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.
Read MoreERISA Basics National Institute 6-Part Webinar Series
June 15th – 17th 2020, I will be speaking on two Employee Benefits Claims panels at the American Bar Association Joint Committee on Employee Benefits sponsored – ERISA Basics National Institute 6-Part Webinar Series. On the panels, I will present: 1) Statutory Overview and 2) Benefit Claims: Administrative Procedures & Litigation. The great news is that – it is virtual! Now you can join in without the burden of travel! #silverlinings. I look forward to the discussions, questions, and sharing of insights/ideas.
For more, see event details: https://www.americanbar.org/events-cle/mtg/web/394126606/
Or contact: Cassie Springer Ayeni, President of Springer Ayeni, A Professional Law Corporation @ www.benefitslaw.com
#JCEB #EBC #ABA #ERISA #Employeedisabilitybenefits #disablity #ERISAlawyer #Superlawyer #Disabilityclaims #Disabilityappeals #Longtermdisability #ERISAlitigator #ERISAbayarea #Disabilitylawyer #Employeebenefitslawyer #ERISAlawfirm #SpringerAyeni #benefitslaw #presenter
Incoming chair message to Employee Benefits Committee
So much has happened in these few months since I wrote this message to the Employee Benefits Committee as one of its incoming co-chairs. Since then, we had a successful midwinter meeting in Rancho Mirage, but none of us knew that would likely be our last travel occasion for the foreseeable future. Here’s a blast from the near past, which feels like a lifetime ago:
Read More
Here’s a blast from the near past, which feels like a lifetime ago
So much has happened in these few months since I wrote this message to the Employee Benefits Committee as one of its incoming co-chairs. Since then, we had a successful midwinter meeting in Rancho Mirage, but none of us knew that would likely be our last travel occasion for the foreseeable future. Here’s a blast from the near past, which feels like a lifetime ago:
Read More
Springer Ayeni Wins Disability Case Against Aetna
Even in tough times, we are grateful for the hard-working judges and court personnel who continue to decide cases and keep the wheels of justice turning. On March 24, 2020, the attorneys at Springer Ayeni achieved a victory for our client, a man disabled by shoulder pain and denied disability benefits by Aetna Life Insurance Company. Judge Chesney of the Northern District of California ordered benefits paid for Mr. Shaikh’s own occupation and remanded for a determination on the amount. The Court found that Aetna “overly focused” on objective medical evidence and “essentially disregarded” Mr. Shaikh’s credible complaints of pain. Springer Ayeni is now pursuing attorney fees against Aetna. https://law.justia.com/cases/federal/district-courts/california/candce/3:2018cv04394/329565/46/
Read More
A Conversation with Attorney Cassie Springer Ayeni
Q: When did you know you would pursue a career in the legal field?
CSA: As early as junior high or high school, I felt the need to advocate for others, to make a point to stand up for the kids who were being bullied or ostracized. I also realized around the same time that I truly enjoyed writing, reasoning, and debating. The law seemed a natural fit: I could use my skills to make a palpable difference in people’s lives. I had settled on a career in law by the time I was 16 and never looked back.
Q: Can you explain what types of cases an ERISA Attorney handles and why you chose this area of law?
CSA: I primarily help people with their employer-sponsored disability benefit claims. ERISA governs all private employer benefit plans, not just pension plans. Many employers provide disability benefit plans in addition to health and pension benefits. In fact, 65% of ERISA litigation is over denied disability benefit claims. The plans are often insured, and clients typically come to me after they stop working, apply for disability benefits to the insurance company, and are denied. I then step in to try to get their disability benefit income restored while they focus on their health.
Q: What is your approach or philosophy to winning or representing a case?
CSA: I lead with kindness. I want to understand truly what my clients have gone through medically, economically, and emotionally to get to this point in their lives, and how I can help. In representing a client, I am there for that person: I am responsive and listen with an open heart. I believe this the secret to winning a case as well – if I am doing my job right, I am painting a picture of the person and the case to help the court appreciate why my client is deserving of their disability benefits. I have the paintbrush and paint ready because I have spent months getting to know my clients and researching the law. And I also aim to be the best-prepared lawyer in the room with the most compelling brief … that helps too.
Q: If we interviewed all your past clients … what is “one” common word that comes up when they describe working with your law firm?
CSA: Compassion
Q: What are some of the most popular topics you are asked to lecture on?
CSA: I speak frequently on ERISA topics, especially in my current role as the co-chair of the ABA’s Employee Benefits Committee. I love presenting to newer attorneys about the fundamentals of ERISA litigation, because I am eager to energize attorneys about how engaging ERISA work is. ERISA is fun! The law is always evolving, providing constant intellectual stimulation, and practicing ERISA law is also a great way to help people in need. I also enjoy speaking to women about re-defining what it means to be a successful litigator, and how to challenge traditional law firm standards to achieve a better work-life balance.
Q: What advice would you give to young women who want to pursue a career as an Attorney?
CSA: Any woman who wants to pursue a career as an attorney should make sure that her potential work environment values diversity and inclusion, fosters a sense of belonging, and creates opportunities for women at every turn. If she is unable to find that environment, she should open her own law firm and create those opportunities herself.
Q: How do you maintain a work/life balance?
CSA: Being the owner of my firm allows me to make up the rules: I look to the best practices of progressive companies and pick policies that I believe are imperative to work/life balance for everyone. I figure that everything I need to raise four children and work full-time as an attorney is what everyone at my firm needs too. I offer unlimited PTO, great benefits, four months of fully paid maternity leave, the ability to bring children in to work as needed (in fact I have brought each of my babies into work until they needed another environment), the ability to work from home, and a practical approach to parenting … like closing the office on Halloween and Valentine’s Day so that we can all attend class parties without rushing to or from work. I, of course, avail myself of each of these policies, which is why I created them in the first place. That’s not to say that I don’t wake up early to work for a bit so that I can focus fully on my kids to take them to school, or grab a few hours on the weekend to pound out a brief, but family always comes first, for me and for everyone who works at Springer Ayeni.
Q: What’s one lesson you’ve learned in your career that you can share with our audience?
CSA: I have always learned to be myself. If you are authentic, you are compelling as an advocate and a counselor: you listen and communicate better when you are not spending energy on worrying about how you should come across. I also believe in the power of preparation. If you are committed to doing your best and preparing your utmost, then even a negative outcome cannot be met with regret, but a positive outcome is much more likely. And if you’re nervous before a court appearance or speaking engagement, just take a breath and realize that even in a worst-case scenario, you will survive and move forward … we all do.
Q: What are some of the challenges you feel women face today?
CSA: Looking at women lawyers only, there is much progress to be made. As Joan Williams at the UC Hastings Center for WorkLife Law has analyzed convincingly, women lawyers (and women in other fields too) are asked to “prove it,” then “prove it again.” In other words, women need to do the job before getting the promotion, whereas men are promoted based on potential. This is a major obstacle to women’s promotion and needs to be addressed systematically.
Five Things About Cassie Springer Ayeni
1. If you could talk to one famous person past or present, who would it be and why?
There are so many! But if I had to pick one it would be Harriet Tubman – her courage and vision even in the face of medical problems were and are awe-inspiring.
2. What’s your favorite holiday? Why?
Valentine’s Day! I don’t view it as just a romantic holiday, but as a day to express to those around you how much you care.
3. If you were a superhero, what would your special powers be?
Time-traveling. That would be magical!
4. What app can’t you live without?
Facebook – it has allowed me to make great connections with other lawyer moms – lawmas!
5. Favorite food to eat?
Strawberries. Now, then, forever, and always.
See the interview at https://bayareawomenmag.com/news/view/11665/Her_Firms_Achievements_-_Results_are_Measured_by_the_Satisfaction_of_Her_Clients_A_Conversation_with_Attorney_Cassie_Springer_Ayeni
Read More