Provident Life Demands Disabled Dentist Submit to SurgeryAugust 1, 2012 | Disability Claim Denials
Under California law, a disabled dentist who is receiving disability benefits may be required to undergo curative surgery in order to remain eligible for disability benefits.
This was held in Provident Life and Accident Ins. Co. v. Van Gemert. In Van Gemert, a disability insurance company, Provident Life, brought an action against a disabled oral surgeon after the oral surgeon refused to undergo curative surgery. The surgery would supposedly fix the vision problems that had prevented the disabled oral surgeon from practicing.
Provident Life argued that the disability insurance policy required the oral surgeon to undergo corrective eye surgery. It relied upon the “appropriate care” provision in the policy which stated that the disability claimant must “receiv[e] care by a physician which is appropriate for the condition causing disability” in order to continue receiving disability benefits. Because Provident Life’s doctors determined that surgery would correct the oral surgeon’s vision problems thereby enabling him to work again, it demanded that he undergo surgery or risk being denied his disability benefits. When the oral surgeon did not submit to corrective surgery, Provident Life filed a declaratory action seeking intervention from a district court in California.
The California court interpreted the “appropriate care” provision of the disability insurance policy to require the disabled oral surgeon to undergo surgery, but “only if such care reflected the only treatment option a reasonably prudent person would choose.” Because Provident Life had not established whether curative surgery was the only available treatment option, the oral surgeon could not be required to undergo the surgery. However, if it could demonstrate that curative surgery was the only available treatment option that was reasonable, then the oral surgeon would need to submit to surgery. These questions, the California court concluded, would need to be answered by a jury at trial.
Considering the risks associated with many surgeries, we think it is a rare case when corrective surgery can be considered the only treatment option available to a reasonably prudent person. If your disability insurance company is demanding you undergo surgery to continue receiving disability benefits, contact a disability insurance lawyer.