Physicians Disability Insurance Claim Attorneys

In the past, doctors, surgeons, orthopedists, and other medical specialists were targeted by insurance companies as perfect candidates for long term disability insurance policies. Their earnings were high, so they could afford costly private disability insurance. They tended to work late in life and relatively few filed claims. The number-crunchers at insurance companies looked at doctors and saw profits.

Disability insurance policies sold to physicians from the 1970s to around the 1990s were also generous. When claims were filed, the physician could be fairly confident of receiving benefits, with few or no challenges. But the landscape has changed.

Many years of low interest rates, turbulent markets and an increase in claims has created a corporate culture of disability claim denials. The insurance companies themselves went from big to massive, buying other insurance companies and expanding into subsidiary businesses whose sole focus is reviewing claims. 

What does this mean for the doctor with a disability claim?

Expect your claim to be challenged. The disability insurance company may ask for additional medical or financial information (which it may not have a right to request or receive). There may be requests for you to attend an IME – Independent Medical Examination – or an FCE – Functional Capacity Examination. You may also receive a letter stating that your disability does not qualify for coverage under your policy or that you are not deemed to be disabled based on the records received.

An anesthesiologist working at one of the top 25 ranked hospitals in New York State was diagnosed with disseminated shingles which resulted in severe postherpetic neuralgia, chronic pain, complex regional pain syndrome, and numerous orthopedic conditions. Her treating physician advised that she only work on a part-time basis to avoid exacerbating her condition. After paying residual benefits on a private policy with Lincoln, her claim was terminated. Jason Newfield aggressively attacked the termination and her claim was reinstated, with her monthly benefit paid in arrears. She continues to receive benefits.

What kind of disability insurance do most physicians own?

Upon graduation, most physicians purchase long term disability insurance policies through a medical association and during the course of their careers, purchase private or individual policies to supplement the association policies. Most physicians today are employees of large medical groups or hospital systems and receive disability coverage through their employers, known as group policies (ERISA). Today’s seasoned physician usually owns multiple policies, including the association, private and group policies. Newer physicians are more likely to own association policy and group policies. They may or may not have purchased a private or individual policy.

How have changes in the medical field impacted disability claims? 

Senior doctors, similar to business owners, have complex disability claims that often overlap with practice ownership  and licensing issues, residual claims, and other complicated fact patterns.  The physical and mental challenges of practicing medicine in a post-COVID world placed unprecedented pressure on physicians. We hear from doctors who have been shifted from their own specialty area to working in the ER, being confronted with an overwhelming number of patients, repeated patient deaths and critical care scenarios. Many doctors having weathered the pandemic are now suffering from PTSD and are not sure if they qualify for disability insurance coverage. 

If you are considering filing for disability insurance benefits, we invite you to call our office and discuss your situation. Call us at (877) 406-7883 to learn what your options are in making a claim.

What type of physicians has the Newfield Group represented?

Jason Newfield has represented many different physicians, including general practitioners, internists, surgeons, emergency room doctors, anesthesiologists, radiologists, obstetricians, gynecologists, orthopedists, oncologists, and other all treating physicians in the medical profession. 

Can the insurance company dictate my care and treatment?

We often hear from physicians who are stunned to have an insurance company representative tell them benefits will not be paid unless they undergo certain treatments, including surgery. The insurance company takes the position that the physician is not pursuing the “appropriate care and treatment.” This is unsettling for a layperson, but outrageous to a physician, who has a better grasp of their medical condition.

If it feels wrong to have an insurance company making medical decisions for a physician, that’s because it is. We have represented numerous doctors, including surgeons, and dentists with carpal tunnel syndrome who have been told their appropriate care and treatment is surgery. Carpal tunnel surgery is not always successful and can result in a patient with less dexterity and more pain than before. It is not always the best solution for CTS.

Mandating any type of care or treatment, including surgery, is extreme and contrary to two important but often overlooked insurance concepts – acting in good faith with the insured’s interest being put first and fair treatment, meaning conforming to the terms of the insurance policy without twisting provisions to deny claims. 

Why Do Disability Insurance Companies Deny Physician Claims Frequently?

This is a simple answer: profits. Physicians purchase disability insurance because they are cognizant of protecting high salaries. Protecting their six and seven-figure incomes is the entire reason to invest in a privately owned LTD policy. But when the promised monthly claim is reviewed by a claims adjuster, it’s red flagged based on the size of the benefit. This is true whether the claim is for a private disability insurance policy or a group or ERISA policy.

A Complex Case Resolved For A Physician 

A doctor was diagnosed with Chronic Lyme disease, which damaged his nervous system and made it impossible for him to continue to practice. Jason Newfield helped him navigate the maze of short term disability and long term disability claims. Among the issues were the relationship between his multiple policies, ERISA with his employer and one individual (or private) policy. The group or ERISA policy insurance company had objected to giving the doctor the full monthly amount, saying he had not followed certain procedures. We worked to navigate all of the issues, countering each and every one. The doctor began receiving benefits from both policies.

What about Own Occupation Disability Policies? 

Most physicians purchased an “own occupation” policy, a disability insurance policy that insures their ability to practice their occupation. If the claimant is not able to perform the material and substantial duties of their occupation, they are eligible to file a claim for disability benefits. A true own occupation policy pays benefits if the claimant can’t perform in their occupation, but there are always ways the insurance companies use the policies to deny claims. 

One of the strategies we see frequently is the insurance company attempting to prove the physician is not actually performing their specific duties at the time of their claim. If a surgeon is reviewing and consulting on cases as well as performing surgery, the disability insurance company will try to deny the claim, maintaining the doctor is able to review and consult and their disability insurance policy is covering only their occupation as an active surgeon.

We have represented physicians in cases where they have been able to receive either residual (partial) or full benefits while working in a more managerial or consulting aspect of the practice.

The difficult situations presented for physicians makes it critical to speak with an experienced long term disability insurance attorney to guide them through the complexities of disability insurance.  To learn more, call us at (877) 406-7883. Jason Newfield will discuss your unique situation and explore your options.