Healthcare workers have responsibilities to the general public to get everyone safe and healthy while in their care. However, medical professionals are not exempt from suffering from a temporary or permanent disability. One of the most brutal truths for any healthcare worker is coping with being unable to work in the profession they have spent years building. Long-term disability benefits (LTD) are available to healthcare workers and will help make the transition easier financially. For more information, please contact a long-term disability lawyer.
How to purchase long-term disability
Long-term disability benefits are available through an employer’s group policy, or you can purchase them directly in an individual policy. Doctors and physicians will typically have both policies, but other healthcare workers may only have access to one: the group policy.
The best way to determine which policy and benefits you can access is to ask your employer. If there is a benefits department or human resources, they can guide you on your benefits and obtain a copy of your benefit plan.
You will need to look into your records and request those documents independently for individual policies. There are times medical professionals purchase individual policies that include long-term disability. Review all of your plans and documents to determine what you have available to you. Even if you do not think you will need to use the benefits, you should know if they exist and what your benefits are under the policies.
Always read and understand what is in your policy because it will dictate the disability benefits you will have when the unthinkable happens. You must know many definitions, deadlines, and limitations within policies. While you do not expect that you will need to use the benefits, it is essential to know what is available to you.
As your career advances, you can be under additional stress and strain and may need to upgrade your policy limits. Even if you never need to use these benefits, you know they are available and should cover your needs.
You need to be aware of various definitions under any insurance policy. When it comes to LTD, the first definition you need to make a note of is what disability is. You will need to meet the guidelines for this definition to be eligible for these benefits. Within the description, you will know how much impairment you must meet and what evidence you will need to provide for the impairment.
You can also determine the level of protection that your policy will provide based on the definition. When you file an LTD claim, you will need to provide evidence to the policy issuer, such as medical records, physician reports, and statements from witnesses such as family, coworkers, and friends.
Medical professionals will have additional definitions to be aware of, including own occupation and any occupation. Own occupation relates to your ability to perform the material duties of your employment on a physical and cognitive level. Under the definition, your job duties will be compared to the national economy and not under your specific employer.
Any occupation relates to your ability to perform duties of any occupation. If you can complete job duties in a different field that allows you to earn between 60 and 80 percent, it will impact your disability claim. When you can work in another field, disability claims can be challenging. The more specialized your area is, the harder it can be for you to change direction and work in a different role.
Potential issues when filing as a physician
Medical specialties will impact determining own occupation in disability claims. Primary care physicians must do a lot of lifting, bending, sense of touch, and finger manipulation to provide an accurate evaluation. Within the profession, these physicians provide general wellness and preventative treatment. They will also help with chronic conditions and are the first contact when a patient has a new condition. They will also refer patients to other specialists and provide referrals.
Emergency room physicians have different responsibilities in each shift because they face many unknown factors. Among their duties are examining, triaging, and evaluating patients. They also order diagnostic tests and administer medications.
Depending on the circumstance, ER physicians must set broken bones, suture and staple wounds, and provide CPR. These professionals hold various patients’ lives in their hands and must perform their jobs effectively. The fast-paced and traumatic environment and long, irregular hours can heavily affect their work performance and life.
Radiologists focus on providing imaging services to patients, such as MRIs, ultrasounds, and CT scans. Within this profession, there is no medical care given to patients. They will, however, be on their feet and can experience exposure to different radio waves. There are procedures to prevent exposure, but it can still happen. In general, radiologists will need to pay attention to detail and have problem-solving skills.
Orthopedic surgeons treat patients with medical conditions with their tendons, ligaments, muscles, joints, bones, and nerves. As the name suggests, orthopedic surgeons complete surgeries. There are specialties within the field as well. The use of arms, hands, and fingers is prominent, as is standing for extended periods. You will need problem-solving skills, concentration and focus. Irregular hours are typical.
Anesthesiologists administer medication to patients before, during, or after surgery and other procedures. Additionally, they will need to review the patient’s medical history and monitor them throughout the procedure. Anesthesiologists will work long hours and are often in uncomfortable positions during surgeries to monitor patients. They must think critically and pay close attention to the patient.
OB/GYNs are responsible for reproductive care for men and women. They focus on pregnancy and will be with a woman from beginning to end. They will order ultrasounds, blood tests, and basic physical exams. They also deliver babies from viable pregnancies. The profession requires standing for long periods and staying in very awkward positions when delivering a baby. Since childbirth is unpredictable, hours are very irregular.
While these are only a few professional examples, it shows that while all of these professions are very different, they are physically and mentally demanding. Even a minor medical condition can heavily impact a medical professional’s ability to perform their job duties. If a person suffers a disability, it is a substantial loss to the patient. Suppose a medical condition requires a physician to only work in a sedentary position. In that case, they may need to leave their role because that is not a reasonable accommodation for their work.
Medical specialties can influence benefits, because while a medical condition can disable one physician, a physician in a different specialty with the same condition may continue to work. An emergency room physician is under extensive stress, and if they have a condition that requires them to reduce stress, they will need to change professions. Conversely, the same stress condition may not affect a physician who work in a less stressful environment.
For long-term disability, it is essential to look at your job roles and how a medical condition will affect it. If your medical condition does not allow you to perform your duties as you did, you may qualify for LTD. Consideration for medical specialties will go a long way. Still, it will not be the only factor in whether you can get disability benefits for your condition.
You may need to provide further evidence that your condition is genuinely debilitating for your role. Identifying a condition and getting proper treatment are also vital because physicians have other people’s lives in their hands. When a condition places others in danger, it is essential to stop working and get long-term disability benefits.
There are several reasons you can suffer a claim denial for LTD, some more common than others. The first and most common is failing to understand the definition of disability under your policy. While there is own occupation and any occupation coverage, the insurance company will be very adamant about these definitions and where your claim falls.
Another reason you may face a claim denial is that you exclude some of your disabling medical conditions. While the insurance company does not need you to disclose every medical symptom, you must disclose conditions that affect your ability to work and earn income. The severity of your medical condition in your life will impact your long-term disability claim.
Medical professionals better understand the medical field and conditions but do not always use the best language when describing a situation to the insurance company. While you must be honest, you should not exaggerate your condition. You cannot use definitive language like “never” because the insurance company will find that you complete these tasks. Instead, you should say it is challenging. If you cannot lift, you should say how much instead of you cannot lift anything.
Medical professionals are often the most challenging patients. Since you have more knowledge than others, you try to use it when seeing a doctor. During all doctor’s appointments, you must maintain open communication so that your medical records accurately reflect how your condition is progressing. You should also reiterate the condition during every visit. Documenting the condition once is insufficient. You will need to tell your doctor all of the restrictions and changes you suffer during each visit, even if you see them weekly.
Relying on the insurance company is a mistake. They are not looking for evidence that will help your claim but instead that will hurt it. The insurance company will request medical records on your behalf, but that does not mean you will have access to them. Additionally, there is other evidence you will need for a claim that the insurance company may not want to request. Knowing what evidence you will need is complex, and you should consult with a long-term disability attorney to determine what you will need for your claim.
Deadlines are the essential elements of an LTD claim. The insurance company will request various documents during the process, and you cannot ignore these requests. When the insurance company sends you documents to fill out, they will also have a specific deadline. If you fail to meet the insurance deadline, you will have a claim denial. Claim denials often happen when there is a missed submission deadline or inaccurate information.
Nurses, doctors, and others are in the profession of helping people get better, but when it comes to helping themselves, the tides change. Many people will put off filing a claim because they believe the condition will get better or they can learn to live with it. However, if you push off filing, you can miss critical deadlines, which results in complete claim denial.
A positive outlook on life and your medical condition are excellent because that will help with healing. However, you must also be very realistic about the condition and follow the advice of other medical professionals. Facing a disability and the possibility that you can no longer work is daunting, especially in the medical field, but it can be an indisputable fact. If you are unsure of your options as a nurse practitioner, physician, nurse anesthesiologist, or physician assistant, you must speak with an LTD lawyer near you.
What if an LTD claim gets denied?
If you face an LTD claim denial, you have options. You can appeal the insurance company’s decision with the help of an LTD attorney. You do not have much time to appeal, so you must move quickly.
Contact an Experienced LTD Lawyer Today
Contact a trusted law firm for a free case evaluation to learn more about how an attorney can help you. When you are in for a long fight, you need an experienced long-term disability attorney to spearhead your counterattack.
You need legal help from the beginning of the process or immediately after learning of a denial.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts