Are you a doctor who needs to apply for long-term disability benefits? Or has your insurance company denied your claim? Do you need tips for maximizing your chances? Well, you’re in the right place. This is your guide to long-term disability claims for physicians and doctors.
To learn more about long-term disability claims in general, check out our Ultimate Guide to Long-term Disability.
Disability claims can be more complicated for doctors for a couple of reasons. There may be a bias that since you’re a doctor and have dealt with disability claims for your own patients, you know how to win. People might believe that you know how to “work the system.”
However, you know better than anyone else that leaving work is the last thing you want to do. You went through many long years of school and training. Now, you work hard days to support yourself and your family. Leaving work for illness or injury is never part of the plan. But that doesn’t mean you can’t be prepared.
In this article, we discuss some challenges that we’ve seen in physicians’ long-term disability claims, and solutions for winning your benefits.
Whether you’re thinking of filing a disability claim or already have one open, don’t go any further until you have read this article. You can also download a free copy of my book, or schedule a free phone consultation with us. Just call us at (888) 732-0470 or fill out the form at the bottom of the page.
Unique Challenges of Physician Long-Term Disability Claims
Long-term disability claims for doctors have some unique challenges. Unless you’re a lawyer who has dealt with a physician’s disability claim, you might not be aware of some of these.
Doctors will often work through the pain to the point of breakdown
Unfortunately, many physicians don’t reach out until they have suffered a complete physical and mental breakdown. When you get to that point, you’re on your way to a much greater crisis, and then you’re more likely to make mistakes and bad decisions.
Your job is already difficult. So, when you start suffering a disability, things can escalate quickly. You have to be careful not to burn yourself out. As a medical professional, you understand impairment and disability better than most people. You can anticipate what conditions may worsen over time. Use this to your advantage and start planning early. There is no shame in planning for the possibility of sick leave or reducing your workload.
Physician long-term disability claims usually involve individual insurance policies
Most of the information you find online relates to group disability insurance policies. If you have an individual insurance policy, you need specific information.
Your policy is much more complicated. It’s full of ways for insurance companies to deny or limit your benefits. For example, it will likely include several definitions of disability and occupation. You will see terms like total, partial, and presumptive disability. You might also see terms like regular occupation, own occupation, and gainful occupation.
The insurance company may seek to have your long-term disability policy declared invalid
With individual insurance policies, insurance companies have the opportunity to have the policy declared void. This is a secret tactic most people don’t know about until it is too late.
When you bought long-term disability insurance, you had to fill out several forms. These forms have lots of open-ended questions about your medical history. It is easy to answer these quickly without giving much thought. Sometimes brokers will read the questions to you quickly. Once you file a long-term disability claim, the insurance company will order your historical medical records. The insurance company will then compare those records to the answer you gave when buying the insurance. They will look for inconsistencies so they can claim you misrepresented your health when buying the insurance. If they can prove misrepresentation, then the court will declare the insurance policy void.
Who treats the doctor?
It might be hard to admit, but as a physician yourself, you may not be the best patient. After all, you have a lot of training and practice with diagnosing and treating conditions. So, be careful of treating yourself or getting treatment from a colleague or friend.
While this seems innocent, getting treatment from friends or colleagues creates major problems for your long-term disability claim. The opinions of your treatment providers are likely to be seen as biased because they are your friends. Or, you might not have the proper documentation of your symptoms and condition.
Luckily, this is an easy mistake to fix. Stop getting treatment from colleagues or friends and work with independent treatment providers. Also, ensure your treatment goes through their normal procedures and office hours. Make sure everything is properly documented.
How to Doctors can Win Long-Term Disability Claims
Start planning early
Create a plan for a successful transition from work to sick leave. Learn as much as you can about the eligibility requirements for long-term disability benefits under your policy. Seek advice from a disability lawyer on when your medical condition and impairments will qualify you for long-term disability benefits.
The key to planning is knowing your long-term disability policy. Does it allow for partial disability? How impaired must you be to qualify for full payments? What evidence do you need for your policy? What income loss (if any) will you need to show to qualify?
You can get started now by downloading a copy of my book, A Beginner’s Guide to Disability Insurance Claims in Canada. Then, contact us for a free policy review and consultation about your situation. We can help you develop a plan for success as part of our free consultation.
Gather strong medical & financial evidence
You’ll need to have your doctors fill out medical forms and reports. However, it is just as important that your treatment providers’ records document everything. They should show your medical history, treatment plan, response to treatment, and your willingness to try all treatments. In addition to medical records, you may need financial records. These might include timekeeping, billing records, tax returns, and annual corporate financial statements. It’s critical that you have all of these documents in good order before sending them to the insurance company.
Understand your policy requirements
Individual disability insurance policies are complicated. You can’t rely on what you read online because that usually relates to group disability insurance policies.
You need to know how your policy defines total disability. Is it based on your inability to perform job duties? Or is it based on the percentage of earned income lost? You need to know the implications of accepting partial disability as opposed to total disability. Partial disability often has a much shorter benefit period. This means that you may not have coverage for as long as you think. What does your policy allow regarding attempts to return to work? What about part time work? These are all things you must know so you can avoid surprises.
Prepare for surveillance
Once you start a long-term disability claim, you can expect the insurance company to put you under surveillance. This won’t be all the time. But, it can happen for several days at a time. Surveillance is almost certain if you have a high monthly disability payment. It’s also common when your disability is invisible or has subjective symptoms like pain, fatigue, or depression.
Be prepared to speak with the insurance adjusters
Insurance companies always look for ways to limit or deny payments. So, you need to know how to describe your business and duties to the insurance adjusters. They will ask questions and suggest answers, hoping you will agree with them. You need to be able to clarify and give the correct response. Once you give a written or verbal statement, it is harder to undo it later. This is because it will look like a lawyer is getting you to change your story, even if what you wanted to say was the truth all along.
You must also learn the right way to describe your work to the insurance company. You should have a disability lawyer review your disability insurance policy, and then apply the definition of “regular” occupation to your practice.
Lawyers for Doctor Long-Term Disability Claims
Resolute Legal Disability Lawyers has experience representing physicians in long-term disability claims. We give free consultations and policy reviews to doctors at all stages of their claims. We can represent you in preparing your initial application or appeals, and in lawsuits against the insurance company when necessary.
