Physicians Disability Insurance Claims Attorney

Skilled Doctor and Surgeon Disability Insurance Claims Attorneys

An uninsured disability can wreak financial havoc. It stops income, increases expenses, and drains savings and retirement accounts. Disabilities have caused nearly half of all mortgage foreclosures.

Fortunately, the vast majority of physicians and surgeons have in place insurance coverage — Disability Insurance — to protect them when a sickness or injury prevents them from working. But all too often, physicians and surgeons learn that the coverage that they thought would protect them provides no protection at all, either because the type or nature of insurance that had been purchased was inadequate or because their insurer set out to wrongfully deny payment of benefits.

When a sickness or injury prevents, or threatens to prevent, your ability to work in the profession that you love, the highly experienced and respected physicians disability lawyer at Pillsbury & Coleman, LLP are here to help you navigate the tricky claims process, so that you understand the terms of your policy, understand your rights, and obtain the benefits you are owed. We have decades of experience representing all types of physicians and surgeons, including Urologists, OB/GYNs, Radiologists, Internists, Ophthalmologists, Orthopedic and Neurosurgeons, Hand Surgeons, Chiropractors, Oral Surgeons, and Emergency Medicine Physicians. We have beaten every major disability insurance company in the United States, including Unum and its affiliated companies Paul Revere Life Insurance Company, Provident Life and Accident Insurance Company, Unum Life Insurance Company of America, and General American Life Insurance Company; Protective Life Insurance Company; Ohio National Life Assurance Corporation; Standard Insurance Company; MONY Life Insurance Company; and Guardian Life Insurance Company and Berkshire Life Insurance Company. And we have deep knowledge of the rigors and demands of physicians and the common disabling conditions that necessitate a claim submission. When you need help with a claim, an experienced physician’s disability lawyer is your best ally.

How We Help Physicians and Surgeons

The attorneys at Pillsbury & Coleman help Doctors and Physicians obtain the disability insurance benefits they are entitled to. The knowledge of a skilled doctor disability lawyer is invaluable in these situations.

• Before Any Claim Is Submitted: Our surgeon disability attorney helps you understand the coverage that you have purchased. Not all coverage is the same, and many Physicians and Surgeons have multiple policies with varying terms and conditions. Some policies may be governed by ERISA. We have deep knowledge of the governing law (state law or ERISA) and the policy provisions that are important to understand, including the Benefit Period (the maximum period of time the insurance company is obligated to pay benefits, often to Age 65 or Lifetime); the Definition of Disability (whether the insurance protects you in your ability to work in your Own Occupation or Medical Specialty, or instead contains a more rigorous definition); Residual or Partial Disability (which pays a partial benefit when the insured is only partially disabled); and COLA provisions (whether benefits are increased over time to account for inflation). We talk with you and review your medical records to help you understand how your insurance company may react to a future claim for benefits and how best to present a claim to improve the chances that it will be accepted by your insurer. A surgeon disability attorney understands the complexities of these cases.
• During A Claim: Often, something happens during the course of a claim that causes concern. Perhaps your insurer has asked for voluminous financial records or procedure codes without explaining their relevance; perhaps they are slow to accept your claim or act adversarially towards you; perhaps they have requested an in-person interview or medical examination. Our attorneys help prevent a claim denial. Sometimes this involves simply assisting behind-the- scenes. Other times, we become directly involved advocating on your behalf with the insurer. Insureds are entitled to a full and fair review by their insurance company, which is obligated to treat them fairly and in good faith. We help make sure that insurance companies abide by the terms of their policies and comply with the law.
• After A Claim Denial: If benefits are denied, we carefully review your coverage, medical records and other documents, and we scrutinize the insurer’s denial. Sometimes, we can overturn denials without the need for litigation. Other times, a lawsuit is necessary. Our attorneys are among the top trial attorneys in the country, and we have the track record of success to prove it.

Our Decades of Success Representing Doctors and Physicians

Pillsbury & Coleman has a proven track record of success representing Physicians and Surgeons whose disability insurance claims have been denied or terminated. Our successes include:

• Chapman v. UnumProvident. In this case, we obtained the largest disability insurance bad faith verdict in California history. Our client was a Marin County Ophthalmic Surgeon who became unable to work due to Specific Phobia, a debilitating psychiatric condition that resulted in hand tremors, obviously precluding his ability to perform delicate eye surgery. This was a landmark case, not only for the record size of the jury’s bad faith verdict — $32.7 million, including $30 million in punitive damages, but also because of its impact on disability bad faith litigation, particularly against Unum. We uncovered decades- worth of evidence detailing Unum’s improper claims handling practices. Unum did not just voluntarily turn such evidence over — we had to obtain multiple Court Orders compelling production. And we were able to convince our Court to deny Unum’s request for a blanket protective order, which would have kept this evidence secret, and to instead institute a “sharing provision” that allowed us to share the evidence with other plaintiff’s attorneys who also were representing Unum policyholders in other bad faith litigation. Because of our work in this case, we were able to share the evidence we gathered against Unum with attorneys throughout the country, helping hundreds of other Unum policyholders achieve justice.
• Kirby v. Unum Group. Our client was a Urologic Surgeon who was insured by one of Unum’s subsidiaries, The Paul Revere Life Insurance Company. He had been on Partial Disability with Paul Revere due to a progressively deteriorating back condition, but then underwent unsuccessful fusion surgery, which forced him to stop performing surgeries altogether. After Unum initially refused to reclassify his claim as one for “Total Disability” rather than remaining “Partial,” we got involved. We convinced Unum to honor his claim as one for “Total Disability.” But this was no simple task. Because our client retained the ability to examine patients, Unum tried to argue that his inability to perform surgery would only entitle him to partial benefits. Determining whether a physician is totally or partially disabled can be quite complicated and requires a deep analysis of the physician’s procedure codes and financial records and a complete understanding of the insured’s usual and customary activities. We gathered the evidence, and after significant back-and-forth with Unum, convinced it to honor our client’s claim on a “Total Disability” basis, without the need for litigation. This was important; under his Policy, our client was entitled to Lifetime benefits if he was totally disabled, but would only receive benefits to Age 65 if he was partially disabled. We secured his rightful entitlement to benefits for the remainder of his lifetime. Our work on this matter, however, did not end there. Although Unum agreed with our analysis as to his total disability status, it nonetheless sought to reduce the amount of his monthly benefit based on its interpretation of a Lifetime Total
  Disability Benefit Rider attached to his policy, which purported to reduce the amount of the lifetime benefit based upon the age at which the insured became totally disabled. Our reading of the policy as a whole revealed that Unum’s interpretation was in conflict with other portions of the policy, including the Schedule of Benefits that gave no indication to the insured that the total disability benefit would be subject to reduction. After Unum disagreed with our analysis, we sued, and we won. The court granted our motion that Unum was obligated to pay 100% of his benefits, not the reduced amount that it had tried to pay. We then secured a confidential settlement on our bad faith and punitive damage claims against Unum.
• Doe v. Lincoln National. In this matter, we represented a Stanford physician partially disabled due to chronic pain and limited range of motion due to kyphoscoliosis, osteoporosis and spondylolisthesis. Her treating physicians all supported a 4-hour workday, but Lincoln, which had issued a group disability policy covering Stanford physicians, disagreed. It denied benefits, claiming that its physician consultant had reviewed her medical records and determined that she had a full-time work capacity. Policies such as hers are governed by ERISA. Because ERISA has been held to preempt California’s insurance bad faith law as well as the remedies available to insureds whose claims are denied in bad faith, we have observed some of the most abusive claims handling practices under claims arising under ERISA-governed policies, including this one. In this matter, Lincoln’s reviewing physician never spoke with or examined our client, never spoke with her many treating specialists, and ignored key medical evidence substantiating her disability. Although ERISA significantly limits the remedies available to claimants, we are often able to secure benefits for our clients through an administrative appeal to the insurer. We take great care in compiling and presenting these administrative appeals. It presents our clients’ only chance of convincing the insurer to pay benefits without the need for protracted litigation. Such appeals can include additional testing, such as independent medical examinations, functional capacity testing, or imaging studies, witness statements, physician reports, and supporting medical literature. We consider how best to persuade the insurer to honor the claim. In this matter, we were able to convince Lincoln to reinstate benefits. Our client receives her monthly benefits to this day.