Physician Awarded Settlement for Wrongfully Denied Disability Claim Involving Activities of Daily Living Coverage

When faced with a denied disability claim, it can be an overwhelming process with many questions and uncertainties. But when a family practice physician found himself disabled and with a denied insurance claim after suffering a stroke, he was fortunate to turn to Donahue & Horrow LLP for legal assistance. The insurance company denied his claim, but after filing a lawsuit and engaging in discovery, the firm was able to secure a favorable settlement of $50,000.

For over 20 years, the physician paid premiums to an insurance company to ensure he had disability income protection in the unfortunate event he was ever unable to continue in his career. His policy also contained a somewhat unique provision that promised an additional payment if his health deteriorated to such a degree that he required assistance with two or more specific Activities of Daily Living, such as:  bathing, dressing, toileting, transferring, continence, and eating. Unfortunately, our client suffered a stroke that left him with permanent issues that not only prevented his return to work, but also required him to have stand-by assistance for several Activities of Daily Living.  

Despite the fact that his other disability carrier was paying a similar claim, and that our client provided the insurance company with medical records demonstrating his ongoing restrictions and limitations—when our client submitted his claim for disability benefits, the insurer outrageously only awarded him less than two months of benefits related to his inability to continue working as a physician. His claim for the additional payment due to his need for assistance with certain Activities of Daily Living was denied in its entirety.  

After contacting Donahue & Horrow LLP, the firm filed a lawsuit in Riverside County Superior Court, asserting claims of breach of contract and breach of the duty of good faith and fair dealing, as well as claims seeking punitive damages. The insurance company then removed the lawsuit to the Federal Court system, specifically—to the Central District of California.

Once litigation was underway, written discovery was served on the insurance company, after which they turned over their entire claim file and answered questions about their claim decision. Shortly thereafter, the parties scheduled a mediation with a mediator who—prior to becoming a mediator—had years of experience litigating these exact types of cases. Using her experience, the mediator was able to assist the parties in reaching an agreed-upon resolution of the lawsuit. Finally, our client could stop worrying about this fight with the insurance company and use his time and energy to focus on recovering from his stroke.

Our client should not have been forced to resort to a lawsuit in order to get the insurance money that was due under his policy. Unfortunately, this is an all-too-common tale. Thankfully, the attorneys at Donahue & Horrow LLP have decades of experience litigating these types of cases and are available to help clients get the benefits they deserve.

If you believe your disability insurance, life insurance, AD&D or long term care insurance claim was improperly denied by your insurance company, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation.