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Insurance Provider Disputes Covered Condition

August 19, 2013 Insurance Bad Faith

An ear surgeon had been diagnosed with essential tremors which eventually prevented him from performing surgery. He performed his last surgery and closed his practice, after which he made a claim for disability benefits under his insurance policy. The doctor was told there would be a three month review period, and when that passed, the insurance company wanted to delay another month to figure out the details of payment under the claim.

When that month passed, they concluded that they did not owe the policyholder under the terms of the contract and refused to pay the claim. The doctor also had another policy through a different insurance company which had already determined that he was disabled and had been making payments through the policy. WKW settled the case with the insurance company at mediation.

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