Long-Term Disability Insurance Denial by Sun Life Insurance Company for Disabled Physician with Colorectal Cancer Recovered in Lump-Sum Settlement in Court
Cancer is a common cause of long-term disability for physicians. Our client, Dr. David Jones (not his real name), is an ear, nose, and throat physician (otolaryngologist), whose duties include performing surgery. He went out on disability in 2020 due to multiple medical issues, including colorectal cancer requiring surgery and causing ongoing gastrointestinal issues.
Sun Life Insurance Company terminated Dr. Jones’s claim for long-term disability benefits after paying for a very short period, claiming that after chemotherapy treatment, he was able to resume all of his duties as before.
The problem was, Dr. Jones was only able to return to a part-time schedule, and clinical work only. He was unable to perform surgery due to unpredictable emergent bathroom needs, and his income from performing surgery was a substantial part of his income.
Dr. Jones had true “own specialty occupation” long-term disability coverage. That means he is considered disabled if he could not perform all of the duties of his chosen specialty, even if he were able to earn at the same income level as before by working in a different specialty.
Jones’s treating physicians opined that he was absolutely unable to safely perform surgery and that he would be putting patients at risk for obvious reasons. Yet Sun Life ignored their opinions and Dr. Jones’s graphic testimony about why he could not perform surgery. Sun Life didn’t dispute Dr. Jones’s unpredictable bathroom needs. But it actually found a physician to testify that a quick diarrhea break during a surgery was acceptable. Then Sun Life’s vocational expert’s analysis focused only on physical exertional requirements of Dr. Jones’s surgical specialty when there’s obviously much more to consider from the perspective of safe patient care. So Sun Life denied Dr. Jones’s appeal of the benefits termination.
Being accustomed to a steady (and high) income, Dr. Jones was scared to death about losing everything. He never imagined having to fight Sun Life for the benefits he purchased to protect himself, all while coping with a difficult medical condition and dramatic loss of earnings.
How Dr. Jones Won His Case: Obtaining Better Medical Support and Presenting His Story Effectively
With Dr. Jones’s help, we were able to speak with some of his treating physicians and create detailed physician notes to better support the claim. We were also able to create a much more vivid, detailed statement for Dr. Jones’s own signature describing his symptoms, and how he would have no warning at all that he was about to have a bathroom emergency that could last an extended period of time. We presented this and other new, overwhelming evidence to Sun Life for reconsideration of the claim prior to filing suit. That way, it became part of the official administrative record and could be considered by the Court. Sun Life again denied the claim, and we filed suit.
A Just Outcome
Dr. Jones’s description of how his medical condition affected his ability to perform surgery was compelling. Thankfully, presented with undeniable new evidence in James’s appeal, and facing trial, Sun Life Insurance Company finally did the right thing.
Victims Of Disability Should Always Appeal Unfair Claim Denials
In the end, because he continued to fight, appealing the insurance company’s denial of his disability claim rather than just accepting it as the final word, then filing suit when denied on appeal, our client was able to maintain his financial security.
Unfortunately, disability insurance companies unfairly deny legitimate claims every day, but anyone faced with an unfair claim denial should continue to fight and properly present stronger evidence on appeal or in court if necessary.
Our client deserved the benefits he had paid premium for over the years, and it was an honor to help such a wonderful physician and person overturn such an unfair claim denial.
Results may vary. Every case is different, and no outcome can be guaranteed.
