The Pandemic and the Increasing Need for Disability Insurance

This article originally appeared in America’s Benefits Specialist Magazine June 2021

Events of the past year have changed the benefits landscape. Many working Americans who have
been impacted, directly or indirectly, by COVID-19 might be rethinking which benefits they truly
need to create a safety net for themselves and their families during a crisis.

Disability insurance is all about preparing for the unexpected and ensuring the policyholder’s ability
to earn an income. Now is an important time to make sure your clients’ income-protecting DI
policies are up to date, especially for those clients who are doctors. The pandemic-related pressure that these professionals have experienced on many levels during the past year has
led to higher levels of burnout.

THE IMPACT OF BURNOUT

All Americans are now eligible to receive the COVID-19 vaccine. But until a majority of Americans are
vaccinated in mid-summer, and until the CDC fully understands how new variants of the virus might
further impact the population, our healthcare community will continue to be at significant risk of
experiencing burnout.

COVID-19 has produced higher-than-normal levels of burnout for doctors, according to a September 2020 study from a group of U.S. and Swedish researchers. The study included 2,707 professionals from more than 60 countries and found that 51.4% of providers from 33 countries were experiencing burnout. Here in the U.S., a 2020 report by the Society of Critical Care Medicine surveyed 9,492 intensive care unit clinicians and found that median levels of self-reported stress increased from 3 to 8 (on a 0 to 10 scale) as the pandemic unfolded.

Research regarding doctor burnout is variable due to a lack of agreed-upon terminology,
according to The American Journal of Medicine. However, it is generally thought that between 40%
and 50% of doctors experience burnout during an average year.3 It is also thought to be most
prevalent among doctors aged 45 to 54—an age of peak income and productivity—and to
regularly transition into major depression, substance abuse and even suicide. In fact, burnout-related
depression appears to be more common for doctors than for other types of
professionals. This statistic has only gotten worse with the pandemic.

EVALUATING DI POLICIES FOR DOCTORS

Burnout can lead to a mental health disorder and/or a substance-abuse problem that can impact a
doctor’s ability to work, so it is important for brokers and advisers to discuss disability insurance
with their clients. If pandemic-related stress leads to severe emotional anguish that disables the
healthcare professional on a short- or long-term basis, will the existing disability insurance policy
provide sufficient income replacement during recovery? Will it provide a benefit payout at all?

Doctors have high income levels, usually comprised of multiple income sources,
and sometimes own practices or manage heavy debt from student loans. Like many other
professionals, their financial solvency relies on their ability to work. Unlike many other
professionals, losing the ability to work affects more than just their capacity to support themselves
and their family: It sometimes affects the solvency of a medical practice or the doctor’s ability to
meet his or her loan-repayment obligations.

Doctors are also unique in that they regularly specialize in a particular area of medicine that is
razor-thin in its definition. Examples include broader specialties like anesthesiology, neurology,
emergency medicine and radiation oncology, and more specific sub-specialties like neuroradiology,
medical toxicology, congenital cardiac surgery and hematology. These professionals need disability
insurance that uses a narrow and specific definition of disability. Under this type of definition, a
claimant’s CPT/ CDT-coded procedures determine disability. If the claimants’ disability prevents
them from performing even one of their regularly performed CPT-coded procedures, they are
considered totally disabled. Individual disability insurance policies and certain IDI-like group long-term
disability policies provide this specificity level.

Beyond this important policy definition, Mental & Nervous and Drug & Alcohol (MNDA) coverage
must be part of the disability insurance conversation – even in non-pandemic years, when burnout
is already high.

Disability policies that doctors can benefit the most from offer:

1. Robust MNDA benefits: Some LTD policies will not cover preexisting conditions like major
   depression or anxiety disorders, and many MNDA disabilities can be recurring in nature.
2. No lifetime max on benefits: Many LTD policies cap MNDA benefits at 24 months, which is
   insufficient for the field of medicine and its higher levels of stress.
3. “Per occurrence” coverage: Policies with this specific language can pay benefits if the doctor
   suffers a relapse or if the disability caused by burnout manifests differently.

Some LTD policies may also require stringent proof of a disability to start paying out on the claim. If
an insurer requires examinations or rigorous interviews to pay on an MNDA-related incident,
doctors can face an undesired compounding of additional stress and pressure.

ARE YOUR CLIENTS FINANCIALLY PREPARED FOR BURNOUT?

COVID-19 has opened many people’s eyes to the importance of coverage for all types of disabilities,
both physical and mental. However, overworked doctors may have neglected to
review their plans to make sure their expectations for policy payouts align with their contracts’
reality.

Questions that will ensure adequate coverage for burnout-related disabilities include:

• Do all of their disability insurance policies offer MNDA coverage?

• Are the coverage amounts high enough to replace all income and cover any business expenses or
student loans?

• Will the policies pay benefits on a relapse under the MNDA provisions? In what timeframe?

• Will the policies cover all possible mental and physical conditions that could be attributed to
burnout and extreme work stress?

• Are there any preexisting condition exclusions that may affect their ability to collect benefits if they
become disabled due to burnout?

Brokers and advisers can earn their clients’ trust by working on grasping the realities of their day-to-day
lives, their unique risks and how much coverage they need. Consider this: The American Journal
of Medicine cites specific concerns about burnout rates for a number of doctors in
certain fields. Their list includes family physicians, emergency-room physicians, psychiatrists,
anesthesiologists, cardiologists, radiologists, general internists, dermatologists, oncologists, general
surgeons, gastroenterologists, trauma surgeons, obstetrician-gynecologists and physiatrists.

Until doctors become more comfortable seeking early treatment without the fear
of stigmas or professional repercussions, and until their workloads decrease to the point where
they can take time to care for themselves, burnout will continue to be a risk factor for disability in
the healthcare industry. Make sure your clients are covered through comprehensive disability plans
tailored to their specific needs.

Jeff Brunken is president of MGIS, a national insurance program manager that builds and manages
specialized disability insurance programs for doctors. He is a member of the Salt
Lake Chamber’s Board of Governors and a graduate of Brigham Young University.