Own Procedures Definition of Disability — and Why It Matters
Welcome to the MGIS IncomeProtect Individual Disability Insurance (IDI) series. In this module, we will be discussing Own Procedures protection definition of disability. CPT code-based definitions are a core component of the Individual Disability Insurance (IDI) supplement solution. When a physician submits a disability claim, our benefit consultants who focus solely on physician claims review that doctor's or dentist's actual CPT billing codes for the 12 months prior to disability. This tells us how the disability impedes the individual physician's ability to practice the procedures they have built their practice on. If they cannot perform one or more of these actual procedures, they may be considered disabled and eligible for benefits. There is no income test.
Let's see how this definition compares to other available solutions. The definition of disability should be narrow and specific. A broad and subjective definition leaves the doctor vulnerable to being disqualified from receiving benefits. A typical IDI policy definition of disability is known as true own occupation and is considered the gold standard of definitions. Traditional group LTD definitions are more broad and subjective, ranging from any occupation to one noting specialty or sometimes sub-specialty. But even doctors with the same specialty or sub-specialty have built their practice on very different procedures.
Just consider orthopedics. A surgeon who replaces hips requires very different skills than one who works on hands. A back issue may prevent the hip surgeon from doing his or her procedures but not impede the hand surgeon. So, specialty, sub-specialty is not an IDI-like definition. The IDI supplement definition of disability closely mirrors the IDI definition by specifying a doctor's own procedures based on CPT or CDT procedure codes. This clearly defines what a physician or dentist has been doing for the previous year as the basis for whether they can still perform their own procedures. As you consider additional coverage to supplement your IDI, be sure the policy narrows the definition of disability down to identify your own specific procedures. Thank you for watching the MGIS IncomeProtect series. We hope you enjoyed this episode. Want to learn more? Click on the next video or visit us at mgis.com.