A Surgeon Seeking Disability Benefits Needs These Tips To Collect Benefits
Surgeons have incredibly physically – and cognitively – demanding jobs. Something as seemingly minor as a mild tremor or a moment of inattention can have dire consequences in the surgical field. What should surgeons know when filing for long term disability benefits?
The definition of “disability” in your policy is very specific and must be understood.
Many long term disability insurance policies are group policies that are governed by the Employee Retirement Income Security Act (ERISA). These ERISA policies aren’t very claimant-friendly and can make it tough to qualify for benefits.
But surgeons are fortunate to have been courted by long term disability insurance carriers, and many of the long term disability policies issued to surgeons have among the most generous definitions of “disability” available. Under many of these policies, the definition of the claimant’s “regular occupation” depends on the surgeon’s specialty; this can render a surgeon “totally disabled” even if they’re able to perform other surgical duties more than half the time.
A surgeon’s production code reports will be scrutinized to determine your “material duties.”
One of the easiest ways for a long term disability insurance carrier to assess the “material duties of the occupation” of a particular surgeon is to analyze the surgeon’s production codes. This can reveal which procedures the surgeon performs most often and may be used to challenge the surgeon’s characterization of their specialty. If a surgeon’s practice doesn’t take insurance (and therefore doesn’t use production codes to bill insurance), this can make proving the material duties of the occupation a bit more challenging. An experienced long term disability insurance attorney can help with this process, gathering the necessary records and reports to prove what procedures the surgeon does most frequently.
Your ability to continue working without doing surgery and collecting total disability may be an option.
There is plenty of gray area between shutting down one’s practice entirely and continuing to work full-time as a surgeon while dealing with a serious medical condition. Depending on your condition and the terms of your policy, you may be able to continue working (albeit not performing surgery) while collecting disability benefits. This can allow surgeons to maintain their pre-disability income without putting patients at risk.
Working with a chronic medical condition and then deciding to file for disability benefits is a challenge for most surgeons.
Many surgeons are Type-A personalities, and this can present a unique psychological barrier when it comes to admitting that you are too disabled to continue to perform surgeries. It is important for surgeons to focus on the medical issues they’re experiencing and how the impact of these conditions can ultimately affect patient care. Stepping back from a high-pressure surgical career can alleviate some of these problems and may even improve the surgeon’s ability to return to full-time work in the future.
Disability insurance companies are notorious for using their own “hired gun” doctors to deny disability claims.
Disability insurance carriers have a vested interest in denying claims for long term disability benefits, particularly high-dollar benefit claims like the one’s surgeons tend to file. As part of this process, the insurance carrier may hire its own medical experts to review your medical records and determine whether you are disabled under the terms of the policy. Knowing to expect these “hired guns” can help surgeons gather the necessary medical evidence to rebut the internal expert’s assertion.
Video surveillance and review of your social media are common tools used to challenge a surgeon’s complaints.
Another tool disability insurance carriers often use when denying a claim for benefits is the tool of surveillance. From monitoring your social media accounts to see how you are spending your time to engaging in actual video surveillance, your insurance carrier will stop at nothing to gather evidence it can use to deny your claim later. Surgeons must remain conscious of this surveillance and be honest when answering the insurance carrier’s questions – if you’ve told your insurer you can’t drive for more than 10 minutes and are then witnessed taking a 2-hour road trip out of town, your claim is likely to be denied.
Trying to navigate the ins and outs of a long term disability claim on your own can be frustrating and time-consuming. At Dell & Schaefer, we’ve helped hundreds of surgeons secure their long term disability benefits by submitting a comprehensive claim package. Get in touch with one of our experienced attorneys today to schedule your free consultation.
