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Multi-Year Lapse Before Filing Disqualifies Injury Claim
Description Doctor forced to quit practice due to psychiatric problem filed for injury benefits after his illness benefits expired. Appeals court upheld denial of disability benefits for injury because the notice requirements of the policy had been violated by many years.
Topic Insurance
Key Words Psychiatric Illness; Injury; Disability Insurance
C A S E   S U M M A R Y
Facts River, a surgeon, was diagnosed as manic depressive in 1980. In 1985, the problem became bad enough that he had to quit practice. His insurer provided "sickness" disability benefits until 1992, when benefits ran out. In 1996, Rivers sued the insurer, claiming his psychiatric illness stemmed from an accident that happened in 1980. If an injury ended his career, the insurer would have to pay disability benefits for life. District court granted summary judgment for insurer, ruling that River had failed to satisfy conditions precedent to receiving "injury" benefits under the terms of the policy. Rivers appealed.
Decision Affirmed. River failed to satisfy the notification requirements of the policy. To claim an injury 16 years after the fact, and 10 years after the problem forced retirement, violated policy requirements of notice within 20 days. Since River had professional assistance, it is not credible for him to claim that he forgot about the terms of the policy. River is not eligible for "injury" benefits.
Citation River v. Commercial Life Insurance Co., 160 F.3d 1164 (7th Cir., 1998)

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