![]() In fact, an essential duty may generate comparatively little income.” The court recognized that prior cases on this issue take two approaches: The court found, “An important duty does not necessarily generate a large portion of one’s income. 2004), income was key factor in determining “important duties.” However, the court observed that the nature of one’s important duties does not necessarily correlate to income. Unum used that fact to assert that based on Gross v. However, approximately half of the plaintiff’s income was derived from his business activities and not from the active practice of dentistry. Leonor spent 2/3 of his time performing dental procedures and the other third of his time managing his other dental practices and businesses. From the evidence presented, prior to surgery, Dr. Thus the court easily denied that aspect of Unum’s motion.Īs to the second issue, the court found that the answer to whether the insured was totally disabled from performing the duties of his own occupation turned on defining Dr. The court found the second issue had not been raised in the defendants’ answer, but was also not supported by the evidence. Leonor was totally disabled as well as whether he was under the care of a doctor as required by the policy. Unum sought summary judgment both as to the question of whether Dr. ![]() ![]() ID # 920.)Ī second Paul Revere policy contained a nearly-identical set of definitions except that “Your Occupation” was defined as “the occupation or occupations in which You are regularly engaged at the time Disability begins.” The Provident policy also defined “Your Occupation” as “the occupation or occupations, as performed in the national economy, rather than as performed for a specific employer or in a specific location, in which You are regularly engaged at the time You become Disabled.” “Your Occupation” is defined as “the occupation in which You are regularly engaged at the time You become Disabled.” (Pg. Your Loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your Occupation or another occupation and You are under the regular and personal care of a Physician.Īs of the Commencement Date, Residual Disability means that due to the continuation of that Injury or Sickness:Ī. Your Loss of Earnings is equal to at least 20% of Your Prior Earnings while You are engaged in Your Occupation or another occupation andĬ. (1) You are unable to perform one or more of the important duties of Your Occupation or (2) You are unable to perform the Important duties of Your Occupation for more than 80% of the time normally required to perform them andī. “Residual Disability,” prior to the Commencement Date, means that due to Injury or Sickness:Ī. You are under the regular and personal care of a Physician. You are unable to perform the important duties of Your Occupation andī. “Total Disability” means that because of Injury or Sickness:Ī. The Paul Revere policy contained the following definitions: However, following the surgery, he ceased performing dentistry, although his income increased. Prior to undergoing surgery in March 2009 to repair a cervical spine disc herniation, the plaintiff still worked as a dentist for 35 to 40 hours per week. Leonor also owned supply companies and various commercial and residential properties that generated income. The plaintiff had first begun practicing dentistry in 1987 however, shortly after he began his practice, he started acquiring other practices and employed the dentists working there. Hence, the insurers determined that he was not “totally disabled” as defined by the policies. Although the plaintiff ceased practicing dentistry, following his disability, he continued to manage several dental practices and other businesses. Leonor’s claim, Unum ceased paying benefits. His ensuing claim for benefits under three policies issued to him by Provident and Paul Revere Life Insurance Company was initially approved as a “total disability” claim. The plaintiff, a dentist, had to cease working due to a cervical spine disc herniation. April 30, 2014)( Issue: Total versus Residual Disability/Dual Occupation). Provident Life and ., 2014 U.S.Dist.LEXIS 59816 (E.D.Mich. Many individuals derive their income from a variety of sources and courts use two primary approaches in determining whether a person is disabled from performing their own occupation as the following discussion of a recent court ruling decided by a federal court in Michigan shows: In evaluating disability insurance claims, determining the insured’s pre-disability occupation is often a complicated task.
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