Disability Insurance Challenges for Doctors and Healthcare Professionals 

As a medical doctor, you have spent years in school and in post-graduate training, an investment in time and money unmatched in any other profession. You were wise enough to obtain a physician disability insurance policy in order to protect your financial security should an  injury or sickness impair your ability to work in your occupation.

Now that a medical condition has affected your ability to work in your occupation, it is important for you to assess your eligibility for disability benefits and to pursue a claim in a timely manner. As experienced disability insurance lawyers, we work with doctors just like you across the country. We see the challenges doctors face in coming to terms with claiming disability and we understand how to transcend doctor-specific issues to help our physician clients receive all the benefits they deserve.

As a professional with significant responsibilities and obligations, you cannot afford to give up your future income under any circumstances—which is why you almost certainly carry significant individual or long-term disability protection. It is a wise move: you are three times as likely to be disabled for at least 90 days prior to the age of 65, as you are to die before that same age.

A New Environment

Sadly, the protection you count on from your disability policy may not be as reliable as it once was. In recent years, disability insurance companies have become extremely aggressive about denying liability and minimizing payouts. These companies literally have forensically trained teams of consultants reviewing every word of every document you submit in search of ways to defeat your claim. They can be calculating and systematic, especially in considering high-dollar-value claims like yours. Favorite strategies for non-payment include a host of legal issues such as: the incontestability clause, pre-existing conditions, legal and social disability defenses, the “risk of relapse” defense, choice or lifestyle change issues, lack of severity, not receiving appropriate medical care, not satisfying contract definitions of total or residual disability, or an argument that the insured is residually disabled instead of totally disabled. Another tactic is to demand more and more non-pertinent information—to dissuade the processing of claims.

Failure to Seek Out Appropriate and Timely Medical Treatment

Unlike other highly skilled professionals suffering from medical issues, doctors often rely on their medical background and are more likely to engage in self-treatment or consult with colleagues on an informal basis. Doctors often pursue informal treatment for many reasons, including the constant threat of medical malpractice lawsuits and concerns that formal documentation of their medical issues could be used as legal fodder in some frivolous lawsuit.

While the desire to pursue informal treatment and limit documentation regarding the nature and severity of a doctor’s medical condition may make sense, what this means from a disability insurance claim perspective is there could be insufficient medical documentation substantiating the claim of disability. Without the records to substantiate a doctor’s claim, the insurance carrier will almost certainly deny the initial disability claim, citing a lack of supporting medical evidence. Because the disability insurance attorneys at Seltzer & Associates regularly represent doctors who are facing this type of pushback from the insurance companies, we know how to address these issues and get our clients the disability payments they are entitled to.

Medical Professionals Show Reticence to Accept Total Disability 

We know from experience that a doctor who has the drive, focus and dedication to go through the years of training and sacrifice that it takes to become a physician will struggle to accept that a medical condition is limiting their ability to practice. We also know that many of the physiological and psychological medical conditions that limit a doctor’s ability to practice are degenerative and get worse over time.

Doctors that obtained disability insurance coverage that includes a residual — also called partial disability — rider can often continue to work while receiving some disability compensation for loss of earnings that result from their disability. We help physicians invoke the terms of these riders, when appropriate, so they can receive treatment while continuing to practice medicine. And we make sure that the payments they receive under the rider are properly calculated and sufficiently compensate them for the loss of earnings they are experiencing due to their medical condition. Furthermore, we are mindful of the potential legal issues that exist for doctors working in this capacity and work to ensure they are protected from same. If and when a doctor’s medical condition renders them medically unable to work in their occupation, we help them successfully transition their claim to one for total disability. 

A Sensible Approach

However, there are things that you can do to protect yourself. One basic precaution is to choose a doctor who will give your claim maximum credibility, specifically one who is well credentialed, forensically trained, and specializes in your exact disabling condition. When you see your doctor, be sure to give him/her an education on your specific occupational and professional duties, what is required of you to perform those duties, and how those duties may be impacted by your disabling condition. For instance, be sure to advise your doctor if your job entails the performance of multi-tasking, decision-making, and functioning at an executive level, so he or she can make a full and accurate assessment of your ability to work.

Other crucial steps include understanding your own contractual obligations under your policy and identifying issues that might derail your claim. It is also essential to establish the duties and responsibilities of your “own occupation” and then to clearly determine, with your treating physicians, any and all restrictions and limitations you face as a result of your medical condition. You should then clarify how these restrictions and limitations affect your ability to perform your occupational duties.

Most importantly, you should realize that a disability insurance company will scrutinize all claim information you submit with extreme care. Succeeding in your claim depends on not only making sure all appropriate and pertinent information is submitted to the company, but also having every detail perfect. Seltzer & Associates is among the few practices nationwide who handle these kinds of cases every day.

Contact One of Our Philadelphia Disability Insurance Attorneys Today for Help Nationwide 

If you are a physician seeking to make a claim for disability, or if your disability claim has been denied, we can help. Contact a Seltzer & Associates disability insurance attorney today for a free initial consultation by calling 888-699-4222.