Recent San Mateo Private Disability Insurance Denial Reversed

Donahue & Horrow recently helped a dentist collect the private disability insurance benefits to which she was entitled, but which were improperly denied by the insurance company.

After many years of dutifully paying premiums for an individual disability policy that she purchased to protect herself financially, should she be unable to continue working as a dentist, the unthinkable happened. After months of feeling ill and chronically fatigued, our client was forced to stop working as a dentist. After seeing a series of specialists, she was diagnosed with a variety of conditions, including chronic fatigue syndrome, myalgic encephalomyelitis, and systemic exertion intolerance disorder (SEID), and her treating physicians agreed that she could not return to work as a dentist.

However, when the dentist filed her claim for disability insurance benefits, the insurance company denied her claim and refused to pay her benefits. The company did not dispute that our client was unable to perform the duties of a dentist, but stated that because she was also a business owner (she owned the dental practice) and since her disability did not totally prevent her from performing those tasks, she was not entitled to disability benefits.

Our firm filed a lawsuit in the County of San Mateo, and the insurer removed the matter to Federal Court, in the Northern District of California, in San Francisco. After some discovery, the parties agreed to an early mediation. While the terms of the settlement are confidential, our client is satisfied that the outcome of the litigation will enable her to get all of the benefits from the policy she purchased.