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This policy provides DENTAL and VISION insurance only. Background.

Dr. Leonor would prevail on this fact alone.Before suffering a spinal injury, Dr. Leonor worked as a dentist and owned his own practice. This policy provides DENTAL insurance only. 03-17, 9021 EHB-C NY Rev. This is an overview of the benefits dental insurance provides, but there are limitations and exclusions. They argued that Dr. Leonor was still engaging in some of his important job duties and thus not totally disabled.Dr.

Many physician practices would have a difficult time adding surcharges because rates are dictated by contracts with insurance companies. A Michigan Dentist wins lawsuit for total disability benefits against Provident Life and Accident Company and Paul Revere Life Insurance Company (referred to as the “insurance companies”).

Dr. Leonor estimated he spent two-thirds of his time performing dental procedures and one-third of his time managing dental practices and other businesses he owned.In short, the insurance companies argued that to be found disabled, Dr. Leonor must be unable to perform all the duties of his occupation. 03-15, 9021 NY Rev.


Vision benefits rider form 0PD1M. The simple fact was Dr. Leonor could not perform the important duties of his occupation and was thus entitled to benefits.Disability insurance law is complicated. Group Dental and Vision Insurance underwritten by The Standard Life Insurance Company of New York is provided under policy form numbers: 9000 NY Rev. The benefits are based on the terms of the contract that were negotiated between your employer and the dental insurance company; not your dental office.
Leonor appealed the termination of benefits and argued that because he was unable to perform most of his occupational duties, he was totally disabled under the policy.The dispute before the court was whether the definition of total disability required Dr. Leonor to be:No longer able to perform dental procedures, Dr. Leonor filed a claim for total disability benefits.The court found that the definition of total disability is ambiguous. Dental care can be similar. Here are a few questions to think about when determining the type of coverage that’s right for you and your employees:Access to dental insurance also helps employees manage their out-of-pocket costs—and being covered makes it more likely they’ll visit the dentist regularly.

Because he continued to be able to perform the managerial duties of his job, the insurance companies argued he was not totally disabled.The court did not care that Dr. Leonor continued to earn a high salary from managerial duties following his injury. The goal of most dental insurance policies is to provide only… 03-15, 9000 NY Rev. With the largest dental network in the U.S., our dental plans cover more people — individually and through company plans — and have more participating dentists than any other dental benefits insurance coverage program. To get the full experience of this website, please update to most recent version. For example, a higher deductible comes with a lower premium but more out-of-pocket cost for employees. We work with employers, individuals, and families to deliver fundamentally better care.

For basic and major care, insurance covers a percentage of the cost, and the patient is responsible for the remaining cost.

And with multiple price points, it’s easy to create a design to fit a wide range of budgets.Look for in-network dentists in your area with our provider directory.Many employees consider group dental insurance an essential part of their benefits package. Nor did the court care that there was a partial disability benefit available to Dr. Leonor under the policy. As one of the most used group benefits, dental insurance can be a worthwhile investment for helping to attract and retain great talent.You can choose to pay for all, part, or none of the premium with Principal dental insurance. Dr. Leonor also purchased additional dental practices as investments.Your browser is out of date.

After his surgery, he was no longer physically able to perform dental procedures. Insurance doesn’t need to be complicated.