Surgeon Long Term Disability Insurance Claims

The disability insurance law practice of Frankel & Newfield represents surgeons in all specialty areas, including Neurosurgeons and surgeons in these and many other specialty areas: Orthopedic, Cardiovascular, Thoracic, Pediatric, Craniofacial, Dermatologic, Vascular and Head and Neck, to name a few.

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Being a surgeon is a demanding occupation and the pressure is both physical and mental. Over time, this can lead to disabling conditions, including chronic pain conditions and degenerative orthopedic injuries. There is an emotional toll that occurs as well, as the surgeon’s daily tasks include making life and death decisions, often in a short window of time. It is not easy to be a surgeon.

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Disability insurance companies have always targeted surgeons, selling individual, association and group policy policies to doctors at various stages of their careers. The reason for disability insurance makes sense to the surgeon, who seeks to protect their income. But when the surgeon needs to make a claim for disability insurance benefits, the unexpected response to their request is usually a surprise.

High Benefits Attract Long-Term Disability Claim Adjuster’s Attention

There are a number of issues the surgeon needs to be aware of when pursuing a long-term disability insurance claim:

Large Monthly Benefit = Red Flag. Insurance adjusters seek to minimize financial exposure, so the larger the claim, or the longer the time period that it might be paid, the bigger the red flag. For an individual earning in excess of $500,000, the cost to the insurance company over time will be significant. There is no downside for the insurance company to delay or deny the claim, so there is no incentive to move the process along. Any high income earner can expect push back - - especially surgeons.

Own Occupation Specialty-Specific Disability Insurance vs. Any Occupation. Here is where your insurance broker earns her keep. A surgeon needs to have their own occupation, specialty-specific disability insurance. This means that the insurance policy is insuring not only your occupation as a surgeon but your occupation as a surgeon in your specialty.

If you are a neurosurgeon with a hand injury, you won’t be able to perform complex and delicate surgery. But if your long-term disability insurance policy does not include the specialty-specific provision, you could be told that even if you can’t do neurosurgery, you can perform general surgery and therefore are not fully disabled.

We would advise any surgeon reading this page to locate their long-term disability insurance policy and read the provisions regarding own/any occupation. If you have questions, please feel free to call our office to discuss your policy. It’s better to understand what is covered and what is not before you need to file a claim. We can be reached at 877-583-2524.

Residual v. Total Disability Claims

Another question to be answered concerns the residual and total disability provisions of your disability insurance contract. If you were encouraged to take a lesser policy to minimize the expense of your premiums, it is possible that you purchased a policy without residual policy riders. We’ll hope you did not.

A residual disability describes a partial disability that leaves you unable to perform the totality of your prior practice, but with the ability to perform in some meaningful capacity. The disability insurance will make up the cost between your pre-injury salary and what you are able to earn with a disability. For some surgeons, this is an ideal situation: they can continue to practice to some degree, but are not compelled to maintain a full surgical schedule.

Orthopedic Surgeon Who Can No Longer Operate Entitled to Residual Benefits

When our client could no longer perform surgery, he continued to manage and perform as an administrator in the office. We reviewed his policy and determined that he was entitled to residual benefits for a period of time prior to the time of total disability. We advised him on how to file for the residual claim for the earlier time period, and helped him secure significant additional benefits. He did not need us to pursue the claim aggressively, but we were ready if the need arose.

Not Every Surgeon is Able to Work, Even on a Limited Basis. That’s Why You Need Representation.

Frankel & Newfield has represented surgeons who wished to continue to practice, in a lesser capacity, but found that they were not able to do so.

There are tactics we see on a fairly regular basis – underpayment, reclassifying a specialty surgical practice as a generalist, applying a narrow definition of total disability, or trying to limit the months or years that the disability payments are made.

Whether or not your disability claim succeeds depends to a large extent on how your first claim is prepared. The long-term disability claim is nothing like a claim for health insurance or homeowner’s insurance. This is where many claimants lose their way.

Every piece of information provided in your claim forms is potential minefields. The date of your disability determines when the window of exclusion begins. What tasks did you perform after that date? Any records that indicate that you performed surgery or anything that shows that you were engaged in any recreational activities that would have been contraindicated by your disability will be sought. That includes social media posts.

Your treating physician’s notes will become part of the claim file, another point in the disability claim process where claims are denied. The material tasks and duties of being a surgeon and your inability to perform those tasks are what make you disabled – not a diagnosis.

Is your treating physician the right doctor for your disability? It is challenging to defend an orthopedic condition, for example, if the treating physician is not an orthopedist. We have seen claims where high esteemed specialists have had their credentials challenged, even as the insurance company doctors have no knowledge whatsoever of the claimant’s condition.

These are the kinds of insights that we have gained through our years of experience representing surgeons, physicians and other high income claimants. We understand the challenges of being a highly-skilled surgeon and how disability impacts the family and its finances, as well as how to fight back against the disability insurance company. We are effective in appeals, negotiations and when necessary, litigation.

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney