Apr 1, 2008 - Publications by Mark F. Seltzer
How today’s disabled physicians can effectively protect their benefits.
In Part I of this series, you learned work-related and other health conditions that impair physicians’ abilities to practice. In Part II, you learned what to expect from an insurer when confronted with a disability claim. Now, in Part III, you will learn how to protect your benefits when your company is confronted with your disability claim.
The most important factor to understand about the entire claims process is that your disability insurance policy is a contract. It is crucial to appreciate the important and pertinent provisions of your policy that you need to satisfy, and how to satisfy them, in order to obligate your Company to pay you benefits.
Most physicians have policies which define disability by the inability to perform the specialty which they practice. However, you need to consider every aspect of your occupation, globally, and how that relates to the definition of disability.
Not only must you understand your occupation, but your treating doctors must understand it also. Make sure your doctor knows the impact your condition has on your ability to perform your duties. You need to choose a doctor that is not only someone with whom you have achieved a trustful treatment alliance, but also a doctor who is most appropriate to treat your condition, understands and is willing to participate in the claims process, and that is well-credentialed and well-qualified in their respective specialty.
Remember to always cooperate and keep open communication channels with the Company. Make sure you provide all pertinent information requested in a timely fashion with the goal of perfecting your claim. Your failure to do so will most probably be used against you by your Company.
Maintain your own personal claim file. Keep copies of any forms or information which you submit to, or receive from, your Company.
Beware of the technology age of today. Your Company will obtain any and all information about you, from any source available, as part of its investigation and consideration of your claim. They will even know your golf handicap.
Essentially, you need to prove that your medical condition is a disabling condition. Your Company will make a determination on whether or not you have restrictions and limitations and, if so, the negative impact they have on your ability to perform your occupation.
The key is to stay on the road and not end up at a detour and on foot. Because if you do, you better know a podiatric dentist.