HomeLearnFirst, Do No Insurance Harm

The majority of new physicians entering practice today still take some form of the original Hippocratic Oath – a body of ethical guidelines originated in the time of Hippocrates that prescribe a physician’s actions and interactions with patients. While not strictly part of that oath, an associated guiding principle widely espoused by doctors is the notion of “first do no harm.”

As insurance professionals serving physicians, we also strive to act in our client’s best interest. So the question is, are our insurance solutions causing harm to physician clients – even unknowingly? In the case of many physician group disability policies, the unfortunate truth is yes, we are harming doctors. There are roughly 10 provisions routinely found in traditional group LTD contracts that are harmful to doctors at claim time.

The irony is that these provisions are completely appropriate for the non-physician client. But because of the highly specialized nature of their profession, doctors can be significantly harmed by the inclusion of common “managed disability” provisions. Because many proposals omit details on these provisions, you may unknowingly go against this foundational principle of medical and insurance ethics.

For example, many traditional LTD policies include a mandatory rehab provision that requires a doctor to participate in the carrier’s stipulated rehabilitation program in order to continue receiving benefits. However, some doctors may have access to resources or knowledge that would be better alternatives for their rehabilitation than what is being offered, and would prefer to opt out without affecting their benefits. Also, some carriers say their programs are optional, and the doctor can opt-in if they wish. What they don’t disclose, though, is that once you have opted in, the program is mandatory, meaning that once you start the rehabilitation, if you don’t finish it, your benefits will terminate.

Here are the 10 provisions that should NEVER be included in a physician LTD contract:

  1. Mandatory rehab and opt-out requirement
  2. Part-time work requirement
  3. “Maximum capacity” reductions
  4. 40 hour work week limitation
  5. “Recommended treatment” requirement
  6. Self-reported symptom limitations
  7. Inadequate accommodation of compensation
  8. Restrictions on international travel or residency
  9. Non-specific definition of occupation and duties
  10. Lifetime aggregate M&N limits

Carefully read your group LTD contracts and ask for details in proposals for these provisions and make sure that you “Do No Harm” to your physician clients. With our exclusive focus on the physician market, MGIS and Sun Life have carefully crafted a specialized physician group LTD contract that acts as an IDI supplement and specifically excludes all of these harmful provisions. Over the years we’ve seen provisions that both harm and help doctors, and have adjusted our contract appropriately.

First, do no insurance harm. With MGIS/Sun Life, you can check off this ethical standard and focus on adding value. Contact us for more information on these provisions, and to explore the “must have” features for doctors that are also typically excluded from traditional group LTD contracts.

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 93P-LH, 07P-LH-PT/07C-LH-PT, 12-STDPort-C-01, 12-GP-01, and 12-DI-C-01. In New York, group life and disability insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Windsor, CT) under Policy Form Series 13-GP-LH-01, 13-LTD-C-01-MGIS, 13-STD-C-01-MGIS, 13-ADD-C-01-MGIS, 13-GP-LF-01, 13-LF-C-01-MGIS, 12-GPPort-01, 13-LFPort-C-01, 13-ADDPort-C-01 and 12-STDPort-C-01.

The disability policies provide disability income insurance only. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Insurance Department.

Administration for physician products is provided by Medical Group Insurance Services, Inc. (MGIS), in all states, except as follows: in CA by MGIS Insurance Agency, Inc.; in NY by MGIS Insurance Agency. Product offerings may not be available in all states and may vary depending on state laws and regulations.

Producer use only.

© 2015 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

GGEL-PHY-490 SLPC 26841 11/15 (exp. 6/16)