In Own Occupation Disability Insurance Claims, You May Be Entitled to Receive Benefits if You Perform Your Job Incompetently

Eve-Lynn Gisonni's Insurance Legal Blogs

Licensed for 20 years

Attorney in Huntington, NY

Eve-Lynn Gisonni

Serving Huntington, NY

Principal at firm Gisonni Law Firm, P.C.

Serving Huntington, NY

Awards AV Preeminent

Attempting to do your job, albeit really incompetently, does not
prevent the collection of benefits under an own occupation
disability insurance contract if the cause of your incompetence is your medical
condition. Own occupation disability insurance protects the
insured against the inability to perform his or her chosen profession. These
policies were written in the 70’s, 80’s and early 90’s and protect an insured
if he is unable to perform the principal duties of the occupation he was
performing when he became disabled as a result of a sickness or injury. It is
irrelevant if the insured professional can do other types of work or earn
income in some other capacity. I have touted the benefits of this type of
insurance over the years because it is the best money can buy, and it really
protects professionals when they can no longer pursue their chosen occupation
because of a medical condition. Claims under own occupation
disability insurance policies are highly scrutinized by disability insurers who
attempt to wiggle out of their obligations.

Consider the recent case of a New York City plastic surgeon who
was addicted to drugs and suffered from BiPolar Disorder in the case, Jacobs
v. Northwestern Mutual Life Insurance Company
. Even though he was in a fog
and under the influence of drugs, Dr. Jacobs continued to treat patients until
his medical license was suspended. He made a claim under his own occupation insurance policies with Northwestern
Mutual Life Insurance Company, but the company refused to pay claiming he
continued to work as a surgeon and only stopped because he had his license

Acknowledging the value and meaning of own
disability insurance, a New York Appellate Court gave the
surgeon a complete win without the necessity of a trial. The court determined
that a professional like Dr. Jacobs may be at work every day of the week, but
if he is not performing at his pre-disability capacity, he is entitled to be
paid his disability benefits. In his case, failure to perform his occupation
competently as a result of a mental health condition satisfied his burden of
proving total disability.

Jacobs v. Northwestern Mutual Life Insurance Company, 2012 N.Y.
App. LEXIS 8630 (2d Dep’t 2012).

Because so much money is at stake, professionals with claims
under own occupation disability insurance will likely meet
resistance and unfair tactics by disability insurers. When that happens, call
an experienced own occupation disability insurance


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