California Doctor Questions Guardian's 'Total Disability' Definition

Guardian contends that Kamali can qualify as being totally disabled after five years only if “because of injury or sickness, you are not able to perform the major duties of your occupation, and you are not at work in any occupation,” according to an excerpt from the denial letter included in the complaint.

Kamali contends that, in California, state law always requires an issuer to use a relatively broad definition of “total disability” and never lets the issuer make not working at all part of the total disability definition.

He further asserts that, under California law, he qualifies as being “totally disabled” because he “cannot perform the substantial and material duties of his own occupation in the usual and customary manner with reasonable continuity.”

Perspectives

Representatives for Guardian were not immediately available for comment.

Matthew Bourhis, the lead attorney on the plaintiff’s team, said in an interview that his firm is one of just a handful of firms in California that handle many disability insurance claim cases.

Many disability insurance issuers use their national definitions for total disability in California, and a large percentage of those issuers back away from that approach once they understand that California has had its own statutory definition of the term since the 1940s, Bourhis said.

Bourhis said that he represents several California clients who have run into problems with total disability claims because of Guardian’s approach and that he’s trying to determine how many other claimants have faced similar situations.

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