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Brokers’ Critical Role: Health Care Professionals and Disability Insurance

This article originally appeared in benefitspro.com

The new normal for brokers is assisting their clients with benefits that work in our changing world. One priority is helping health care professionals ensure their income protecting disability insurance policies are up to date.

The COVID-19 crisis has taken a toll on people all over the U.S. From elementary schools to pro sports, almost every piece of our society has felt the effects of the virus. But perhaps no one has felt more pandemic-related pressure than health care professionals.

This was tragically displayed when an ER physician in New York committed suicide due to the horrors she experienced while working on the front lines of treating COVID-19. Health care workers are risking their lives to care for their patients. They are also witnessing widespread sickness and suffering while dealing with concerns about having enough PPE and life-saving equipment to do their jobs. With the surge of coronavirus cases the country is experiencing, hospitals are lacking beds, so health care professionals are having to decide which patients to treat from home and which ones to admit.

As a result, these medical workers face trauma, sadness, and fear of what will happen next. Although the COVID-19 vaccine is now available, it may be mid-year before everyone who wants the vaccine is able to get it. We hope a year from now the immediate COVID crisis will be over. But meanwhile, our health care community is at significant risk of experiencing serious burnout.

How, then, can health care professionals ensure that they are healthy enough to do their jobs effectively? Can the pressures of this unprecedented situation cause mental health issues that rise to a disability level? And if COVID-19 related stress leads to an illness or injury serious enough to cause long or short-term disability, will typical disability insurance policies cover this unique situation?

Stress is one of the most common triggers of physical and mental health problems. When considering all the underlying conditions or diseases one might have, stress will invariably make things worse. Stress may exacerbate conditions like:

  • Heart disease
  • Autoimmune diseases
  • Depression and anxiety
  • GI problems
  • OCD
  • Asthma
  • Migraines
  • and more

Because of this, COVID burnout is a real threat to U.S. patients and their families. If a doctor is too sick or stressed to offer the best possible care, then they may be unable to perform their job duties properly because of their condition.

Will disability insurance cover claims based on health care professional burnout?

As one might imagine, it can be challenging to convince an insurance provider that increased job stress is a reason enough to pay out a disability claim. After all, aren’t health care professional careers inherently stressful? Perhaps. But the COVID-19 crisis differs from the workplace stress that health care pros encounter during normal times.

To be most helpful to their health care clients, it’s essential for brokers to understand the mental health problems or stress-induced diagnoses that various disability insurance carriers might cover.

The average disability policy and burnout issues

Many health care professionals understand the importance of having “own occupation“ disability coverage versus “any occupation” coverage. An own occupation policy ensures that a health care worker can collect disability payments in the effect that the worker is unable to work in their usual occupation. However, even with an “own occupation” definition of disability, some carriers may deny a claim if the health care professional can still practice medicine or work within their field in a different or limited capacity.

The ideal solution is for health care professionals to have a disability policy that will pay out in any situation where a health care professional cannot perform their actual specific procedures and duties. They need something beyond own occupation – a more narrow, specific “own procedures” definition of disability that covers them based on the CPT or CDT codes for the procedures they perform. Without this narrow protection, your health care professional clients may be at risk for having their benefits denied or reduced at claim time.

Here’s an example. Imagine that a highly skilled surgeon is experiencing tremors caused by stress from the COVID-19 pandemic. While the surgeon might be able to practice general medicine, they may not be able to perform their usual surgical procedures.

Some income protection policies may also require stringent proof of disability to qualify for disability benefits. If an insurer requires examinations or rigorous interviews to pay on a burnout-related claim, the health care professional faces even more stress and pressure.

Now is the time for brokers to help health care workers make sure their policies are up to date

The COVID-19 crisis provides a good reason for health care professionals to ensure they understand the extent of their disability coverage. Will their coverage kick in as soon as a burnout-related disability affects job performance? Or does the health care professional need to undergo a comprehensive and detailed investigation of their disability? Who approves the disability claim and benefits? If the claim is approved, can the health care professional client/insured decide when they are ready to return to work? Or does the insurer mandate a return-to-work for benefits to continue? These are crucial questions brokers must make sure their health care professional clients or prospective clients understand when they discuss disability coverage with them.

Like everyone, insurance professionals are dealing with uncharted territory right now. That’s why experienced insurance brokers must prepare to help their clients navigate their way through this challenging time. But armed with the right disability insurance options, brokers can help our health care heroes on the front lines enjoy the protection they really need.

Jeff Brunken is president of MGIS, a national insurance program manager partnering with brokers to provide the disability income-replacement and specialty coverages that healthcare professionals expect.

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