LTD Claim Representation for Dental, Medical, Chiropractic Practitioners
Own occupation disability insurance covers physicians against the inability to pursue their specialized daily line of work. The provision is a key feature of income insurance protection for skilled medical professionals.
The language and terms used by an insurance company to define “disability” is the most important part of any long-term disability insurance policy. Most LTD insurance providers use variations of one or two types of disability definitions: OWN occupation or ANY occupation. The differences between these two definitions of disability are significant.
We will inform you of options about your own occupation disability policy to make sure you are protected – or to discuss appealing a denial immediately.
How an “Own Occupation” Policy Defines Disability
Own occupation coverage is specific to your specific medical or dental profession. If your insurer examines your disability claim using an “own occ” standard, you only have to prove that you cannot do the substantial and material duties required for your specific occupation or specialty, in order to qualify for disability benefits under the policy.
For instance, medical, dental or chiropractic practices often establish a high case load of routine procedures. A sudden injury to a hand, a back impairment, or the onset of Parkinson’s can impair the dexterity or stamina required for a surgeon or dentist to do routine surgeries or clinical dentistry. Imagine the loss of income that occurs when that person is no longer able to perform the daily procedures of his or her practice.
Own Occupation Disability Insurance in Private Policies
Several insurance companies offer “own occupation” coverage under private disability policies. The provision may be written into the policy or attached as an own occupation benefit rider supplementing a base plan.
Although the language may differ from policy to policy, a true own occupation policy will define Total Disability along the lines of the following:
If you cannot perform the material and substantial duties in your own medical specialty due to illness or injury,
- the insurance company will consider your regular occupation to be the occupation you are engaged in at the time of disability onset, and
- the insurance company will pay the full monthly benefit amount for the full benefit period, even if you are gainfully employed in some other capacity. You will be eligible to receive your full monthly benefit regardless of how much income you are earning in another field.
The Definition of “Regular Occupation” in a Private “Own Occupation” Policy
Regular Occupation is generally defined in specialty-specific policies as follows:
- Your occupation at the time disability begins.
- If you have limited your practice to a professionally recognized specialty in medicine, the specialty will be deemed to be your regular occupation.
The insured’s occupational duties would be clearly identified and classified—otherwise it can result in either a denial of the claim or reduced benefits.
In this manner, a specialty-specific definition of disability allows for full disability payments in addition to money earned from other sources. It also pegs the time of disability as the point at which the illness or injury occurred – not at the time of filing claim (at which point the physician may have cut back hours or duties in efforts to continue working to keep his or her practice alive.)
Examine your policy. Does it define your occupation, and have provisions that establish a framework for determining your material duties?
Be aware, not all own occupation policies are equal. There are true, or pure, own occupation disability insurance, and there are modified versions.
Modified Versions of “Own Occ” in Individual Disability Insurance Policies
Some own occupation definitions continue with a clause that says to be considered totally disabled, “you are not engaged in any other gainful occupation.” This provision weakens your policy by eliminating your ability to work in other forms of medicine or other job and still receive benefits.
Other modified forms start out as a true own occupation policy, but after 24 or 60 months the “own occupation” is replaced by the “any occupation” definition. To collect disability benefits in keeping with this definition, you must be unable to work in any occupation, not just your own. This drastically changes your eligibility to continue receiving benefits, and what you must demonstrate to the insurance company to prove your claim.
Policies also may offset benefit payments to counterbalance income you earn from other sources, like teaching, lecturing or consulting.
Own Occupation Disability Insurance in Group Policies
Most group LTD policies, such as employer group disability benefits and some professional association plans, have limited own occupation benefits. Under group plans, usually a modified version of own occupation benefits are provided only for the first 24 months of disability.
After the first 24 months, benefit provisions shift, and are provided only under an ANY occupation clause.
Partially Disabled / Gainfully Employed under Own Occupation
Some individuals find they are no longer able to perform all of their duties and procedures, but can still work in their medical field. A urologist might still be able to help and treat patients, but not as a urological surgeon.
If you are capable of doing some, but not all of your material and substantial duties of your occupation/specialty, you may be considered partially disabled under your policy. In this case, you would need to be gainfully employed in order to be eligible to receive a proportionate disability insurance benefit.
If you have been denied benefits, contact physician’s disability claim attorney Marc Whitehead
It is easy to see how insurers find opportunities to challenge and deny a claim. Whether you have a group or individual own occupation disability insurance policy, before you file a claim for disability it is important to consult with a lawyer.
If your claim was denied, do not accept the denial decision by the insurance company. Call us. Identifying an unjust denial of your disability claim requires the knowledge and insight of an attorney with extensive dealings and background in the insurance industry.
We are ready to help you now. Contact doctor disability denial attorney Marc Whitehead & Associates and find out if you have legal recourse.