As a physician, you spend years learning how to care for sick patients and truly spend your days saving lives. But, if you become unable to work due to injury or illness and want to file for disability benefits yourself, you may be surprised at how complicated the process will be for you.
In this article, we talk about:
- Why it’s so difficult to file a long term disability claim as a physician;
- How to create a strong administrative file; and
- How you can obtain a professional evaluation of your disability insurance policy.
Why Is It So Difficult To Get Your Claim Approved?
Physicians face several challenges when filing for long term disability. Why? Because the insurance company is looking at your case from a financial standpoint. They look at how much it will cost them to provide you with benefits throughout your disability. The longer it could potentially take you to get back to work, the harder it will make it to get your claim approved.
In addition to your regular salary, you may have a rider that helps recover what you have lost during your illness or injury. This would apply to physicians who have their own medical practice instead of working in a hospital. For example, if you are disabled for two years due to a significant illness and come back to work, you probably have patients who had to seek medical attention from another provider; this rider will help support you while you rebuild your business and patient list.
Guidance for a Successful Disability Claim
Tip #1 Create a Strong Administrative File
Although you, as a medical professional, spend time noting your own patient’s pain levels and completing forms for disability cases, you might find it much different from being on the other side as the patient. A strong administrative file is key to winning a disability claim if it goes to court. Here are some things that need to be included in your administrative file:
- Copy of your long term disability policy. Knowing how your insurance company defines “disability” is very important to your claim;
- Copies of all letters from your insurance company and you to the insurance company;
- Why you can not 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 that summarize all conversations (by phone or in-person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to all parties involved in the communication via certified mail as proof it was received;
- Keep everything chronological so that if your claim is denied, you have a complete record of how your claim was handled;
- Proof of your monthly earnings;
- Proof that you are under the care of a physician for your condition and
- All medical documents from your physician regarding your condition, including but not limited to your official medical file, lab reports, X-ray and MRI reports, physician notes, and a list of surgeries, including surgical reports.
Consider a case where a claimant suffers from a severe spine disorder, rendering them unable to sit, stand, or walk for prolonged periods. The most relief comes from lying down for half the day to mitigate pain. Few jobs can accommodate such a requirement, so the claimant must ensure solid “objective medical evidence” backs up their subjective pain complaints. Such evidence could comprise MRIs and X-rays, among others.
Tip #2 Prepare for Surveillance
High-value claims, especially those involving physicians, are likely to trigger video surveillance, which is entirely lawful. During this period, a private investigator may observe the claimant’s residence, discuss the claimant’s daily routines with neighbors, and attempt to use this data against the claimant either in administrative decisions or in court. It’s vital, therefore, not to resume physically strenuous activities too soon during the claim process.
Tip #3 Minimize Social Media Activity
Given the high possibility of social media monitoring during long term disability claims, it’s advisable to minimize or entirely avoid social media use during the claim period. While you, as a busy physician, might not typically spend much time on social media, the idleness associated with recovery might tempt you to increase activity on platforms such as Facebook, Twitter, Instagram, LinkedIn, or Snapchat. Insurance investigators may attempt 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, particularly for active professionals like physicians. The transition from an intensive schedule to weeks or potentially months of rest can feel confining. Physicians should resist the temptation to resume work prematurely. An attempt to reenter the workforce before full physical and mental readiness could pose the risk of exacerbating your condition.
Tip #5 Remember Cognitive Issues
“Cognitive impairment” refers to diminished cognitive functioning, which may involve challenges with memory processing, perception, problem-solving, and language. Symptoms can vary significantly between individuals but commonly include memory loss, difficulty planning and organizing, confusion, inappropriate stress management, time management challenges, and communication difficulties. These cognitive difficulties could even manifest physically, causing poor motor coordination.
Such cognitive impairments could arise from severe medical conditions such as dementia, Alzheimer’s disease, Parkinson’s disease, or Huntington’s disease, among others. They could also result from other medical problems like 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 may lead to cognitive issues.
Insurance policies typically entitle you to disability benefits if you cannot perform your professional 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, yet insurance companies may still reject 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 might require the claimant to undergo an “independent” neuropsychological examination by their chosen medical professional. Understandably, the paid neurophysiologist often produces a biased report, concluding that the claimant can resume work despite any cognitive limitations. Experienced legal professionals can assist claimants and have successfully overturned denial decisions, even those initially supported by an unfavorable neuropsychological examination.
Common reasons for claim denials include incomplete documentation, erroneous information, and missed deadlines. It’s crucial to provide all necessary information promptly. A seasoned attorney can support you in assembling documents and adhering to deadlines.
Representation by an Experienced Long Term Disability Attorney
As a physician, it can be challenging to get a long term disability claim approved due to the substantial cost 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 against the insurance company and help you stay organized. The Ortiz Law Firm is based in Florida but represents claimants nationwide. Receive a free consultation by calling (888) 321-8131 with no obligation. We can help you evaluate your claim to determine if you can access long term disability benefits and how to proceed with the process.
Request a Free Policy Evaluation
Suppose you are considering purchasing disability insurance or have recently purchased a policy. In that case, we will help you understand what you are entitled to and whether there are deficiencies in your coverage that could lead to a denied claim. It is easy for individual policyholders who are not trained to read insurance policies to misread or misunderstand the disability policy. As part of our evaluation, we will explain what everything means to you in your situation.
Some of the aspects of your policy we will review include: