Surgeon Not Entitled to Total Disability Benefits When Still Actively Employed as Surgeon

Summary of Klay v. Axa Equitable Life Insurance Company (W.D.Pa. September 28, 2010) :

The claimant is a cardiovascular, thoracic and vascular surgeon. He had purchased a policy of long-term and partial disability insurance which defined total disability as the “inability..to engage in the substantial and material duties of your regular occupation.” After the surgeon was diagnosed with diabetes, he had to curtail his surgeries to include only some shorter cardiothoracic surgeries and vascular surgeries. He had also maintained insurance and hospital privileges regarding the full range of his specialties. He sought total disability benefits based upon his inability to perform longer and more complicated surgeries, arguing that constitutes “substantial and material” duties of his profession. The court disagreed, holding that the surgeon’s interpretation would render total disability the equivalent of partial disability.