Dabdoub Law Firm, Disability Insurance & ERISA Attorneys have significant experience representing doctors and dentists who have a claim for total disability insurance benefits with their insurance company.
Many doctors have individual disability insurance that is known as an “own occupation” disability policy. This type of disability policy protects your income if you become disabled from practicing in your specific field. Own occupation disability policies allow you to be paid total disability benefits even if you work in another occupation.
Insurance companies use several tactics, however, to avoid approving total disability benefits. One method is to delay approving the disability claim by constantly requesting information. Another common tactic is to approve residual or partial disability benefits only. The insurance company may seek to deny total disability because you continue to work, although in a different capacity than before you became sick or injured.
Why are Physician Disability Claims Denied?
Long-term disability insurance companies do not like seeing claims filed by anyone in an occupation that provides a significant salary. On average, a physician earns at least $100,000 a year, but many can earn three or four times that amount. Insurance companies know as much, and this is why they often give physicians a difficult time when they try to file a claim for disability benefits that would replace a portion of their wages, up to a cap.
One of the favorite tactics among disability insurance companies that handle physician disability claims is to say that the physician can still perform their job duties despite their disabilities. The insurer will try to argue that the physician claimant can continue seeing, diagnosing, and treating patients from a sedentary position, so it should be expected of them to do the vast majority of their work-related duties.
To counteract insurance company tactics to deny a disability claim, a physician should always:
- Keep thorough medical records: As a skilled physician, you undoubtedly know the importance of keeping thorough medical records for your patients. You need to use that same skillset when keeping track of your own health and disabilities. Insurers will have a more difficult time contesting your disability claim if you can back it up with a clearly explained record that shows both your disability and how it is impacting your day-to-day work.
- Use CPT codes: CPT codes act as shorthand to make creating, tracking, and entering a medical bill faster and easier for hospitals that see hundreds or thousands of patients a day. Many small medical offices or clinics do not use CPT codes when itemizing a patient’s bills, though, because there is not the same demand or time crunch. Unfortunately, disability insurance companies like to misconstrue a lack of CPT code usage as evidence that the physician was not performing the medical services that they claim they do on a regular basis.
- Know new patients: Insurance companies will make some surprising decisions to try to deny a physician’s disability claim, including sending an insurance investigator to the physician’s clinic under the guise of being a new patient. The “undercover” insurance agent will be looking for signs that the physician is not disabled or, at the least, that they are capable of continuing to work like normal. Physicians should always know preliminary information about their patients to know who is actually in their clinics.
The Claim & Investigation Process
Your disability insurance company will request documents and information related to your practice as part of its investigation of your disability claim. It is important to present the disability claim in a way that accurately portrays your occupation from the outset.
We are familiar with the improper claim practices that disability insurance companies use to deny or delay payment of disability benefits. If you have an “own occupation” disability policy, our disability attorneys can help with the application process. If your disability claim was denied or if your disability benefits were terminated, we can appeal that decision for you or file a lawsuit for total disability benefits. We also negotiate lump-sum settlements for people regularly receiving disability benefits.
Call (800) 969-0488 to speak with a disability insurance attorney. We will answer your questions and can give you a free disability case consultation. The firm helps clients nationwide.