An interesting question in the world of disability insurance benefits is whether a physician (or a dentist, lawyer or other licensed professional for that matter), can be deemed to be disabled despite the fact that their license to practice the profession has been taken away.
The answer is maybe, and the answer typically depends upon when the medical disability occurs in relation to what is commonly known as the legal disability. The legal disability is the occurrence of the loss of one’s license to practice their profession (due to some type of misconduct), which results in a suspension, revocation or other action against one’s ability to continue practicing. A recent decision from New York has denied summary adjudication to both sides, where the insurer sought to justify its claim decision on the basis of legal disability, while the insured claimed to be medically disabled prior to the time he lost his license.
The facts of the case serve to highlight the issues. The doctor, a plastic surgeon, claims to have suffered from bipolar disorder, which caused him to abuse several drugs. His conduct also led him to surrender his license when faced with charges of unprofessional conduct in his profession. His claim was submitted on the basis of the bipolar disorder, and was back dated to the date prior to the surrender of his license. When the insurer denied the claim, suit was filed.
We have helped a number of medical and other professionals combating this issue with their insurance companies, securing good results in these cases, by developing strong support for the medical disability, even in the face of compelling evidence to support a legal disability. If you are faced with one of these difficult challenges, please do not hesitate to contact our office to discuss and strategize your issues.