Doctors spend so much time providing care to patients that they sometimes forget to look out for their own interests. Indeed, a physician’s ability to work and earn an income is their greatest asset. If you can’t be productive in providing care to patients, your ability to earn an income is limited and so are your finances.

You may be wondering why you need a disability policy as a doctor. When filling out disability claims for your patients, keep in mind that the odds of a typical worker becoming disabled are as high as 25%. Therefore, you as a doctor may also become disabled at some point during your career. A disability policy gives you the cushion you need to remain financially stable if you’re unable to work for a period of time.

How important is disability coverage? Even if you were to save 10% of your income for ten years in an emergency fund, you would exhaust all your savings in less than six months if you were to become disabled for a period of time.

Disability insurance for doctors is a complicated financial instrument. Even more concerning is having your disability claim denied after paying your premiums faithfully for many years. Having a disability claim denied is almost certainly financial doomsday for most physicians. This is because you have a limited capacity to work and to earn an income for your daily expenses. Also, the medical expenses you may have to take care of can further cripple you financially.

If your disability claim is denied, you should seek the help of a law firm in contesting the claim. Many physicians have their legitimate claims denied by insurance companies when they need such coverage the most.

What is Disability Insurance?

Simply put, disability insurance is an insurance policy that covers workers against loss of income if/when they become disabled. Such a policy is tailored towards meeting the financial needs of a disabled worker for the period of time that they are unable to work. Disability insurance is different from many other insurance policies. This is because such coverage is designed to provide protection for a longer period of time. In addition, the average disability insurance payment is also higher than many other insurance policies.

Physicians need disability insurance more often than they think. In fact, 1 in every three physicians is likely to experience a period of disability at some point during their career. Furthermore, there is a 40% chance chance that such disability will last for at least seven years. The long-term nature of a temporary or permanent disability makes it necessary for physicians to obtain coverage against loss of income. They should also be prepared to file an appeal for any claims that may be denied in the future.

Understanding the inner working of disability insurance can be complex. For example, some disabilities allow you only to work temporarily, while others allow you to work but in a different capacity than your original responsibilities.

In the case of an injury, you may need a few months to recover and get back to work. However, a terminal illness may permanently put you out of the workforce.

Important Components of Disability Insurance

Disability insurance for physicians contains many different elements. From defining what constitutes an actual disability to determining coverage options, physicians have many important decisions to make when it comes to identifying a policy that will protect them.

A typical disability insurance policy will contain the following components.

  1. A Definition of the actual disability

    Every disability policy will have a clear definition of the actual disability. This definition is what you’re paying premiums for, and it will define the benefits you’re entitled to should you make a claim. The best and most complete definition of a disability is “own-occupation.” Own occupation refers to a total disability, where a doctor is regarded as being disabled if they can’t fulfill the specific tasks that their occupation demands. This means that as long as you can’t work in your normal capacity as a doctor (due to a disability), you are entitled to receive full benefits.

    Any physician who is unable to fulfill the material and substantial duties of their occupation is entitled to full benefits even if they can work in another capacity to supplement their income. The “own occupation” definition of disability provides the complete coverage for any practicing physicians.

    A disability insurance policy may also define disability as a “loss of earnings.” This definition provides a lower level of coverage than the own occupation, but it does protect physicians from incurring the loss of income due to a disability. The loss of earnings definition states that any doctor who is unable to perform their substantial duties and is also unable to engage in any other occupation to earn wages will receive full benefits for their disability.

    This means that if you can’t perform your regular physician duties, but you can supplement your income by working in another capacity, you will receive partial or proportional benefits to supplement your current wages.

    Finally, the lowest level of coverage lies under the “any occupation definition.” This definition provides benefits only when a physician is unable to engage in any other occupation that fits their current education, work experience, and level of training.

  2. Coverage for a partial disability

    Coverage for physicians should also consider cases of partial disability. A partial disability occurs when there’s a partial loss of income as a result of one’s current condition. The partial income loss can add up over time and cause a significant dent in your wallet

    Therefore, it’s essential to have this coverage in case you’re only partially able to carry out your regular duties. Most partial disability policies kick in when your income decreases by 15-20% or more.

  3. Group disability insurance

    An employer provides a group disability insurance policy to its group of physician staff. Unlike individual disability policies, a group policy provides coverage to several physicians at once, and it can extend coverage to other activities outside of the workplace. Some group policies also pay higher benefits than individual plans, and they may have more flexible terms of payment.

    The disadvantage of group plans is that they may not provide long-term disability coverage. There are often limits tothe timelines when you can receive benefits. Also, many group plans tend to run out when you leave a particular employer.

  4. Consider medical exclusions

    Some disability benefits come with excluded medical conditions for which you may not receive coverage. For example, certain pre-existing conditions (such as back issues) or mental and lifestyle-based conditions may be excluded from the disability coverage.

    Make sure you carefully take note of all medical exclusions so you can receive the coverage you need when making a claim.

Choosing the Right Policy

Many doctors don’t realize how vital their disability coverage is until they need to use it. Understanding the ins and outs of disability insurance can be complex, so it helps to work closely with an insurance broker when selecting the right policy for you.

Many disability policies for physicians are purchased through brokers who work on behalf of the insurance company. It often doesn’t cost extra to use a broker, as they’re essentially employees of the insurance firm. When looking for the right disability policy, here are important factors to consider.

  • Experience

    You should start by looking for a broker and an insurance company that has experience in selling disability policies. Experience will help you select a company that offers favorable coverage options (and a company that honors its claims). The last thing you would want is an insurer who fails to honor physician disability claims or has a complicated claims process

    By working with an experienced broker,you can ask such important questions and learn more about the policy you intend to purchase.

  • Independence

    You should also work with a broker who has the independence to provide clear and objective information. Some brokers are merely puppets of the insurance company, and they aren’t able to provide objective analyses of different disability policies.

    However, an independent broker can help you compare policies across various companies so you can make the best decision.

  • Knowledge of insurance firms

    Many different insurance companies offer disability benefits. As a physician, you should be aware of the leading firms that offer competitive policies to meet your needs. You can then compare what you know with the options being presented by your broker to make a complete decision.

In addition to the coverage options presented above, there are other kinds of policies that are provided by insurance companies. These policies may supplement a current coverage plan that you have, or they may work well as stand-alone policies. Here are some useful alternative coverage options.

  • Short-term disability insurance

    A short-term policy can be an excellent supplement to a long-term disability plan. Short-term policies have the benefit of beginning payments after as little as seven days, while long-term policies can have a waiting period of up to 90 days before payments kick in.

    Short-term policies provide smaller, but more timely benefits that can last for between 3-6 months (as your insurance company plans the long term disability payments).

  • Social security disability

    The Social Security Administration also provides disability payments to all workers who are enrolled in social security. For any worker who is disabled and cannot perform their prior work activities due to a medical condition that is expected to last for at least a year, the SSA can provide monthly benefits.

    There are many other requirements that you would have to fulfill in order to qualify for social security disability benefits, but this is a useful coverage option that doctors can consider.

  • Worker’s compensation

    Worker’s compensation refers to the benefits that workers receive due to a job-related injury/disability. If a workplace accident caused your disabling condition, you may be able to receive workers’ compensation.

Medical Conditions That Qualify You for Disability Benefits

When talking about disability claims for doctors, you can be easily consumed by all the little details surrounding coverage policies. However, do you know which conditions can make you disabled?

Here is a list of some of the most common disabling conditions that can cause both short-term and long-term disability.

  • Cardiovascular conditions: heart disease, heart failure, and coronary artery disease

  • Mental disorders: autism, depression,schizophrenia, mental retardation, etc

  • Musculoskeletal complications: back injury, spinal disorders

  • Neurological disorders: Parkinson’s disease, epilepsy, multiple sclerosis,etc.

  • Digestive tract problems: liver disease, kidney complications, etc.

  • Cancer.

There are many other physical and mental conditions that can cause disability in physicians. The ones mentioned above are some of the most commonly experienced in the workforce.

How Doctors Can File for A Disability Claim

As a doctor, if you become disabled in your line of work, filing a successful claim will be critical. Disability claims will help you receive the benefits you need if you obtain a short-term or long-term disability. As previously mentioned, disability benefits are more reliable than depending on a savings or emergency account. But how can you make sure you file a successful claim for disability benefits?

Providing accurate and detailed information is critical when submitting a claim. And as a doctor, you probably know how challenging it can be to communicate exactly how a patient is suffering from a specific medical condition. In fact, it’s not uncommon for insurance companies to deny coverage because they deem a specific medical condition as not being serious enough to warrant compensation.

To reduce your chances of having a claim denied, make sure that your application has detailed records describing your medical condition. Here’s what you should have in hand when preparing a disability claim.

  • Medical records

    The most important aspect of your claim is detailed medical records. The records should point to the specifics that surround your current medical condition.

    Make sure you include CT scans, x-rays, blood tests, medication being taken, and even surgical records. All medical evidence should point to the difficulty being experienced when treating your current condition.

  • A personal letter

    To humanize your medical complication, it helps to prepare a personal letter that details how your current condition is preventing you from living a normal life. You can detail how you’re unable to work or engage in other regular activities as a result of your disabling condition.

    Along with medical records, a personal letter will make it easier for the disability insurance company to relate to your current situation.

  • Records of doctor visits

    It also helps to keep records of all visits that you made to various doctors. Many claims for disability are denied because the insurance company claims that you didn’t seek sufficient treatment for your condition.

    By showing that you’ve visited multiple colleagues and specialists seeking treatment, you can provide sufficient grounds that you deserve compensation for a disabling condition. It also shows how much your current condition is preventing you from performing normal work duties.

Common Reasons Why A Claim Is Denied

When you’re not able to work due to a disability, the financial burden can be enormous. It is during such times that you will need your disability coverage the most. However, it’s not uncommon for your claim for disability to be denied by insurance.

There are many cases where physicians remain stuck because they can’t receive the disability benefits they need. And because such doctors are also not able to work as normal, a denied claim is often a financial nightmare.

There are many reasons why a disability claim can be denied. Some of the most common include:

  1. Lack of sufficient medical evidence

    The most common reason why disability claims are denied is that there wasn’t sufficient medical evidence presented. The key is to show that your disabling condition is so severe that it prevents you from engaging in your line of work.

    If your policy is under the “own occupation” coverage, you simply need to show that your medical condition prevents you fromcarrying out regular physician duties. However, if your policy only covers “any occupation”, then you need to show that your disability is severe enough to prevent you from doing any other line of work.

  2. A history of denied claims

    In some cases, having a history of denied claims can make it more challenging for you to receive disability benefits. It is sometimes better to appeal a denied claim than to submit a claim afresh. Working closely with a law firm can help you prepare a strong appeal to a denied claim.

  3. The specifics of your policy

    another common reason why claims are denied is that the claim is made contrary to one’s disability policy. For example, filing a claim for long-term disability may not be fitting if you only have short-term disability coverage. Make sure your coverage options are in line with what you’re currently filing for.

Help with Disability Claims for Doctors Near Me

If your disability claim is denied, you may feel stuck and overwhelmed. The best course of action is to seek legal help as you appeal this decision. Stop Insurance Denial Law Firm can help you contest a denied claim and receive the benefits you truly deserve.

We have experience in tackling big insurance companies and fighting for the rights of patients and physicians. Did you receive a denied disability claim? Contact our disability claims attorney today at 310-878-1771.