When it comes to protecting your income against the risk of injury or disability, having the right policy matters. As a physician, chances are good that your ability to earn an income hinges on your physical ability to do things like these:
- Remain on your feet for much of the day.
- Retain excellent manual dexterity.
- Retain enough strength to do surgeries and other medical procedures.
- See clearly.
- Communicate clearly.
- Work without having to take medications that make it difficult or impossible to function.
- Remain free from debilitating mental illness.
- Avoid having to go through chemotherapy, radiation and other treatments that make it impossible for you to work.
- And much more.
But not all insurance policies are created equal. When it comes to protecting a physicians’ income, some policies do a much better job than others. The key: The definition of disability included in the policy.
Let’s Take a Look at an Actual Disability Insurance Case that Occurred in California:
Dr. Gross was an orthopedic surgeon. As such, a big part of his job – and his income – hinged on remaining physically capable of performing frequent, physically demanding surgeries.
But Dr. Gross was diabetic. Eventually, his diabetes resulted in vision problems and numbness in his hands. He was therefore unable to continue performing his chosen medical specialty. Gross filed a claim with his disability insurer – and was turned down.
Why? The insurance company pointed to the language in the policy. The policy only paid out if the insured was totally disabled. Specifically, the policy defined “total disability” as follows:
- You are unable to perform the important duties of your occupation; and
- You are under the regular and personal care of a Physician.
Dr. Gross disputed the denial – arguing that he couldn’t continue as an orthopedic surgeon if he couldn’t do surgery. The two parties went to a hearing before a judge – who ruled against the doctor.
Why? The insurance company argued that Gross only spent a small fraction of his time actually performing surgery. The judge ruled that the critical issue was this: Was the doctor able to perform in-office patient care in his “usual and customary way?”
The diabetes made it impossible for him to perform surgeries, personally. But the judge ruled that Gross could still run his practice on office consults and less demanding treatments. “That Plaintiff is no longer seeing patients “as an orthopedic surgeon” does not compel the conclusion that he is unable to perform his in-office patient care duties in his usual or customary way,” ruled the court.
Further litigation followed. But meanwhile, Gross experienced significant financial hardship as a result of the loss of his ability to perform surgeries on his patients.
How to reduce your chances of a claim denial
Avoid it!
The best way to beat a claim denial is to avoid it in the first place. For physicians, it’s critical to deal with a reputable carrier that understands the medical professional market, and to consider an own occupation disability insurance policy with robust protections written into the policy.
Own your own disability insurance
There’s nothing wrong with a little extra coverage from the employer, but understand that group policies are marketed to appeal to employers. They aren’t marketed to appeal much to the insureds themselves. Employers will typically choose a lower-priced provider because they don’t get any upside from a better policy. But you do!
Pay a bit more premium
Good coverage costs more. The better the definition of disability from the insured’s point of view, the more likely it is to actually pay out on your claim. This increased likelihood is reflected in the premiums. But nothing’s worse than being disabled – and having your claim denied after paying own occupation disability insurance premiums for years.
Keep records
If you have serious medical problems that could lead to a claim, record-keeping quickly becomes a job in itself. But it’s vital to keep careful records of your medical treatment and expenses throughout the process.
Don’t try to care for it yourself
Some doctors attempt to save money by treating their illness or injury themselves, rather than going under another doctor’s care. In practice, this could delay or sabotage your disability insurance claim. For example, it gives the insurance company a chance to order an examination by their own physician. This is a useful check and balance against fraud – but if you haven’t sought the care of a doctor of your own who can provide an independent attending physician’s statement to counter your own, you could be jeopardizing your case.
