HomeLearn10 Things a Disabled Doctor Doesn’t Want to Hear

Submitted Courtesy of Keith Mangrum
MGIS Regional Vice President

You may have purchased individual disability insurance early in your career and, like many other physicians, you may have added Group Long Term Disability (LTD) insurance to supplement this income protection. But not all LTD policies are alike. Here are 10 things you don’t want to hear at claim time from a Group LTD claims examiner:

1)       Your policy defines your occupation merely as “medical doctor.” Find out if your LTD policy defines your occupation only as MD — or is limited to just a few specialties — instead of the comprehensive list of specialties/sub-specialties  recognized by the American Board of Medical Specialties (ABMS).

2)      Your material and substantial duties are not the specific procedures you were performing. If you perform cutting-edge or experimental procedures, or your specialty is not yet recognized by the ABMS, then you may have difficulty qualifying as disabled.

3)    We think you can be retrained as some other type of medical doctor. If you refuse, we can reduce — or even terminate — your benefit. Find out if rehabilitation or retraining is mandatory with your policy.

4)      If we can find some type of job you can perform, whether in the field of medicine or not, we may not consider you to be disabled. If this job is within a 50 mile radius of your practice, and it could provide at least 80% of your previous income, you may not meet the policy’s income loss qualification.

5)      If you can work at least 40 hours per week, regardless of how many hours you worked previously, you may not qualify for a benefit. Your ability to work the number of hours you had been working may not be protected.

6)      If you can perform some of your duties, or work part-time, then you must do so. Otherwise, we may reduce or terminate your benefit. Some physicians may attempt to work part-time while disabled, but no doctor wants to be forced by the insurance carrier to do so.

7)      We think you could work more hours than you are — and your benefit will be based on how much you could be earning. This “maximum capacity” provision places a very subjective determination in the hands of claims examiners.

8)      If you move outside the U.S. or Canada, we may terminate your benefit. Foreign-born physicians who become disabled may want to return to their home countries. Other disabled physicians may want to retire in other countries. Benefits could be terminated if a disabled physician leaves the U.S.

9)      If you are disabled and working, your monthly benefit may be reduced to only $50. Most LTD policies pay a generous benefit for the first 12 months of partial disability, but differ significantly thereafter. A common formula found in some policies can reduce the monthly benefit to only $50-$100.

10)   If you are a disabled partner receiving K-1 income, you may receive a reduced disability benefit … or none at all. If your LTD policy compares all the income you receive while disabled to your pre-disability income, you may lack the required loss of income. And, in some policies, K-1 income reduces the monthly benefit dollar for dollar.

Ask a Group LTD expert to help you understand how LTD policy provisions can affect you at claim time. Purchase LTD based on policy language that protects you instead of on price alone — the difference at claim time can be dramatic!

Leave a Reply

Your email address will not be published. Required fields are marked *

3 − two =