Will My Insurance Company Challenge my COVID-19 Claim?
A Case Study

COVID-19’s impact cannot be overstated, particularly on the medical community. While it might seem like something in the rear-view mirror now, COVID-19-based disability claims continue to be revisited and challenged by insurance companies.

One such case is that of Osborn v. The Paul Revere Life Insurance Company[1] (Unum). Dr. Osborn was an oral and maxillofacial surgeon with over thirty years of experience. He suffered from several medical conditions that predispose him to adverse outcomes from COVID-19 infection and he was no longer able to safely practice. As a result, he filed claims for benefits under his individual disability insurance and business overhead expense insurance policies with Unum during the pandemic.

Unum argued that he was not totally disabled under the terms of his policy and, the lower court found for Unum. However, the Ninth Circuit Court of Appeals determined that there were several factual issues that were relevant regarding whether a reasonable jury could find that Dr. Osborn was unable to perform his occupational duties as an oral surgeon because of injury or sickness.

There were several issues that the Court found were relevant. First, it noted that Dr. Osborn could not recall the advice his physicians had given him in March 2020 and could not verify that his physicians immediately advised him to stop practicing.  However, Dr. Osborn’s staff and an expert witness did testify that Dr. Osborn was unable to obtain the necessarily personal protective equipment (PPE) that he needed to keep his practice open and Dr. Osborn’s physicians testified that he had a pulmonary embolism in August 2020 that made it unsafe for him to return to work, even if the adequate PPE had been sourced.

In light of these facts, the Court found that a reasonable jury would need to weigh these facts to determine if Dr. Osborn was indeed totally disabled either in March or August 2020. However, the Court also determined that Unum’s conduct was not unreasonable and dismissed Dr. Osborn’s bad faith claims.

This case illustrates the unique and complex fact scenarios that disability insurance claims based on COVID can be. It also highlights how long disability claims can be entangled in litigation and the importance of securing important documentation in real-time and filing your claim correctly with adequate support and legal counsel from the start.

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] Osborn v. Paul Revere Life Ins. Co., No. 1:21-CV-00842-CDB (E.D. Cal. June 13, 2024).

 

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