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As a doctor, you spend years learning how to care for sick patients and truly spend your days saving lives. But, when an injury or illness prevents you from working and you need to apply for long-term disability benefits yourself, you may be surprised at how complicated the process is.
In this article, we will talk about:
- Why it’s so difficult to file a long-term disability claim as a physician;
- How to build a strong administrative file; and
- How to get a professional evaluation of your disability claim.
Why Is It So Difficult to Get Your Claim Approved?
Physicians face several challenges when filing a long-term disability claim because the insurance company looks at your case from a financial standpoint. They look at how much it will cost them to provide you with benefits for the duration of your disability. The longer it could potentially take you to get back to work, the harder it will be to get your claim approved.
In addition to your regular salary, you may have a rider that helps you recover what you lost during your illness or injury. This would apply to doctors who have a private medical practice instead of working in a hospital.
For example, if you are disabled for two years due to a serious illness and return to work, you will likely have patients who have had to seek medical care elsewhere; this rider will help support you while you rebuild your business and patient list.
Tips for a Successful Disability Claim
Tip #1 Create a Strong Administrative Record
Although as a medical professional you spend time recording your own patient’s pain levels and filling out forms for disability cases, you may find it very different from being on the other side as a patient. A strong administrative record is critical to winning a disability claim if it goes to court. Here are some things that need to be included in your administrative file:
- Your long-term disability policy. Knowing how your insurance company defines “disability” is very important to your claim;
- All letters from your insurance company and from you to the insurance company;
- Why you cannot perform your job duties (this will require medical documentation);
- A list of all medical providers that you have seen for this condition and a letter from each provider stating that your condition prevents you from working;
- Letters summarizing all conversations (by phone or in person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to everyone involved by certified mail as proof of receipt;
- Keep everything in chronological order so that if your claim is denied, you have a complete record of how your claim was handled;
- Proof of your monthly income;
- Proof that you are under the care of a physician for your condition; and
- All medical documentation from your physician regarding your condition, including, but not limited to, your official medical record, lab reports, x-ray and MRI reports, physician notes, and a list of surgeries, including surgical reports.
Consider a case where a claimant has a severe spinal condition that prevents them from sitting, standing, or walking for long periods of time. The greatest relief comes from lying down for half the day to relieve pain. Few jobs can accommodate such a requirement, so the claimant must ensure that solid “objective medical evidence” supports their subjective complaints of pain. Such evidence may include MRIs and X-rays, among others.
Tip #2 Prepare for Surveillance
High-dollar claims, especially those involving doctors, are likely to trigger video surveillance, which is perfectly legal. During this time, a private investigator may observe the claimant’s home, discuss the claimant’s daily routine with neighbors, and attempt to use this data against the claimant in administrative decisions or in court. Don’t return to physically strenuous activities too soon during the claim process.
Tip #3 Minimize Social Media Activity
Given the high likelihood of social media monitoring during a long-term disability claim, it’s wise to minimize or entirely avoid social media use during the claim period. While you may not normally spend much time on social media, the idleness associated with recovery may tempt you to increase your activity on platforms such as Facebook, Twitter, Instagram, LinkedIn, or Snapchat. Insurance investigators may try to use your social media posts against you to refute your claim.
Tip #4 Don’t Rush Back to Work
The recovery period from a disability can be uneventful and feel unproductive, especially for active professionals like doctors. The transition from an intense schedule to weeks or possibly months of rest can feel restrictive. Physicians should resist the temptation to return to work prematurely. Attempting to return to work before you are physically and mentally ready could risk worsening your condition.
Tip #5 Remember Cognitive Issues
“Cognitive impairment” refers to diminished cognitive function, which can include challenges with memory processing, perception, problem solving, and language. Symptoms can vary greatly from person to person, but commonly include memory loss, difficulty planning and organizing, confusion, inappropriate stress management, time management challenges, and communication difficulties. These cognitive difficulties can even manifest physically, causing poor motor coordination.
Cognitive impairment can result from serious medical conditions such as dementia, Alzheimer’s disease, Parkinson’s disease, or Huntington’s disease, among others. They may also result from other medical problems such as stroke, heart disease, brain injury, major depression, anxiety disorders, insomnia, high blood pressure, chronic migraines, lupus, Raynaud’s phenomenon, and fibromyalgia. This list is not exhaustive; other conditions can cause cognitive problems.
Insurance policies usually entitle you to disability benefits if you cannot perform your job duties or any other job for which your education, training, and experience qualify you. A physician suffering from cognitive impairment would understandably struggle to perform their duties, but insurance companies may still deny claims. It’s not uncommon for insurers to insist that the insured can return to work, even in the face of cognitive impairment.
An insurance company may require the claimant to undergo an “independent” neuropsychological evaluation by a medical professional of their choice. Understandably, the paid neurophysiologist often produces a biased report, concluding that the claimant can return to work despite any cognitive limitations. Experienced legal professionals can assist claimants and have successfully overturned denials, even those initially supported by an unfavorable neuropsychological evaluation.
Common reasons for claim denials include incomplete documentation, incorrect information, and missed deadlines. It’s important to provide all necessary information promptly. An experienced attorney can help you gather documentation and meet deadlines.
Representation by an Experienced Long-Term Disability Attorney
As a physician, it can be difficult to get a long-term disability claim approved because of the significant costs to the insurance company. They will try to find any reason to deny your claim. By providing strong medical and financial evidence, you can create a solid administrative case file for your disability claim.
Using an experienced disability attorney will help you protect yourself from the insurance company and stay organized. The Ortiz Law Firm is based in Florida, but represents claimants nationwide. Call (888) 321-8131 for a free, no obligation case evaluation. We can help you evaluate your claim to determine if you are eligible for long-term disability benefits and how to proceed with the process.
