I’m a Physician with a Disability—What Can I Do to Protect Myself?
As a physician, you’re trained to solve complex problems under pressure. You have worked hard for your career, and probably never expected to have to stop working due to a disability. Perhaps you applied on your own for those benefits and the insurance carrier denied your claim, or perhaps you’re beginning the process of applying for long-term disability insurance benefits. What can cause highly educated medical professionals to lose their long-term disability appeals?
It’s not a lack of intelligence. And it’s definitely not because you’re “not really disabled.”
In my work representing physicians and other high-income professionals, I’ve seen a frustrating pattern: doctors who rightfully file for disability benefits are denied just as frequently (and sometimes more so) as people who are not trained in medicine.
Here’s what’s going wrong, and how you can protect your livelihood and your future.
- Doctors are often treated on an informal basis by their colleagues
Any professional with a large network of trusted colleagues will turn to them first when something in their field goes wrong. That’s a given, and I get it. My father was a general practitioner from 1969 until 2021, when he passed away, and he was my first, and often only, phone call when I or my family had a medical concern. However, these initial, informal phone calls and diagnoses don’t make it into your medical records. So while you may have a months- or years-long history of seeking medical advice for your ailment, the medical records may look as though you just started treatment for a condition that has now become disabling. My first task with any of my clients in the medical field is to request their complete relevant medical records, so that I can ascertain how supported their disability is within the records that the insurer will review. And if those records are incomplete or sparse, I develop a strategy, through declarations, letters, or any other means, to make sure that the true course of treatment is documented in the long-term disability claim file.
- Insurers may use narrow definitions of “Disabled” for doctors
If you’re a surgeon who can’t operate anymore, that may seem clearly disabling to you. But your policy might say otherwise—especially if it’s a group policy through your hospital or medical group.
Many doctors are shocked to learn that their policy allows the insurer to deny benefits if they can do any work in a related field, such as consulting or teaching.
What to do: Get a copy of your full policy—not just the summary. A legal review by Springer Ayeni can help uncover how your “own occupation” is actually defined.
- Doctors may think it’s better to scale back to part-time rather than filing a disability benefit claim
In my experience, physicians and other professionals who have dedicated their lives to developing their expertise through education and practice, are incredibly determined to hang onto even part of their work rather than file a claim under disability insurance policies. Why? Because you have worked for your entire life to become a physician, and you may have even set that personal goal when you were just a child. My father never retired as a physician, and even when he became frail and sick, he kept working, forsaking all else, until shortly before he passed. For those of us who truly enjoy helping others in our profession, we may not even contemplate retirement, let alone leaving the practice much earlier than expected due to a disability.
Unfortunately, long-term disability insurers often operate under what I have dubbed the “hit by a bus theory,” where one day you are fully capable of performing your job without limitation, then you get “hit by a bus,” and the next day you are disabled. Most disabilities are not so straightforward, and many physicians continue working as long as they can with progressive disabilities,.
If you have strived in your profession for years and years, then your medical condition causes you to lose some capacity, you might start by scaling back your hours, or switching to more administrative tasks. Before making this kind of career move, please give me a call at 510-926-6768, so I can discuss the strategy of whether you might qualify for long-term disability benefits, and what the impact of switching job duties or reducing hours might be on an eventual disability claim.
What to do: Call me to discuss your disability and the terms of your benefit plan as soon as possible so that you can develop a strategy for whether, and how, you might either scale back your duties, file for disability benefits to replace your lost income, or both. Ironically, disability insurers often scrutinize partial disability claims harder than total disability claims, seeming to punish those who have tried heroically to keep working despite disabling limitations. I am here to help and advise, and I encourage you to let me help you make an informed decision about reducing your hours or filing a disability claim.
- Medical Records or Treating Physician Forms Alone Usually Aren’t Enough
Insurers don’t just want to know your diagnosis. They want to see how your condition limits your ability to perform your specific job duties. In the ultimate “gotcha,” however, insurance forms for treating physicians to fill out either don’t ask the right question (“how”) or don’t leave enough room for your doctor to answer that question thoroughly. Stating an ICD Code and a condition, like “long-COVID,” “Parkinson’s Disease,” “Mild Cognitive Disorder,” “Major Depressive Disorder,” or “Migraine,” etc., is insufficient to prevail on a claim for disability benefits. You and your doctor need to explain how your condition affects your ability to specific tasks in your practice, such as stand during rounds, hold your arms in the correct position during surgery, respond adequately to emergencies, work a nightshift or be on-call, or manage a high-stress practice.
What I suggest: Work with your treating doctor to create a detailed functional report—not just a chart note, by writing down a list of what specific job duties are affected by your disability, and going over that list with your treating physician. It’s best if your medical records can be as detailed as possible about what you are unable to do at work. Also, the boxes on insurance forms are not a limitation! Put in an asterisk and attach a supplemental page or 2 to submit as much helpful information as possible.
- Doctors Are Prime Targets for Surveillance
High-income professionals like doctors are often watched, because they are expensive claims for the insurer to pay. A short video of you walking, driving a distance longer than your restrictions permit, shopping in a store, or attending your child’s sports game can be twisted to argue you’re not truly disabled.
What to do: Make sure all of your social media settings are set to “private.” Be mindful of what you do in public and what your restrictions and limitations are. Be honest in disclosing your actual activities on forms. For example, if your physician has recommended exercise to improve your disabling conditions, make sure you state on your application or update forms what you do and why it was prescribed by your doctor. If benefits have been denied, be sure to request and review all surveillance footage so that you can include context for what was actually happening on that day. Judges ultimately appreciate context, and understand that there may be anomalous events that do not necessarily mean that you can return to the full-time practice of medicine. While insurers may be looking for a “gotcha,” have faith that most judges are wise enough to see the big picture.
- ERISA is brutally technical
The ERISA process has strict rules. You often get only one appeal to submit your evidence, and it must be submitted by a specific date or you lose your right to the claim. Moreover, if you miss including key documents, you may not have the chance to get that evidence in front of the court if you later go to court.
What to do: Don’t wait until after your appeal is denied to consult a lawyer. The best time to get legal help is before you submit your appeal—when there’s still time to shape the record. Reach out to me at www.benefitslaw.com or 510-926-6768 and I would be happy to discuss your specific issue with you in more detail.
