A New York and New Jersey Lawyer Who Represents Policyholders and Beneficiaries in Life Insurance Denial Cases

A New York state trial court has denied motions by both a plastic surgeon and an insurance company with respect to the former’s claim for disability benefits.

The case is interesting because the Court contended with the inter-relation between a “factual” disability and a “legal disability” and how a disability determination is reached when each is in play. A factual disability exists when a person is unable to work in his or her occupation because of an existing mental or physical disability. A legal disability, on the other hand, exists when the person is prevented from working for legal reasons.

In the instant case, the plaintiff, a plastic surgeon, had for many years been addicted to drugs and exhibited compulsive sexual behavior that resulted in 29 disciplinary actions between 2001 and 2005. The doctor formally surrendered his medical license in September 2007 because he could not “successfully defend against acts of misconduct alleged in the Statement of Charges.”

The insurer claimed that the doctor could not work due to a legal disability, beginning in about September 2007 when he stopped practicing medicine, and hence was not entitled to benefits. Proof in support, it claimed, was that he practiced medicine up until that time.

The doctor claimed that he was disabled beforehand because for many years prior to September 2007 he suffered from bipolar disorder and drug dependency. His treating doctors were willing to back up this claim. In denying the motions of both parties for summary judgment, the Court stated:

To adopt the position urged by Northwestern, would be to concldue that a physician, diagnosed with bipolar disorder two months after his license was suspended and who testified that between January and June of 2007, was “self-medicated with crystal meth almost on a daily basis”, was nonetheless unquestionably capable of performing the principal duties of a medical doctor. This Court finds such a conclusion untenable given the evidence presented herein.

The decision is Jacobs v. Northwestern Mutual Life Ins. Co. from the New York Supreme Court, Nassau County.

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