OB/GYN Obstetrician/Gynecologist Denied Disability Claims

There are few professions are stressful as OB/GYNs, who work in an extremely challenging area of medicine. They are not emergency room physicians, but pregnancy, labor and delivery often present emergency medical situations when patients and their babies are at risk. Delivering babies never happens on schedule, unless it’s a planned C-section, a major surgical procedure. And middle of the night calls that start at 2 AM and don’t end until the following afternoon are not unusual for the OB/GYN.

In other words, OB/GYN doctors have a high degree of both stress and physicality in their working days (and nights). This often translates to orthopedic disabilities, including neck, shoulder, arm, and hand problems. The emotional responsibility for mothers and their babies is also challenging, which can exacerbate a mental disability or create a stressful situation causing the OB/GYN to be unable to perform their specialty medicine.

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Why would an OB/GYN have their disability claim denied?

The first pushback from an LTD disability insurance claims adjuster will be that an OB/GYN can still work as a gynecologist, even if they aren’t able to deliver babies and/or perform C-section surgery. The doctor will be told they aren’t eligible for benefits, since they can work as either a gynecologist, administrator, or manager in a medical practice. 

OB/GYN is one profession, and often, insurers try to separate the two.  This doesn’t work for the OB/GYN for a few reasons. For one thing, obstetrical patients want to be seen during their pregnancy by the doctor or team of doctors, depending on the practice, who is most likely to deliver them when the time comes.

Another reason this doesn’t work: most OB/GYNs are now part of larger medical practices where professional managers and administrators run the practice. There’s no need for a medical doctor to serve as a manager or a glorified PA.  The OB/GYN didn’t devote so many years of their life and hundreds of thousands of dollars to this intense specialty area to be an office worker or medical assistant. 

And finally, if you purchased an individual or private LTD disability policy, it likely is an “own occupation” disability policy – meaning you have insured your ability to be an OB/GYN.   Often, we have seen “specialty” clauses, which were sold to OB/GYN’s to protect against performing the full array of duties of an OB/GYN.

The insurance company’s goal will be to treat your claim as if you are a generalist, which you are not. The different types of procedures you performed before your disability will be used by the insurance company to attempt to show how you can do other things and still earn the same amount of income, or even simply qualify only for partial disability benefits.

There will be a request for your monthly CPT reports of what types of procedures you performed prior to onset of disability, how many patients you saw and what your schedule looked like before you were disabled.  This is not an outlandish request, but how it is presented to the disability insurance company may have an impact on whether or not your claim is accepted and how benefits are paid. Newfield Law Group has been through this before with OB/GYNs and we are familiar with the strategies used by the LTD company to deny claims or frustrate claimants.   Information must be presented properly to support your claim, not work against it. 

You Can’t Afford to be a “Casual Patient”

Documenting your disability with substantial medical records is critical to the success of your claim. We have seen many instances where doctors in many specialties have what we call “casual medical care.” If this is familiar, you need to address it immediately.

Let’s say you start having severe pains in your hip that are making it difficult to stoop or perform the maneuvering needed to deliver a baby. Your best friend is an orthopedist, so you might stop by their office for a quick consultation. They might recommend you have an MRI or x-ray to check out your hips. So, you go to your friend the radiologist and have a series of images. 

Depending on how friendly you are with your colleagues, they may or may not have opened a chart and started a detailed report on your symptoms, diagnostic tests and recommended plan for care.  The records do not reflect fully upon the issues, and do not support your claim.  One look at scattershot medical records and you can be sure your LTD claim will be denied. When even comprehensive medical reports are denied, something less than 100% will be dismissed immediately. 

Your medical records, including physician’s notes, diagnostic tests, bloodwork, MRIs, and other images, must align with the information the insurance company is looking for to take your claim seriously and compel them to accept claim liability.  

Pretending You’re Not too Sick to Work  

Doctors are known for being the worst patients. They know how the human body works and attempt to keep going, even when every step is painful, or every breath feels like their lungs are going to collapse. We have worked with doctors who have continued to practice in a variety of medical specialties because they didn’t want to recognize that they would have to stop working because of an illness. 

There is also a reluctance to recognize an illness by an OB/GYN because they don’t want to let their patients or colleagues down. When medical specialists like OB/GYNs are in short supply, no one wants to be the one who can’t practice. Patients and their families depend on their OB/GYN in a highly personal way. But someone who is too sick or in too much pain to practice isn’t doing anyone a favor by continuing to work.

Residual Disability  

For many OB/GYNs, a physical or mental disability makes it hard to maintain a full patient load and they wonder if they can work less and file for residual disability.

Residual disability is a valuable benefit if your long term disability insurance policy contains the right provisions. It means you can’t perform one or more of the critical duties of the occupation you have trained for, but you can perform some of them.

Instead of the entire monthly benefit being paid by the LTD insurance company, your disability insurance policy will pay you part of the portion of your income you’re losing because you’re working less hours or removing certain procedures from your practice. Just be careful to have an experienced disability attorney review your policy. Deciding to take residual benefits may have repercussions to your ability to take total disability insurance benefits in the future.

What Should Your Next Step Be?

We invite you to call disability attorney Jason Newfield to discuss your situation and learn how we can help. Jason Newfield has more than two decades of representing people who are not able to perform their occupations and seek to be paid their disability benefits. We have seen your situation before, we know the insurance companies and their strategies, and we can help.

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