HomeLearnPhysician Group LTD – Own Specialty/Sub-Specialty: A Definition that matters

 The most important question you can ask about your Physician Group LTD policy is this: “Does it protect the income I make in my current specialty/sub-specialty, or merely as a generic physician?” The definition of disability is the key to unlocking the benefits of a specialized Physician Group LTD policy.

DEFINING DISABILITY

Consider this actual scenario. An Emergency Room physician was disabled with diabetic neuropathy and arthritis. Her LTD carrier’s broad definition of disability, called Own Occupation, meant that although she could not perform her specialty, she could still perform as a physician in general and thus could be denied disability status. Because she could not stand for extended periods in the Emergency Room, the carrier determined she was unable to perform all of the material duties of her specialty, and paid the claim for the first two years. After two years, however, the claim was terminated because the LTD carrier determined the she could perform as a physician in general.

For many physicians who specialize in a given field of medicine, this disability train wreck— for lack of a better phrase—is a likely and unfortunate scenario. Most physicians assume their occupation is exactly what have been trained for, certified in, and perform every day. But how a physician group LTD policy defines occupation is at the very heart of a disability policy, and if the language does not specify that your occupation is your sub-specialty, then it is almost certain you will not be fully covered in your sub-specialty. In the real-world scenario described above, only a policy that offers an Own Specialty/Sub-Specialty definition of disability would consider this ER physician to be totally disabled, and would not require her to return to work in a different capacity.

YOUR PHYSICIAN GROUP LTD POLICY SHOULD BE SPECIFIC … VERY SPECIFIC

If you are a specialist, your LTD policy needs to define your occupation – the specific duties that you perform every day — as Own Specialty/Sub- Specialty. Many policies define occupation as Medical Doctor, meaning the LTD carrier can force a physician back to work in a different capacity as some type of medical practitioner. At a minimum, your policy should factor in the specific duties being performed by a physician over the 12 months prior to disability, and use these duties as part of the determination of a claimant’s material and substantial duties.

WATCH YOUR STEP: THREE THINGS TO AVOID

1. Some LTD carriers recognize few specialties or sub-specialties. Be cautious if your LTD carrier has an Own Occupation definition and uses the Department of Labor’s Dictionary of Occupational Titles (DOT) list of occupations. Although the DOT covers virtually every occupation in the U.S. economy, it lists fewer than 10% of the recog- nized medical specialties and subspecialties. If your specialty is listed, consider yourself lucky.

2. Some LTD carriers require Board Certification and specialty-specific income. Although your LTD carrier may have an Own Specialty definition, it may require Board Certification and may also require that more than 50% of your income comes from that specialty within the past two years. This definition is problematic for newer, not-yet-certified physicians.

3. Some LTD carriers do not recognize sub-specialties. Even though an LTD carrier may have an Own Specialty definition, it may not recognize sub-specialties. Such a limited definition is prob- lematic for physicians whose sub-specialty requires certain skills different from those need- ed in that specialty. For instance, consider inter- ventional radiology, which is a medical sub-spe- cialty of radiology that uses minimally invasive image-guided procedures to diagnose and treat diseases in nearly every organ system. Radiology, on the other hand, is a medical specialty that uses imaging to diagnose and treat disease seen within the body. A sub-specialty definition protects the interventional radiologist in the event of a disability, even though he or she may be able to perform the duties of a radiologist.

THE RIGHT STUFF

It seems right to consider what a physician has been doing when determining disability status, not what that physician might be able to do. How a physician group LTD policy defines your occupation is crucial to receiving any disability benefit at all.

 

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Group disability insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York under policy form 93P-LH. 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 13-GP-LH-01 and 13-LTD-C-01. 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 avail- able in all states and may vary depending on state laws and regulations. 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-4902SLPC 26313 12/14 (exp. 12/15)

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