ophthalmology is a surgical specialty.
Because of its evaluation of Dr. Minzter’s occupation, including a review by a vocational rehabilitation consultant, Unum determined that Dr. Minzter was not totally disabled. The Court agreed with Unum, deciding that Dr. Minzter could perform all but one of the substantial and material duties of his occupation, and therefore wasn’t totally disabled. The lawsuit did not address whether Dr. Minzter might be entitled to residual disability benefits, but the Court indicated that it appeared that Dr. Minzter’s claim fell within the purview of that provision.
The takeaway from this case is that insurers (and Courts) will look to what your job duties are at the time of filing a disability claim, not what they were (or what your job title was) at the time you filled out the application for a policy.
If you have questions about whether your occupation is being correctly defined by your insurance company, 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] Minzter v. Provident Life and Accident Ins. Co., No. CV215595MASJBD, 2023 WL 4108850 (D.N.J. June 21, 2023)
