Disabled Doctors: Long Term Disability Claims

Long Term Disability for Doctors

The medical profession demands that you make decisions and perform procedures that can make the difference between a patient living or dying, or between being ill or well.  You can never be less than at the top of your game. The potential consequences of even a slight error can destroy your career, or worse, destroy a patient’s life. If you are a doctor, a disability that might be minor to someone in a different profession could render you unable to effectively and safely treat patients. Even a minimal cognitive or physical impairment could leave you unable to perform at the level the medical profession demands.

As a doctor, you have invested many years and a great deal of money preparing for your medical career. You also spent or continue to spend more money for the best disability coverage available. You expect the policy to protect you if a disability or impairment makes it impossible for you to perform the functions of your chosen profession.

Why Insurance Companies Deny Doctors’ Claims

Doctors typically earn high incomes and carry policies offering excellent benefits which, if the company pays, could have a significant impact on the insurer’s bottom line. Consequently, if you are a doctor, you can expect that your insurance provider will subject you to intense scrutiny and will look for any reason to deny or minimize your claim.

Doctor Disability Insurance Comes in Many Flavors

The disability insurance industry has a variety of products it markets to doctors. The highest form of protection pays a benefit if you are unable to work in your board-certified medical specialty, even if you are able to work in a different specialty or occupation.  Lesser coverage insures your specialty but considers you only “partially disabled” if you work in a different specialty or occupation. We also see policies that only insure your ability to practice medicine, generally. This means the insurer may deny your claim if you cannot perform your own specialty, but are still able to perform a less demanding form of medicine. Whether you are considering filing a claim or are already in the middle of one, it is vital to have an expert long-term disability attorney help you understand your rights and how best to develop proof of claim tailored to your specific policy language.

Partial or Total Disability?

One issue that commonly arises in doctors’ disability claims is whether a doctor is totally disabled (entitling you to full policy benefits) or only “partially disabled,” (reducing your benefits if you still have work earnings).  Many policies define “total disability” as the inability to perform the material and substantial duties of your occupation (or specialty).  Where does that leave a surgeon who cannot operate, but who can see patients in the office, review charts, and/or perform office management tasks?  The answer depends on the law of the State in which you reside and the fine points of your policy language.  This is a common area of dispute, and in many cases the issue of total or partial disability must be tried to jury.

CPT Billing Codes and Doctor Disability Claims

Insurers are increasingly disregarding what the insured says his or her important duties are, insisting on production of CPT billing codes. Insurers often have the CPT Codes analyzed (and not always by a competent, trained professional) to determine how you record your time and earn revenue for your practice. Suffice to say that CPT billing code analysis sometimes leads to strange and unexpected conclusions.  For claims where billing code analysis is central to the claim, our attorneys maintain relationships with some of the most qualified experts in billing coding in the country. In more than one case this has made all the difference in the outcome.

Determining Date of Disability

An additional challenge you may face is determining the date when you became disabled. This may be especially challenging if you have a degenerative condition that has caused you to reduce your duties over time as the problem has worsened, causing your income to gradually decline. We have advised a number of doctors who were not aware that “slowing down” and losing money triggers a claim.  We have known clients who lets years go by failing to recognize that a policy should be paying partial disability benefits.  In some cases we have been successful getting insurers to back date a claim and pay retroactively.

If your health is failing but you are still at work, the specialists at Robinson Warncke can help you determine whether, when and how to file a claim, and give you peace of mind in the process.

Documentation of Your Claim Versus the Insurance “Runaround”

You always paid you premium on time.  It is reasonable to expect the insurer to do the same with your benefits. While there is no getting around the fact that disability claims on behalf of doctors must be meticulously documented, insurers sometimes cross the line into needless delays and oppressive requests. At Robinson Warncke we can help you differentiate between a legitimate request for documentation and an overly burdensome “runaround,” and help push back against the latter.

Physicians We Have Represented, Among Others

• An obstetrician who had to stop working after his fourth back surgery. The issue was whether his disability was due to Accident or Sickness, with lifetime benefits at stake;
• An oncological surgeon with a spontaneously arising vestibular disorder causing dizziness and imbalance;
• An interventional radiologist with multiple medical issues limiting him to non-interventional duties only;
• A cardiologist with heart issues that caused him to have to change specialties to something less demanding;
• An orthopedic surgeon who could no longer operate, but who could perform office duties.
• A board-certified emergency medicine physician whose symptoms prevented demanding ER work, but allowed her to work in a less stressful Urgent Care setting.

Experience, Commitment, and Legal Expertise

The potential complexities and challenges of doctor disability claims are endless. The terms of each policy and the duties of each medical specialty vary greatly, making each case unique.  If you are a doctor with a condition that can be expected to prevent you from practicing, you should consult a highly experienced long-term disability attorney as soon as it becomes apparent that your work ability may be declining.  If you’ve already received a denial, you need legal help immediately.

The attorneys at Robinson Warncke have assisted disabled doctors throughout the country.  Over the last two decades, our long-term disability attorneys have recovered more than $70 million in previously denied claims for clients, 95 percent of the time without even having to file a lawsuit.  If a lawsuit is required, however, the firm aggressively litigates long term disability claims in state and federal courts nationwide.

As a result of our extensive experience with disability claims, we are able to handle virtually any disability denial through any insurer, whether under a private policy purchased individually or a group policy provided through your employer or group practice and covered by ERISA. Contact us today for a free phone consultation.

Before you file your claim, come in to consult with our dedicated long term disability attorneys to begin formulating a plan, gathering the required documentation, and identifying the potential pitfalls that often catch out the unwary or inexperienced.  This will minimize the chances of an initial denial and ensure that your administrative file is complete, with all the evidence you will need to succeed at an administrative appeal or judicial review of an ERISA claim, or in a jury trial if your policy is a private one.

Your financial future depends on having your long term disability benefits approved, and we are fully committed to fighting aggressively to ensure that you receive all the benefits to which you are entitled. We have the knowledge, experience, and resources to make it happen for you with the least amount of stress possible.

Call Robinson Warncke today to schedule a free telephone interview to learn how we can assist you in securing the financial future for you and your family in the face of a disability.