Residual or Total Disability Insurance Attorneys Wagar Law, P.A.

CHIROPRACTOR
Income from Sale of Business

This case began when a chiropractor fell and injured his back, neck and shoulder. At the time of his accident, the chiropractor was a sole practitioner, who spent 95% of his time performing physical therapy on or for his patients. As a result of this accident, the chiropractor filed a claim with his insurance company for his disability benefits. After his accident, he had to hire another chiropractor who could perform the physical manipulations on his patients. To make up for his lost wages, the chiropractor continued to work after his accident but in more of an administrative and managerial capacity. Even after all of this, his insurance provider denied his claim for disability benefits.

The Florida disability lawyers at the Wagar Law firm brought a lawsuit against three insurance companies on behalf of our client, the chiropractor. We were able to have him placed back on claim with one of his carriers. We then, through mediation with the other two insurance companies, resolved the matter by negotiating a lump-sum settlement for our client. To make this happen, we worked extensively on pre-litigation research, discovery and preparation. We also spoke with the chiropractor's office staff and other referral doctors concerning the daily activities of our client prior to his accident. We ultimately determined the chiropractor's insurance provider denied his claim for benefits because they claim he made more money. The chiropractor did in fact make more money, however the source of his earnings was from the sale (not ongoing operation) of his business.

Individual disability insurance policies normally state when an insured/claimant owns his/her own business, they are not prevented from earning other income. The insured/claimant may have his/her benefits denied if their new occupation is similar or identical to their prior occupation. For more information, please read Kirk Wagar’s article on the importance of detailing exact job duties in the initial claim form.

RAGDALE v UNUM
Mental and Nervous Exclusion for Alcoholism

The disability lawyers at our firm represented a gentleman who was a leading and well respected advertising executive and creative consultant in charge of large client accounts. At the peak of his career, our client suffered a devastating injury, when equipment from a commercial photo shoot accidentally fell on him. Prior to the accident, he was a recovering alcoholic in full remission. During his recovery, he was given prescription pain killers which contributed to an alcoholic relapse. He began to drink again and ultimately sought in-patient help for his addictions. UNUM denied his claim based on an exclusion that provided only 24 months of benefits for “mental or nervous” conditions. The attorneys at the Wagar Law firm carefully reviewed his case file and medical records. We were able to demonstrate the physical limitations our client experienced were as a direct result of his accident. The client won a full Plaintiff’s Summary Judgment against UNUM and his disability benefits were reinstated.

TRIAL LAWYER
Material and Substantial Duties: "The" vs. “A” Classification

A well-known Miami trial lawyer was diagnosed with prostate cancer. Aggressive medical therapy and intense treatment caused his prostate cancer to go into remission. He became “cancer free” but at a price. As with many people who suffer a life threatening and deadly disease, our client suffered emotionally with damage to his psyche and confidence. The Miami trial lawyer's treating physicians advised him not to appear before a judge or jury as he could no longer concentrate on any one issue for any period of time. His cancer and subsequent related medical treatment led to his inability to perform in the courtroom. His insurance company denied his claim for disability benefits, claiming he was able to perform secondary occupational duties. It is difficult if not impossible for a trial lawyer to be a trial lawyer if he/she is unable to take a case to trial. The Miami trial lawyers' inability to stand in a courtroom and fight for his clients means he is unable to perform his primary duty. While there are other tasks he can perform, his inability to argue a case in front of a judge or jury rendered him completely and totally disabled from his occupation. We convinced his insurance company that he was no longer able to perform the material and substantial duties of his profession and should receive his disability benefits.

SURGICAL ANESTHESIOLOGIST
Job Title v. Actual Job Duties

This case study is about a surgical anesthesiologist and Florida resident who spent his career either training in residency or performing surgical anesthesiology in hospitals. At the age of 50, he began to experience frequent and powerful migraine headaches while performing his job duties in the operating room. A number of other doctors and physicians were consulted by the surgical anesthesiologist about his medical condition. Unfortunately, he never received a definitive diagnosis regarding the cause of migraine headaches.

The insurance company denied his claim stating that there are other duties that an anesthesiologist can perform besides working in an operating room. Their claim, however, is quite irrelevant for the purpose of an “own occupation” disability policy. In response to his insurance company's refusal to pay benefits, we filed a Motion for Summary Judgment, asking the court to rule on the definition of our client’s occupation under the terms of his policy. After the Summary Judgment hearing, the insurance company settled the case in favor of and to the satisfaction of our client. This case study further demonstrates the importance of fully understanding all of the terms and conditions of your disability insurance policy. It also demonstrates the benefit of having an experienced and knowledgeable attorney working for you.

ORTHOPEDIC SURGEON
Is She Totally or Residually Disabled?

An orthopedic surgeon from rural North Florida, who suffered from a degenerative spinal injury sought relief through neck fusion surgery. After her surgery, she was no longer able to perform her duties as an orthopedic surgeon. She transitioned her career to an office practice where she became support staff for other doctors. Her insurance provider denied her claim for disability benefits, insisting that she had always had an office practice. They also argued that no surgeon spends every waking moment of their job in surgery. As co-counsel in this case, the attorneys at the Wagar Law firm were able to deconstruct the insurance company's argument, proving her disability was a result of her surgery. Prior to her own surgery, our client has approximately seven hundred surgical patients to whom she provided pre and post-operative consultations. After her transition to the new practice, she no longer maintained any relationship with her former patients. We were able to show her insurance company that, despite her ability to continue working, her duties as an orthopedic surgeon were completely different prior to her becoming disabled.