Pogue V. Northwestern Mutual Life Insurance Company – Licensed Professionals Be Warned

A recent case heard in the appellate court of Tennessee sends a chilling message to physicians or any licensed professionals who need to file a claim on their disability policies and have licensing issues which may impact their continued ability to practice.

Dr. Pogue, a physician who practiced in Nashville, Tennessee, owned three private disability insurance policies with Northwestern Mutual Life Insurance (Northwestern). He submitted a claim to Northwestern, stating that he suffered from a severe anxiety disorder, had experienced a total nervous breakdown and could no longer think clearly enough to practice medicine. He said that he had surrendered his medical license.

Northwestern denied all three claims and accused of Pogue making intentional and even fraudulent misrepresentation to them in order to secure benefits under his policies. Supporting its position, Northwestern pointed to the order of the Tennessee Board of Medical Examiners suspending Pogue’s medical license due to his improper prescribing of controlled substances to patients and family members.

Pogue appealed this claim twice, and twice Northwestern upheld the denials.

Dr. Pogue then filed a lawsuit against Northwestern, who responded with a motion for summary judgment, asking the court to dismiss Pogue’s lawsuit. Northwestern’s court papers said that the disability insurance contract stated “there will be no benefits for a disability or loss that result from or is caused by or contributed to by the suspension, revocation, or surrender of a professional or occupational license of certificate.” This, Northwestern claimed, served to bar his claims for benefits under his policies.

Our office has represented a number of physicians and other licensed professionals who have had issues with their professional licensing and we have fought aggressively against these types of provisions, and had many successes in securing benefits for clients under these challenging circumstances. However, the court in this case has sent a clear message and it’s not a good one for claimants. Each of these situations will be a case-by-case, fact-specific and fact-intense inquiry, but important strategies can be employed in these situations.

Unfortunately for this doctor, every count of Pogue’s claims was dismissed by the court – sending a frightening message to licensed professionals.

Further, Northwestern claimed that while he may have had a nervous breakdown, it was unable to establish proof that apart from his licensing issues, he had been unable to perform the duties of his occupation because of a disabling psychiatric illness.

Another issue in the case was Pogue’s seeking to obtain documents about his case from Northwestern, saying that they were unauthenticated and should not be relied upon. He claimed that the insurance company was relying on evidence that is not properly before the court, and that some of the statements between two expert doctors are actually inadmissible hearsay.

Addressing these procedural issues, the court refused to grant him the ability to get these documents and ruled against his assertion that some of the documents are hearsay.

At every step of the way the court ruled against Pogue. Many of these issues are matters we have been able to overcome for our clients, but this court seems to have taken a clear stand against his claims.

When licensing issues are involved, claimants need to be certain to have an experienced disability insurance attorney representing them at every step of the way, from preparing the claim to negotiating with the insurance company and, if necessary, taking the case to litigation and appeals.

If you are a licensed professional with private insurance policies and have a licensing issue relating to your disability insurance, call our office at 888-583-4959. This is one battle you don’t want to go alone, and you don’t have to.