Doctor sues insurer over denial of disability payments

Kelly Holleran Jun. 23, 2010, 7:10am

A doctor who developed a muscular disorder and had to stop working has filed suit against the insurance company he claims stopped providing him with disability benefits.

Dr. Michael D. McCord worked as an anesthesiologist and says he owned a long-term disability policy through defendant Prudential Insurance Company of America which he purchased through defendant Texas Medical Association Trust. The policy was to provide payments to him if he became disabled.

On June 28, 2007, McCord filed a proof of loss with Prudential, informing the company he suffered from tubular aggregate myopathy, a progressive, untreatable muscle disease that left McCord totally disabled, according to the complaint filed June 9 in Jefferson County District Court.

After the company learned of McCord's disease, they began paying him $7,000 per month beginning on Aug. 30, 2007, the suit states. The payments were not supposed to stop until Jan. 1, 2026, the complaint says.

On April 3, 2009, the Texas Medical Board suspended McCord's license, saying McCord's condition prevented him from safely practicing any type of medicine, he claims.

McCord continued to receive his disability payments from Prudential until Aug. 30, when the company sent him a letter saying his long-term disability claim was closed, according to the complaint.

"The reason given by Prudential was that a Dr. Loar, who was hired and paid for by Prudential to examine Plaintiff, opined that Plaintiff was not disabled," the suit states. "Prudential also stated that Plaintiff's physician, Dr. Harati, refused to comment on Dr. Loar's opinion. This is an allegation that is false."

Prudential bought facts to create a false reason to deny paying the disability benefits, McCord alleges.

"Defendants actively worked to create a false record so as to deny Plaintiff his benefits," the suit states. "Specifically, Defendants used a bought and paid for report and an alleged failure of a treating doctor to return a phone call as reasons to cut off Plaintiff's benefits."

Although McCord has attempted to appeal Prudential's decision, his appeals have been denied and he continues to be without disability payments, the complaint says.

McCord alleges breach of contract, violations of the Texas Insurance Code, noncompliance with the Texas Insurance Code, breach of duty of good faith and fair dealing, violations of the Texas Deceptive Trade Practices Act and conspiracy to commit fraud against Prudential and Texas Medical Association Insurance Trust.

McCord seeks actual, consequential, compensatory and treble damages, plus the amount of his claims, 18 percent per annum post-judgment interest, attorney's fees, pre-judgment interest, costs and other relief to which he may be entitled.

Patrick C. McGinnis and Edward F. Downing III of Gauthier, Houghtaling and Williams in Houston will be representing him.

The case has been assigned to Judge Donald Floyd, 172nd District Court.

Jefferson County District Court case number: E187-038.

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