A doctor addicted to crystal methamphetamine lost his ability to practice plastic surgery before the state took away his medical license, an appellate panel found, making an important distinction in determining whether the doctor's insurer is obligated to provide him with medical disability coverage.
A 4-0 panel of the Appellate Division, Second Department, rejected Northwestern Mutual Life Insurance Company's attempt to dismiss on summary judgment Brad Jacobs' suit seeking disability payments. The insurer claimed Jacobs' debility resulted from the loss of his medical license, and not, as he maintained, from a bipolar disorder that he said he tried to self -medicate by using crystal meth and anti-depressants.
Jacobs' eight disability policies all required that he establish he was totally disabled and no longer able to perform the functions of his profession when his illness or injury began.
Northwestern's assertion that Jacobs treated patients until the hour his license was suspended by the state Board for Professional Medical Conduct on June 18, 2007, for being an "imminent danger" to others, is insufficient to show Jacobs was not debilitated well before the loss of his license, the appellate court said in Jacobs v. Northwestern Mutual Life Insurance , 21913/08.
The insurer argued that it was not bound to pay benefits under the eight policies Jacobs held because he incurred a "legal disability" by having his medical license suspended rather than a "factual disability" because of mental problems and drug use.
"While this approach has the benefit of clarity, it is substantially outweighed by common sense and the reasonable expectations of an insured," Justice Ruth Balkin (See Profile) wrote for the panel. "Disability insurance is concerned with insureds' abilitynot just their attemptto do their jobs… The fact that the plaintiff's waiting room was filled with unwitting patients on the day the plaintiff's license was suspended is not the end of the inquiry. We must also examine the ability of the insured to perform the principal tasks of the profession competently."
Northwestern failed to present evidence rebutting Jacobs' contention that he suffers from a bipolar disorder, nor that his conditions did not exist before his license was suspended, the panel ruled.
Jacobs, on the other hand, submitted affidavits or affirmations from his psychologist and his three treating psychiatrists indicating that he suffers from Bipolar II Disorder and substance abuse secondary to that disorder, the panel said.
"The doctors opined that the plaintiff had been suffering from Bipolar II Disorder for many years before they began treating him, and that, significantly, its effects rendered him unable to perform 'the principal duties of his occupation as a plastic surgeon, let alone safely and competently' before his license was suspended," Balkin wrote.
The court said it refused to accept, as Northwestern argued, that the doctors' affidavits were conclusory.