Issues When Doctors File Claims for Long-Term Disability

Physicians play a key role in their patients’ claims for long-term disability or LTD. A treating doctor’s observations and testing provide key evidence for an insurer to understand whether a claimant’s medical disability meets the definition of disability provided in his or her policy.

But it is a different dynamic when it is the doctor him or herself that is filing for disability insurance because physical or mental impairment is keeping him or her from continuing to practice medicine.

Earlier this year, we wrote about the crucial need for physicians to purchase LTD insurance, whether through an employment relationship or privately if he or she hangs out a shingle independently. In that post, we talked about the financial challenges that can come quickly to a doctor suddenly unable to work who has ongoing high equipment costs, office space and staff salaries.

A new article in MD Magazine talks about unique issues that can arise in doctors’ LTD claims processing. For one thing, the insurer must carefully analyze the question of whether a doctor can continue to work in his or her “own occupation,” when that is the type of policy at issue. The tasks a physician performs are so unique and so delicate that in some situations such as performing surgery what might not be disabling to someone in another profession may be significantly disabling in the case of a medical professional.

In addition, it may be necessary to establish that all doctor’s duties are not the same. Consider the difference between an eye surgeon and an obstetrician.

Think about, for example, what a tremor could do to the ability of a brain or hand surgeon, or a dentist, to perform the usual tasks of his or her job. By contrast, a tremor would not interfere with the duties of some other medical specialties.

The article points out some of the unique challenges of disabling mental health conditions in a doctor’s LTD claim. It can be important that the physician-claimant seek treatment for mental health problems from a seasoned provider so that the diagnosis and its limitations are clearly established in the doctor-claimant’s medical records.

The MD Magazine piece also alludes to the emotional and professional challenges that some doctors can have with the whole process of having their medical conditions under the microscope of the insurance company. The process is intrusive and can involve an investigation that involves the claimant’s own doctors, colleagues and family, as well as online or live surveillance.

An antidote to this problem is the retention of an experienced LTD attorney who can handle the interaction and communication required with the insurer on behalf of the physician-claimant and can prepare the doctor for each step of the claims process.