Disability Insurance Benefits . . .
By: Craig M. Greene Esq.
Dr. Schmukoluvitz (“Dr. S.”) was an orthopedic surgeon practicing in South Miami. In 1989, Dr. S purchased a Pays A Lot Disability Insurance Policy which provided lifetime disability benefits should he ever become Totally Disabled as defined by the policy. Dr. S had a thriving surgical practice when, in 1993, he was involved in a skiing accident, suffering a significant injury to his low back. Dr. S filed a disability claim, and after several insurance company IME’s agreed Dr. S could no longer perform surgery, Pays A Lot began paying benefits. Under the terms of Pays A Lot’s policy, Pays A Lot was required to determine Dr. S’s disability on a monthly basis. That is, 12 times a year, the insurance company was required to evaluate Dr. S’s claim and makes a decision whether he was or was not disabled and was therefore entitled to benefits.