Unlike many other professions, even the slightest injury or illness can end a doctor’s career. Insurance companies make a great deal of money selling disability insurance policies to doctors and other medical professionals such as dentists, chiropractors, nurses and veterinarians.
Filing a claim and obtaining disability benefits should be straightforward, but unfortunately, this is not always the case. Resourceful tactics are historically used by the insurance provider to mislead or confuse claimants and thereby stage a denial of benefits.
- A doctor struggling with severe back injury faces a daily battle with her disability insurance carrier. After filing a claim, her insurance company paid disability benefits for 120 days. The claims handler then sent a letter terminating this doctor’s disability benefits, saying they found her to no longer be disabled.
- A surgeon, diagnosed with Parkinson’s Disease, is no longer able to operate on patients due to hand tremors. His disability insurance provider denied his claim for benefits because it determined he was not “totally disabled” from his “own occupation” as defined by the policy.
- A cardiologist, diagnosed with the onset of dementia, is denied long term disability coverage after a two-year payment period. The explanation given is that his policy’s mental conditions limitation is limited to 24 month’s coverage.
In cases such as the examples above, wrongful denial or termination of doctors’ disability claims stand a good chance of being appealed and won.
Our attorneys represent medical professionals across the U.S. whose insurers have wrongly denied their long term disability claims. Our experience covers the spectrum of medical conditions.
Here are some of the medical vocations our attorneys have successfully represented:
- Medical Doctors / M.D.
- Osteopathic Doctors / D.O.
- Nurse Practitioners
- Physician Assistants
Doctor Disability Claim Denials and “Own Occupation” Policies
MDs, DOs, surgeons and dentists generally buy “own occupation” private disability policies. This is their safety net for replacement income should they become disabled and unable to work in their chosen specialty.
The key is the policy definition of “disabled.” With own occupation policies, generally it states that you are unable to perform the principal duties of your specialty area of medicine. In our experience, physicians long term disability denials are often the result of how the insurer regards the policy definition of the doctor’s occupation and the limits of his or her duties.
The claims handler decides whether the insured is protected from disability in his or her own specialty area of practice and not broadly the ability to practice medicine.
Other times, a claims adjuster will deny a doctor disability claim with no regard for whether the doctor’s regular occupation was defined as his or her specialty. The insurer’s interpretation of wording in the policy, when improperly applied, clearly robs the doctor of the protections actually bought.
A Case of Denied Doctor Disability Insurance Benefits
Insurers often use the Dept. of Labor’s databases — The Dictionary of Occupational Titles (DOT) and O*Net — during the vocational review of a doctor disability insurance claim. For example, the occupations of doctors, internists, ophthalmologists, urologists, dermatologists, dentists, physician assistants and other practitioners are identified as light occupations by the DOT. Light occupations require a significant amount of standing/walking.
But if it sounds vague, it is – especially when so much is at stake. Some insurer’s use the DOT’s general job definitions as opposed to the true definition of the individual doctor’s vocation. By subtly redefining the actual job, the insurer has a way to deny the claim, based on misleading vocational information. It often goes like this:
In a private disability case, a doctor – a urologist – buys “own occupation” disability insurance from an agent. The policy is written to be very specific to her individual practice. The doctor would be determined “totally disabled” if she cannot perform the same specialty area of medicine she had worked before the disability.
She files a claim for disability. The claims handler misinterprets policy provisions and decides the “light” occupational strength level requires the lowest level of capacity. As a urologist, although she can no longer perform procedures, she can still see patients in an office setting and do follow-up work. The claim is denied on the basis that the impairment is not severe enough to stop her from working in her own occupation.
In group disability cases, most claims are filed under “any occupation” insurance policies. A hospital might provide group disability plans for all employees, under which the docto files a claim. The claim handler in this case may apply the DOT’s “light” exertion level to maintain that she can still perform at her previous job’s capacity. They may further claim that she is able to work in any occupation that is reasonably suited to her age, experience, education and skills.
These are only a few examples of why you need to be prepared for an insurer’s attempt to unreasonably deny your claim or terminate benefits.
Learn more about how policies sold to protect specialty duties of your own occupation are often misused by companies to deny doctor’s disability insurance benefits.
Don’t Let the Insurance Company Manipulate You
For every “reason” the carrier uses to deny a legitimate claim, we will reply in kind with a stronger, legal argument:
- Insurers will rely on the opinions of their in-house medical professionals as a basis for denial. These doctors may not be familiar with your condition or may fail to evaluate the totality of your impairment.
- Manipulating the policy’s definitions of “disability” and “occupation” is a favored tactic used to deny benefits.
- The insurance company may seem to make a strong case against your claim for memory deficiency or Alzheimer’. However, mental conditions are not always subject to restrictions or exclusion.
- Insurers often allege malingering, or feigning disability, if their in-house medical examiner cannot find an objective basis upon which to deny your claim.
I could give you hundreds more examples. Unfortunately, many newly disabled doctors and medical professionals blindly accept their insurance company’s decisions to deny or limit benefits. Others try to take on the fight on their own.
Billion dollar insurance companies are accomplished and well-equipped in the art of containing costs and increasing profits. Insureds must be even more prepared in order to protect themselves. When doctor’s disability claims are denied, it is critical that they work with qualified legal counsel experienced in disability insurance law.
Call Disability Attorney Marc Whitehead with Your Questions
By asking for our evaluation of your case, you can decide if taking legal action is in your best interest. Remember, timing may be critical to your case
- Call us directly: 713-228-8888 or Toll Free 800-562-9830. Call any time, day or night.
- Contact us by e-mail. Fill out the brief, confidential form found on the right-hand side of any page on this site.
Marc Whitehead and the attorneys at Marc Whitehead & Associates have decades of experience in disability insurance law, representing individuals with all types of disabling conditions.
We have earned a national reputation for prosecuting doctor disability claims against insurance companies that wrongly stonewall, deny or terminate legitimate disability claims. We have what it takes to handle the insurance company, help you prove your claim and secure the benefits you deserve.