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Disability Insurance Challenges for Doctors



Attorney Stephen JessupAuthor: Attorney Stephen Jessup

Very few occupations carry as much prestige and respect as that of a medical doctor. No other occupation requires such a lengthy commitment to schooling and extended periods of training before one is able to actually start working in their chosen profession. In light of the amount of time and financial investment in one’s education and training most doctors obtain disability insurance policies as a way to insure that in the unforeseen event of a medical condition that prevents them from working they will still be able to support themselves and their families.

Although no one expects to find themselves disabled, it is not uncommon that doctors find themselves unable to work due to a medical condition. From our experience representing numerous doctors, applications for long term disability benefits filed by and on behalf of medical professionals often prove to be some of the most complicated and involved disability claims. This is often a direct byproduct of multiple factors, to include the nature of the practice of medicine, the occupational demands of being doctor, factors related to proper medical treatment, and any potential secondary gains argument.

Doctors Are Not Always the Best Patients

One of the most common occurrences we see when reviewing information in the preparation of filing a claim for disability benefits is a lack of proper medical treatment. Doctors, unlike any other profession, are in a unique position to be able to best understand a medical condition and the treatment of same. This can lead to self-treatment, or as is often the case, treating with colleagues off the record as to the potentially disabling condition. This becomes quite problematic when filing for long term disability as any disability insurance carrier will first and foremost review the available medical records to determine if there is a medically impairing condition and discernible restrictions and limitations on account of same. Without proper medical documentation of applicable restrictions and limitations the insurance company will most certainly determine that there is no evidence in support of an alleged disability.

Doctors, especially in medical specialties that require surgical duties, are usually hesitant to formally have medical conditions and complaints committed to writing. For example, a surgeon whose medical records indicate numbness and tingling in the hands would certainly be faced with the possibility of the end of their career or concerns of a malpractice claim in the event something would unfortunately happen in the operating room. So what is a doctor to do? Unfortunately, the answer is almost always, “It depends.” It depends on various factors, such as the specialty of medicine one practices, the medical condition causing disability, and the actual policy language and provisions contained in one’s disability policy.

The Case for Residual To Total Disability

When applying for a long term disability policy one of the most common riders offered is a Residual or Partial Disability Rider – the terms are generally interchangeable. Simply put, these riders allow a doctor to continue to work and receive a proportionate amount of a disability benefits so long as there is either a requisite loss of earnings or ability to perform ones occupational duties for the same amount of time it used to take- the standard for Residual or Partial Disability is policy specific.

Most doctors I have spoken to are the consummate “Type A” personality and will only consider disability as an absolute last resort. I have yet to meet a doctor who hasn’t faced a great amount of personal turmoil at the thought of ceasing the practice of medicine. One way in which we work with doctors who have concerns about the impact of a medical condition on their ability to work, but are not ready to go out completely on disability is to evaluate the claim for a Residual or Partial Disability claim. A partial disability claim would allow a doctor to not only receive treatment – ideally with direction from their treatment provider to reduce work duties – but to see if the reduced schedule or reduction in certain occupational duties will allow them to continue to practice medicine. It is common that a doctor is covered under a period of residual/partial disability and then transitions to a total disability claim should the medical conditions persist to a point that one can no longer safely perform their occupational duties.

Other Considerations

There are a myriad of additional factors that can affect the filing of a disability claim and maximizing the value of a disability policy, to include:

  • The applicable definition of disability;
  • Whether you can work in another occupation and still receive your entire disability benefit;
  • Business overhead policies;
  • The sale of a medical practice;
  • The disability insurance carrier; and
  • The nature of any disability insurance policy riders purchased with your policy.

Disability insurance claims for doctors can certainly be complicated, but there are many advantages that doctors have over other people looking to file for disability. As the disability income could represent a portion of, or all of, your financial well-being it is wise to be educated as to your rights under same, and to consult with an attorney well versed in disability insurance policies.

If you are thinking about filing a claim for disability, are on disability, or at any other stage of the disability insurance process and have questions regarding your policies please feel free to contact our office to speak to one of our disability attorneys.

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