Settlement Amount:
$2.2 Million

Case Name:
ROE v. DOE INSURANCE COMPANY

Case number and date:
98 CV 1142 BTM RBB Date: 2/16/99

Plaintiffs:
Confidential

Defendants:
Confidential

Facts and Background:
Action for Breach of Contract and Breach of the Implied Covenant
of Good Faith and Fair Dealing arising out of defendant’s
wrongful refusal to pay disability benefits.

Plaintiff was an ophthalmologist with a sub-specialty in
vitreoretinal surgery. Plaintiff purchased disability insurance
specifically covering his sub-speciality, and further obtained a
letter from the defendant that if he were unable to perform the
duties of a vitreoretinal surgeon he would be entitled to
disability benefits. Subsequently, plaintiff suffered spine
disease which prevented him from performing surgery. He could,
however, perform the duties of an ordinary ophthalmologist. The
defendant denied plaintiff’s claim for disability benefits.

Plaintiffs’ Contentions:
Plaintiff procured an insurance policy that specifically entitled
him to recover disability benefits in the event he could not
perform his sub specialty. There was no dispute that plaintiff
could not perform surgery; accordingly, defendant’s wrongful
refusal to pay insurance benefits in accordance with the contract
terms was in violation of the law.

Defendants’ Contentions:
Defendant contended that plaintiff could, in fact, perform the
duties of a vitreoretinal surgeon but was refusing to do so.

Injuries and/or Damages:
Monthly disability benefits payable to age 65. Damages for
emotional distress and financial hardship caused by the
defendant’s wrongful breach of the disability contract.