Understanding Long-Term Disability Insurance Claims for Otolaryngologists (ENT Doctors)

By Gregory Dell and Alex Palamara

Long-term disability insurance claims can be complex and challenging, especially for otolaryngologists, commonly known as ENT (Ear, Nose, and Throat) doctors. 

In this article, attorneys Gregory Dell and Alex Palamara at Dell Disability Lawyers shed light on the unique aspects of disability claims for ENT doctors and provide valuable insights into the process.

Definition of Occupation

One of the biggest challenges in the long-term disability insurance benefits claims for ENTs is the definition of occupation. Most disability insurance carriers tend to underestimate the demanding nature of an otolaryngologist’s profession. Approximately 90% of ENT doctors are surgeons who perform a wide range of procedures from minor interventions to complex surgeries. These procedures include tonsillectomies, ear surgeries, nasal procedures, uvulectomies, high-end, sophisticated, and complex procedures of facial reconstruction, and more.

Even the in-office scoping procedures that ENTs conduct on their patients are considered surgical in nature. This indicates the high physical and cognitive demands of their job, whether performed in the office, outpatient operating room, or emergency room settings.

Unfortunately, disability carriers often underestimate the physical and cognitive aspects of an ENT’s work. While the insurance companies may try to categorize the job as sedentary or light duty, the reality is that ENTs have physically demanding roles. They spend long hours on their feet, perform intricate manual tasks, and require cognitive abilities to diagnose and treat patients effectively.

Because of this, it’s extremely important to present your occupational duties as an ENT doctor in a detailed and descriptive manner. Whether it’s a group policy or an individual disability policy, the insurance carrier may rely on the Dictionary of Occupational Titles when it comes to the job title of an otolaryngologist, which may box you into a very broad definition of your occupation. To prevent this, as an ENT doctor, you need to clearly show which of your occupational duties – both cognitive and physical – are affected by your medical condition and how your disability impacts your work, being very specific about your vocational requirements.

In addition, insurance companies typically analyze an ENT’s daily activities by examining the Current Procedural Terminology (CPT) codes and production data related to their practice. However, the disability carriers may disregard the impact of reduced referrals due to an ENT’s inability to perform surgical procedures. Referrals play a crucial role in maintaining the flow of patients and income for ENT practices. Merely continuing non-surgical activities that are incidental to their main surgical practice does not mean they are not disabled. The inability to perform all material and substantial duties of the occupation is what qualifies for total disability.

Importance of Strong Medical Documentation

Strong medical documentation is vital for ENTs to prove their disability claims successfully. The burden of proof lies in providing comprehensive medical records and support from treating providers. Simply stating that one is an ENT and unable to work is not sufficient. Detailed documentation of the physical and cognitive limitations, chronic pain, objective evidence, diagnostic tests, and any other relevant information is crucial. Lay people often review the initial claims, so the documentation should be clear, easy to understand, and leave no room for misinterpretation.

In our experience, ENT doctors often rely on their colleagues or friends for medical advice instead of actually seeing a physician for their problems. It’s very important to see your treating physician and establish a history or medical records where all your issues and complaints are carefully documented by your treating doctor. This is what the insurance carriers will look into – when did the medical condition start, how has it progressed and worsened, and how it impacts your ability to perform your occupational duties. Without strong medical documentation, your disability insurance benefits claim will get denied.

Challenges Faced by ENTs Working with Chronic Conditions

Many ENTs face chronic medical conditions that they work through for extended periods. They may postpone filing a disability claim due to various reasons, such as their dedication to their practice, financial considerations, or not wanting to give up their career. Often, ENTs choose to grin and bear it because it takes years and dedication to build a strong practice, and it’s difficult to make the decision to give up.

However, insurance companies often use the argument of “what changed?” when an ENT finally decides to stop working. If, as an ENT doctor, you have been working through your medical condition for six months or a year and finally decided you are no longer able to continue, the insurance carrier will ask, why now? How come you were able to perform your occupational duties up to this point, but not any longer? This is especially important if your income level has not decreased over the period; the insurance carrier might ask, “if your condition has impacted your work, how come your income remained the same?”.

Because of this, you need to have a strong paper trail documenting the progression of your condition and how it has impacted your ability to work; otherwise, your claim might get denied.

Effective planning and documenting the progression of the condition can help overcome this challenge and establish the need for disability benefits.

Considerations for ENTs with Physician Assistants

Some ENTs bring in physician assistants (PAs) to assist in their practice, particularly for tasks that do not require the ENT’s direct involvement. However, this arrangement can complicate disability claims. If an ENT gradually reduces their duties and allows the PA to take over certain procedures or patient interactions, it is important to consider filing a disability claim at the appropriate time. Delaying the claim until the ENT can no longer work may raise questions from the disability carrier regarding sudden changes in their ability to perform tasks.

ENT doctors pursuing long-term disability benefits claims face unique challenges due to the physically and cognitively demanding nature of their work. Proving disability requires strong medical documentation, a comprehensive presentation of vocational requirements, and strategic planning to address changes in their ability to work.

When to Seek Assistance from a Long Term Disability Attorney

Seeking the assistance of experienced disability insurance attorneys can greatly enhance an ENT’s chances of a successful claim outcome. By navigating the complexities of the claims process with expert guidance, ENT doctors can secure the disability benefits they rightfully deserve.

We recommend browsing our website for more information on your specific disabling condition, insurance carrier, or occupation and using our resources to educate yourself on how to best prepare your claim. We have summarized hundreds of lawsuits, client reviews, and specific questions you may have to help you arm yourself with the best tools possible.

Alternatively, don’t hesitate to reach out for an initial free phone consultation. One of our experienced disability insurance attorneys will evaluate your case and let you know what we think of your claim and how we can best help you maximize the benefits under your policy. We serve clients all over the country, and we will do our best to get your benefits paid.