Emergency Medicine Physicians Disability Insurance Claims

The disability insurance law practice of Frankel & Newfield represents emergency medicine doctors with long term disability insurance claims. Before the COVID-19 pandemic, emergency medicine doctors were considered to be a higher risk to insure because of the intense nature of emergency medicine and the potentially dangerous scenarios that occur in emergency departments.

The onset of coronavirus has made emergency medicine even more dangerous. Frankel & Newfield anticipates that there will be an increase in disability claims made by emergency medical doctors and related health care workers, including nurse practitioners, nurses and others whose practice is centered in the Emergency Department.

Emergency Medicine Physicians should have “own-occupation” disability provisions in their disability insurance policies.

With an own-occupation disability insurance policy, the doctor who cannot practice in the ER may be able work in a different setting and receive disability benefits for the difference between the highly-compensated EM doctor and a doctor in a private practice or clinic with a lower salary.

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Emergency medicine physicians also need to have disability policies with good residual benefits provisions so a physician who can no longer practice all of the duties of an EM doctor full time, but could work in the same capacity on a part time basis, could work part-time and receive residual disability benefits in proportion to their lost earning power.

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What can the emergency medical physician expect in disability benefits?

Disability insurance is income insurance. The emergency medical doctor who earns $300,000 and more buys long-term disability insurance coverage to protect their income, lifestyle and family. The goal is to have enough coverage to replace income if they are unable to practice emergency medicine because of an injury or illness. The high income is an attractive target for insurance companies, as doctors can afford to pay the premiums.

Why types of disability insurance does the emergency medical physician need?

EM doctors purchase disability insurance policies of various times throughout the stages of their medical careers. When starting a residency, they usually buy a disability insurance policy through a medical association, understanding that they are embarking on a physically and mentally stressful time.

When the emergency medicine physician becomes associated with a hospital or part of a medical center, they receive a disability policy from the hospital. This is part of the employee benefits package and as such, is called an ERISA disability policy, one governed by a federal law protecting disability policies and other employee benefits.

At some point in the ER doctor’s career, they purchase a private disability insurance policy. The ER physician is typically targeted by disability insurance companies in the same way that other doctors or high income professionals are: they can afford to pay for good coverage and statistically speaking are likely to keep working well into their sixties or longer.

The ER doctor today faces many more challenges than other medical specialties, and this makes their disability claims equally challenging:

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Emergency Departments in the Age of COVID-19

The stress and pace of the emergency department skyrocketed when the coronavirus pandemic arrived in America. ER doctors, nurses, nurse practitioners and others in the hospital were overwhelmed, and many suffered PTSD, while others contracted the virus and became patients themselves.

As of this writing, the pandemic continues to take its toll on patients and health care providers. Emergency medical physicians are on the front lines, battling to save lives.

Disability Insurance Claims and the Emergency Department Physician

Emergency medicine doctors considering filing a claim in the months before the pandemic find themselves in a no-win situation. They are reluctant to leave their colleagues to face the overwhelming task of caring for COVID-19 patients, but their disability puts them at risk or makes it difficult for them to perform the tasks of their positions at full speed.

Doctors who are considering filing a claim as a direct result of the coronavirus are in an equally fraught position. If they have had coronavirus and it has left them with respiratory, pulmonary or other complications, they have no choice but to file a long term disability insurance claim. Denials and delays by insurance companies that are inundated by a high volume of claims are entirely possible.

Physicians with underlying conditions who had to stop practicing emergency medicine because of the risk of exposure to coronavirus face a different set of challenges. Will the disability insurance company pay their claim?

COVID-19 Claims for Emergency Room Physicians are a new area for the disability insurance companies. As we know from the past, it sometimes take a little while for the disability claims managers to determine a series of paths to denials. Over time, we are confident that these claims will be funneled through a certain series of “If this, then that” decision trees that we believe are used to determine what claims are paid, which are delayed and which are denied.

What you need to know about filing a disability insurance claim if you are an ER Physician

Most people who purchase a disability policy from an insurance agent or broker will start by contacting the broker to let them know they are filing a claim and need to obtain paperwork. The broker in turn will notify the disability insurance company.

The disability insurance policy that is provided as part of employee benefits will likely have an online claims process through the insurance company’s website. This is where many claims go bad. The forms online are not like the forms prepared for a health insurance or homeowner’s insurance claim. They are complex, require a great deal of detail and become part of a claim file. In ERISA matters, the claim file contains the information that an administrative judge may consider if and when the denial or termination of a claim is being appealed. Every piece of information the ER Physician provides becomes part of what is essentially evidence against their claim.

The association disability policy will most likely also require going through the insurance company’s website.

The ER Physician is advised to work with an experienced disability insurance attorney to protect their claim. The high income level of ER doctors presents an expensive problem for the insurance companies. It also does not cost anything for a disability insurance company to deny or delay a claim: there are no damages for lost income, penalties for being unable to pay a mortgage, etc., suffered by the claimant.

How can you protect yourself when filing a disability insurance claim?

Each claim, for the association policy, the private policy and the ERISA claim, will need to be prepared and submitted separately. Be prepared for an avalanche of paperwork, medical records and reports. Each insurance company has its own methods for filing a claim.

Frankel & Newfield works with clients to prepare their claim before it is submitted. We have seen over time how obstacles presented by the disability insurance company become insurmountable without the help of an experienced disability insurance attorney.

Call our office today at 877-583-2524 to learn how Frankel & Newfield can help at any stage of the disability claims process. Let our experience protect you, your income and your family.

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications