Injured doctor takes insurer to court over disability payments

Kelly Holleran Oct. 1, 2009, 10:00am


A former doctor says his insurance company refuses to pay him disability insurance for the remainder of his life after he sustained debilitating injuries in 2005 that prevented his return to work.

James King filed a lawsuit Sept. 25 in Jefferson County District Court against Provident Life and Accident Insurance Company, Unum Group and Roy Carroll.

King claims he was a doctor who purchased a disability policy with Provident just in case he was unable to return to work. The policy insured King would continue to earn his income in the event he was disabled, according to the complaint.

In 2005, King sustained debilitating injuries and was unable to return to work, the suit states. So, King made a claim under his Provident disability insurance, the complaint says. Because he was under 65 at the time of the accident, King claims he is entitled to disability benefits for the remainder of his life.

Some time later, King attempted to return to work. During this period, Provident suspended all payments to King, even though the company was supposed to pay the difference between the disability policy benefits and King's actual income, according to the complaint.

However, King could not maintain his work schedule because of his disabilities and was again forced to quit working, the suit states.

He demanded disability benefits from Provident, but this time the company refused to pay lifetime benefits and agreed only to pay them until King hit the age of 65, the complaint says.

"Defendants, in a clear attempt to circumvent its contractual obligations and avoid making lifetime payments, alleged that Plaintiff intentionally closed the earlier claim under the Policy and therefore his demand for continuation of payments was, in fact, a new claim for disability benefits," the suit states.

"The distinction is that the 'first' claim clearly entitles Plaintiff to lifetime Policy benefits. Defendants assert that the 'second' claim does not entitle Plaintiff to lifetime benefits, but instead only entitles Plaintiff to benefits through his 65th birthday."

Provident hired Carroll to make visits to King's home to explain the policy process and to discuss coverage issues, King claims. In addition, Carroll was hired to adjust the policy, according to the complaint.

King alleges breach of contract, unfair settlement practices, noncompliance with the Texas Insurance Code in prompt payment of claims and breach of duty in good faith and fair dealing against Provident and Unum.

His allegations against Carroll include unfair settlement practices. Allegations common against all defendants include fraud and conspiracy to commit fraud.

King is seeking actual, treble, punitive and exemplary damages, plus attorney's fees, costs, pre- and post-judgment interest and other relief to which he may be entitled.

J. Steve Mostyn of The Mostyn Law Firm in Houston will be representing him.

The case has been assigned to Judge Milton Shuffield, 136th District Court.

Jefferson County District Court case number: D184-995.

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