“Dr. X” was a successful Dentist in Westchester County suffering from major depression, anxiety, and associated symptoms. She applied for benefits and the insurance company granted them under the policy, subject to the two year mental illness limitation in the policy.
While out on disability, Dr. X subsequently sustained physical injuries to her right shoulder when she fell walking down a flight of stairs. These injuries, independent of her depression and anxiety, precluded her from performing routine dental procedures with her dominant arm.
Dr. X promptly notified the insurance company regarding her physical injuries and submitted medical evidence substantiating her physical restrictions and limitations of her dominant upper extremity. The insurance company, however, discontinued Dr. X’s benefits by invoking the 24-month Mental Illness Limitation, despite the new physical injuries suffered by Dr. X.