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Sample Bad Faith Cases and Lawsuits A Boston doctor was able to receive a $1 million settlement against his disability insurance company that refused to pay after he was diagnosed and treated for cancer. The company argued that the doctor an, obstetrician/gynecologist, was not "totally disabled" even though he could no longer perform obstetrical surgery. The insurance company then denied coverage arguing, the doctor could still engage in some gynecological procedures. The insurer stated the policy required that he be unable to perform all of his work in order to qualify for benefits. The policy in question defined "occupation" as a "recognized specialty." Before getting cancer, the doctor spent saw mainly obstetrical patients. During the course of the cancer's progression, the physician was physically incapable of helping woman deliver babies and related medical duties according to the unanimous opinion of his own four treating physicians. The insurance company denied the claim saying he could still practice gynecology. However, "gynecology" and "obstetrics" are not recognized medical specialties, the medical profession groups "obstetrics and gynecology" as a single recognized specialty. The case settled after mediation for $1 million. Horace Mann Class Action Lawsuit Settles: $5 Million July, 2001 The Horace Mann Illinois insurer has settled a class action suit that was filed against the company from consumers of various disability policies. The $5 million settlement is based on confusing language in
a provision of the policy's offsetting benefits relating to receipt
of others means of income. Offset provisions try and account
for fact that many people have other forms of income to protect
against disability, which includes retirement benefits, social
security and added insurance policies. |