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.
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The Elephant in the Room: Can AI Really Handle Your ERISA Disability Claim and Appeal?
Why Turning to a Bot for Legal Advice Could Hurt Your Claim—And What You Deserve Instead
Let’s be honest: more and more people are asking AI tools like ChatGPT or Google’s Gemini how to appeal a denied disability claim before they ever think of calling a lawyer.
I get it. AI is fast. It’s available 24/7. It doesn’t require talking with a live person about the difficult details of your health. And, of course, AI is free or low-cost.
But when your financial stability and health are on the line, you need to know the full truth: AI is not a substitute for experienced legal counsel. In fact, trusting AI blindly could do more harm than good.
As someone who has spent 23 years representing clients in ERISA disability cases, I’m not here to bash technology. There is much to gain from the efficiency of evolving technology and I am certainly not advocating AI abstinence. I am here, however, to lay out the risks, differences, and reasons why having a compassionate, strategic, and knowledgeable attorney matters for something as critical to your financial health as your long-term disability benefits.
Why People Turn to AI—and Where It Falls Short
If you type into ChatGPT:
“How do I appeal a denied ERISA disability claim?”
You’ll probably get something like this:
“Request your claim file. Review the denial letter. Submit additional medical evidence. Write an appeal within 180 days.” You might even get general “advice” about including medical records and statements in support of your appeal. However, even AI knows its own limitations. A common Bot disclaimer goes something like this:
“Generative AI features are not intended for professional advice. Do not use generative AI features to seek or provide legal, medical, financial, or other kinds of professional advice or any opinions, judgments, or recommendations without conducting your own independent consultation or research. Generative AI features cannot replace advice provided by a qualified professional and do not form any such relationship (e.g., attorney-client relationship).” (https://www.adobe.com/legal/licenses-terms/adobe-gen-ai-user-guidelines.html)
Even tech giants know that the disclaimer is necessary because AI advice is not strategic, not confidential, not detailed, and, in fact, is dangerously simplistic.
For example, AI does not, and cannot, analyze whether your plan’s language requires a de novo or abuse of discretion standard of review in court; whether the facts of your case meet the definition of disability under your plan language; whether the insurer has disclosed all required information in its claim file; whether there is evidence of biased claims handling in your file; whether the insurer has calculated offsets accurately in your case; what evidence in the claim file needs to be rebutted in an appeal; what the likelihood of settlement and possible settlement amount in litigation might be. The list goes on and on. These are the kinds of distinctions that change the outcome of a case—and they’re not in an AI’s toolbox.
The bottom line: AI gives you non-confidential general advice. Springer Ayeni gives you a legal strategy based on decades of experience handling ERISA long-term disability cases.
AI “Hallucinations” and Fake Law: A Dangerous Trend
AI tools are known for hallucinating legal citations—that is, making up case law that sounds real but isn’t. See https://hai.stanford.edu/news/ai-trial-legal-models-hallucinate-1-out-6-or-more-benchmarking-queries I’ve read up on examples of how AI will generate completely fictitious case references and quotes from decisions that don’t exist. This isn’t just sloppy, it’s dangerous.
First, if you submit an appeal letter to an insurer or judge citing bogus cases, you undermine your credibility. Second, insisting that there are cases in your favor when you reach out to an attorney, when those cases are entirely fictious (unbeknownst to you), will make an attorney hesitant to offer to represent you. Attorneys and their clients should be on the same team at all times. Most importantly, you won’t even know when AI has done you dirty with a fictitious citation, because it often sounds right and the wrong cases are mixed right in with actual cases.
The bottom line: Legal writing is not just writing. It’s advocacy, precision, and ethics. AI is still a baby in the world of law, and cannot be trusted to do actual legal research.
AI Is NOT Confidential, and that Can Put You at Risk
AI is not a lawyer. It doesn’t form an attorney-client relationship, as all of the tech User Guidelines state. That means:
- There is no legal confidentiality. What you input may be stored, analyzed, or even discoverable later.
- You might waive privilege by sharing facts about your medical condition, employment, or insurer. Moreover, AI remembers your input from search to search, so even if you don’t share all the facts in one session, it may know a lot more about you, your condition, your family, your history, your dreams, and your goals from all of the data you have input in previous searches.
- There is no duty of loyalty. AI doesn’t protect your interests—it just completes a task. For example, when Chat GPT conversations are shared, Google produces those conversations as “results” upon a simple search. See https://cybernews.com/ai-news/chatgpt-shared-links-privacy-leak/
As an attorney, I never input confidential client information into AI platforms. Doing so risks ethical breaches and the security of your case. Some lawyers are misusing AI and unknowingly exposing clients. That’s not how I work.
If I use AI at all, it’s only for mundane administrative tasks—not for case strategy, legal analysis, or communication.
The bottom line: Your trust is sacred. And your privacy is non-negotiable. AI will not protect you and advocate for you like a good attorney will.
A Real Appeal Tells the Real Story—Not Just the Medical One
An AI might focus only on lab results and doctor notes. But I know that winning a disability appeal requires telling your whole story, not just summarizing medical visits. It also requires understanding the law and how it applies to the facts of your case, and being able to spot and rebut flaws in the insurer’s claims handling and medical reviews.
I listen for and translate the truths that often don’t make it into a medical file, like how your fatigue crashes your productivity by noon, or how your brain fog makes multi-step tasks impossible not just at work but in your everyday life, or how your anxiety prevents you from completing your tasks efficiently, or even how you have good days and bad days, requiring you to rest for days if you have over-exerted yourself on a good day.
I draw out the details of your daily life, your work history, and your limitations, and I explain them clearly and persuasively to the insurance company. This isn’t something a chatbot can do. It takes time, training, empathy, experience, and sound judgment.
The bottom line: I’m not just reviewing records. I’m building your narrative, filling gaps in the file, rebutting arguments, and fighting for your future.
AI Can’t Show Up for You. I Will.
Some pundits say AI will replace lawyers. I do think that technology can make lawyers more efficient at administrative tasks that take away from time spent on actual cases. However, the best lawyers, those who listen, advocate, strategize, work as a team with their client, and ultimately are successful in cases, cannot ever be replaced by a bot. Technology will evolve, but compassion, reputation, and results still matter.
When you retain me, you’re not getting a script. You’re getting:
- 23 years of ERISA disability experience
- Strategic, circuit-specific legal knowledge
- A reputation for success and tenacity among colleagues, insurers, and opposing counsel
- A teammate who sees you as more than a claim number
- A fierce advocate who will not ignore you or reduce you to a piece of datum that will influence future actions
The bottom line: You deserve someone who understands not just the law, but the weight of what’s at stake. You deserve someone who knows how to get results and treats you with dignity along the way.
Final Word: Don’t Trust a Bot with Your Livelihood
AI has its place, but not as your attorney. Not when your disability benefits, your financial survival, and your mental and physical health are on the line.
Before you go down a rabbit hole of chatbot answers, talk to someone who’s been through this hundreds of times, someone who won’t hallucinate law, who respects your privacy, and who knows how to win an appeal, not just write about it.
Contact Springer Ayeni today. Let’s protect what matters most—your income, your dignity, your future.
Springer Ayeni: Compassion. Reputation. Results.
www.benefitslaw.com
In the Kingdom of the Sick: An ERISA Disability Lawyer’s Perspective
In the Kingdom of the Sick: An ERISA Disability Lawyer’s Perspective
By Cassie Springer Ayeni
Springer Ayeni, A Professional Law Corporation
“‘Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick . . . sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.’” – In the Kingdom of the Sick at p. 4 (quoting Susan Sontag).
In Laurie Edwards’s book on chronic illness, In the Kingdom of the Sick: A Social History of Chronic Illness in America, she takes a broad approach to explain obstacles that people suffering from chronic illness currently encounter.
Chronic Illness Defined
Edwards identifies three primary traits in chronic illness: “the symptoms are invisible, symptoms and disease progression vary from person to person, and the disease progression and worsening or improvement of symptoms are impossible to predict.” (pp. 32-33.) She also notes that chronic illness is “treatable, not curable.” (p. 33.) Moreover, chronic illness is often accompanied by its life-altering companion, chronic pain, which can make it “excruciating to engage in physical activities, keep up with a regular work schedule, or even leave the house.” (p. 111.) And it is pervasive. According to Edwards, chronic illness, which includes heart disease, diabetes, cancer, and asthma, affects nearly 50% of the population. (p. 11.) An astounding 81% of hospital admissions are a result of chronic illness, as are 76% of all physician visits. (p. 11.)
Biases Against People with Chronic Illnesses
Edwards devotes much of In the Kingdom of the Sick to explaining the biases that those living with chronic illness encounter, both from an historical perspective and in the modern medical era. For example, Edwards notes that where conditions lack a cure, which is one of the inherent traits of chronic illness, “blaming the patient often follows suit.” (p. 6.) This bias of skepticism leads to potentially devastating consequences: “45 percent of patients with autoimmune disease were labeled as chronic complainers early in their diagnostic journeys, with the resulting delay in diagnosis often leading to organ damage from lack of appropriate treatment.” (p. 78.) In my experience representing ERISA disability claimants for the past 15 years, this inclination towards disbelief extends to the disability insurance context as well, where before a concrete diagnosis is reached insurers are inclined to deny a claim for disability benefits that are based on “self-reported symptoms,” and claimants who cannot seem to overcome their undiagnosed or misunderstood conditions are labeled as “malingerers.” Indeed, these biases have become so pervasive that the trend in long-term disability plans is to limit the duration of benefits payable for “self-reported conditions,” which is an ever-expanding group of non-fatal, but totally disabling conditions. Claimants are often left high and dry after receiving the maximum duration of benefits, but still prevented by their lifelong illnesses from returning to gainful employment.
Additionally, most ERISA disability plans are written with a 24-month or shorter maximum duration for “mental illness” conditions. However, as Edwards points out, people with chronic illness often have secondary depression and anxiety: “what if the person is anxious because he or she has been sick for weeks or months and physicians can’t seem to help? What if the person is depressed because he or she is at home sick, isolated from social events and falling behind in work?” (p. 107.) In my experience, many disability claims adjusters try to label the mental component as primary in order to justify limited payment duration, often ignoring the severity of the underlying physical condition.
Edwards also does an excellent job examining the historical and pervasive bias against illnesses that primarily strike women. She states: “throughout history, deeply ingrained ideas about women as unreliable narrators of their pain and symptoms, as weaker than men, and as histrionic or otherwise ‘emotional’ have had a profound impact on their ability to receive accurate diagnoses and appropriate care.” (p. 20.) Added to this inherent bias is the fact that until very recently, “[w]omen were navigating a hierarchical medical system dominated by males; women lacked knowledge and resources to advocate for their health.” (pp. 76-77.) Although times are changing as there are more women doctors and as studies are increasingly inclusive of women patients, women with chronic illnesses still encounter shades of these gender biases when diagnosed with conditions like chronic fatigue syndrome, where people “roll their eyes at [these patients] or come right out and tell [them] that CFS is a made up disease, a present-day hysteria, or that ‘everybody gets tired.’” (p. 103.)
Chronic Illness and ERISA Claimants
Edwards aptly notes that people with chronic illnesses are often not able to be accommodated by their employers, since the ability to maintain a regular work schedule is a job necessity. (p. 66.) A disability claim is the inevitable conclusion, where the claimants must then “prove” their disability to the insurer. However, the insurer may be skeptical because of the nature of chronic illness, where sufferers experience some days that are better than others. Edwards notes that such fluctuation is a hallmark of chronic illness: “The unpredictability of symptoms and their severity that sets chronic illness apart from certain physical disabilities can also make for ‘unreliable activists,’ individuals who might be able to run workshops or attend policy meetings one day and be bedridden the very next.” (p. 53.) The chronically ill ERISA claimant may encounter the same culture of skepticism in the insurance context that she likely already experienced when seeking treatment for what ultimately became a disabling condition. And this culture of disbelief extends to the health benefit context as well. Edwards poignantly recounts her own experience with chronic illness, stating “I am grateful for the excellent health insurance that I work incredibly hard to provide for my family, and even with that, there are always letters to write, explanations to offer, and battles to wage to convince the people in charge of approving claims that preventative care is truly medically necessary.” (p. 193.)
Skepticism in LTD benefit applications couples with the shame that many chronically ill patients experience in admitting disability to begin with. Edward quotes the experience of one woman who had to apply for Social Security Disability Insurance, which is often a requirement of ERISA LTD applicants: “‘I’m depressed about it because I prefer to live in denial that this is going to be a long-lasting or permanent condition. And I’m embarrassed because even though rationally I know SSDI is an insurance policy that I paid into since I got my first job at age fourteen, it feels like asking for a handout. Like it’s trying to go on welfare.’” (p. 55.)
And still another obstacle faced by many ERISA LTD applicants who are chronically ill is the shock of surveillance that captures “clustering” activities to periods of increased energy, which often then results of days of bed rest to make up for the exertion. Edwards notes that such behavior is a pain management technique rather than an indication of sustained energy, and details that chronically ill patients must engage in extensive planning ahead of time before engaging in everyday routines. (p. 103.)
A Validating Resource for Patients
Overall, In the Kingdom of the Sick is an excellent resource for people suffering from chronic illnesses to obtain comfort that their experiences of disbelief, bias, and isolation are not unique. However, because chronic illness is such an extensive topic, at times the book is painted in too-broad strokes. Edwards tries too hard to lump all chronic illnesses together, such as AIDS, CFIDS, and cancer, to draw the tenuous analogy that people are biased universally against those with chronic illness. The diseases and the movements behind the diseases may have some links, but are also very distinct, and each disease has its own social bias to overcome to generate more attention and funding.
In this lumping together, Edwards also misses the distinguishing factor in chronic pain conditions – most are not inherently fatal. She criticizes that the NIH spends 96% less money on chronic pain research than on cancer, cardiovascular disease, and diabetes combined, but these are all potentially life-threatening whereas chronic pain is perceived as more manageable.
Nevertheless, I would certainly recommend that my clients who are suffering from debilitating chronic illnesses read In the Kingdom of the Sick to understand the historical context of chronic illness and to understand the legitimacy of their own experiences and feelings surrounding their illnesses. I would also recommend that attorneys and doctors alike who are interested in being more compassionate caretakers of their clients and patients read this book. And, in a dream world, every insurance claims adjuster would read it too before making assumptions tinged with societal bias.
Cassie Springer Ayeni is the President and Founder of Springer Ayeni, A Professional Law Corporation, in Oakland, CA, where she focuses on ERISA disability and life insurance cases. She can be reached atcassie@benefitslaw.com or www.benefitslaw.com
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