Provident Life And Accident Company Breached Its Contract With Dentist When Terminating Total Disability Benefits Based On Dentist’s Ability To Perform Managerial Duties

Dr. Leonor, a dentist, recently sued Provident Life and Accident Company after it paid and then terminated his total disability benefits under his disability income insurance policies. The disability income insurance policies at issue obligated Provident to pay total disability benefits in the event that Dr. Leonor became unable to perform “the important duties of [His] Occupation.” The dispute at issue turned entirely upon which duties Dr. Leonor needed to be unable to perform in order to qualify for total disability benefit payments under his disability income policy.

At the time of his injury, Dr. Leonor was spending approximately two-thirds of his time performing dental procedures and approximately one third of his time managing dental practices and other businesses he owned. Dr. Leonor earned about half of his income as a dentist and half of his income from these investments. Following cervical spine surgery in 2009, Dr. Leonor become unable to perform dental procedures, but remained able to manage and operate the businesses he owed. Dr. Leonor’s overall income actually increased after his surgery in 2009.

Dr. Leonor claimed benefits for total disability under his three disability income policies with Provident, and Provident and Paul Revere initially approved total disability benefits under each. However, the insurers stopped paying total disability benefits on the basis that because Dr. Leonor’s occupation at the time of his injury included his managerial duties and because he could still perform those duties after his injury, he was not totally disabled under the policies. However, Dr. Leonor’s position remained that because he was unable to perform any dental procedures, he was totally disabled and entitled to benefits under the policies at issue.

Both the district court and the court of appeals found that “the important duties” could plausibly be read to mean “most of the important duties” and resolved the ambiguity in favor of Dr. Leonor under the law. The court of appeals reasoned in part the following in response to Provident’s arguments: “In the context of disability insurance, reading ‘unable to perform the important duties of Your Occupation’ to refer to each and every important duty does not serve any apparent purpose of the parties. A person is unemployable in a particular profession so long as she cannot perform a substantial proportion of that profession’s important duties. At that point, it does not matter whether there are a few important duties that she can perform, because she will be unable to function in that profession. The insurers’ proposed interpretation appears disconnected from the risk insured against – the possibility that injury will force the insured to quit his occupation. This analysis justifies the approach of the Eight Circuit (applying Minnesota law) and the Eleventh Circuit (applying Georgia law). Those courts have held that “‘most’ or the ‘majority’ of the [important] duties is . . . a reasonable interpretation if an insured is unable to engage in his regular occupation as a result of his inability to perform most or the majority of those duties.’” Leonor v. Provident Life & Acc. Co., 790 F.3d 682, 690 (6th Cir. 2015) (citing Giddens v. Equitable Life Assur. Soc. of U.S., 445 F.3d 1286, 1298 (11th Cir. 2006); Dowdle v. Nat’l Life Ins. Co., 407 F.3d 967, 968, 970 (8th Cir. 2005)).

Despite the court’s well-reasoned holding in the Leonor case, disability insurance carriers regularly challenge insured’s total disability claims on this basis, many times wrongfully. If you are facing a denial of disability income benefits by your insurance company, contact one of our experienced attorneys for a free consultation. Our attorneys regularly represent dentists, and frequently dispute wrongful denials of disability insurance benefits with companies such as Provident, Paul Revere, Great West, Monarch and others.