Our client was an obstetrician/gynecologist (OBGYN) who became disabled following his fourth back surgery. Provident (later UnumProvident and now Unum), the insurance company, approved the doctor for disability benefits.
Unum, however, described the OBGYN’s disabling condition as “degenerative disc disease,” which was a major problem. Ordinarily it is the existence of a disabling condition that is central to the dispute with the insurance company, but in this case, it was the cause of disability that was important. The Unum policy at issue distinguished between disability caused by “sickness or disease” and disability caused by “accidental injury”. Disability caused by accidental injury would result in lifetime benefits, whereas the benefits for disability caused by sickness or disease would be limited to a maximum of 48 months for this client.