Doctor’s Specialty Entitled Him to Residual Disability Benefits
A radiologist certified in the specialty of interventional radiology collected benefits on his supplemental long-term disability insurance policy. After termination of his benefits based on the assertion he was primarily practicing as a diagnostic, not interventional radiologist, he sued his disability carrier. The Third Circuit reversed judgment for the insurer. It held the plan was governed by ERISA and that his employer had sufficiently endorsed the plan to render inapplicable the safe harbor regulation exempting certain plans. The court determined the insured's occupation was indeed interventional radiology and remanded so the claim could be evaluated in the context of this specialty. It also found the insured's failure to exhaust his administrative remedies did not bar his claim for residual disability benefits.