Doctors play a key role in the disability insurance process by documenting (or not) the extent of someone's disability. We explored this at length in an article on treating doctors, noting that even the most well-intentioned doctors can make mistakes in the claims process.
But of course doctors and other medical professionals are people, too, and sometimes they become disabled themselves.
In this post, we will use a Q & A format to address issues that can arise for doctors, nurses and other health care professionals who develop long-term disabling conditions.
Does it matter what kind of insurance you have?
Yes. There is a lot of confusion among the general public about whether you can only collect disability benefits if you are completely disabled and what "total disability" means.
The fact of the matter is that the definition of disability in private or workplace insurance depends on whether the insurance coverage is "own occupation" or "any occupation."
For example, let's say you are an OB/GYN doctor has to stop delivering babies or doing obstetrical surgery because of an orthopedic condition. In this situation, under an "own occupation" policy, you would be considered disabled - even if you could do other things with your medical degree, such as teach at a medical school.
Considering how specialized medicine is, is "own occupation" coverage specific to a medical specialty?
Many policies define "own occupation" for disability purposes as a doctor's medical specialty.
This type of coverage is often available through a group plan.
Is there any detailed guidance under California law on what "own occupation" means?
Yes. Under state law in California, there is a standardized definition of definition for "own occupation" insurance policies, as well as for "any occupation."
For "own occupation," the definition has been applied in case law going back more than 30 years. Total disability, in the context of any occupation insurance, means being prevented "from working with reasonable continuity" in your "customary occupation" or another occupation that you could reasonably be expected to perform "in light of your age, education, training, experience, station in life, [and] physical and mental capacity."
In other words, total disability does not mean a state of absolute helplessness.
Give an example of the California definition of "own occupation" in practice.
Suppose you are a dentist with severe arthritis or some other orthopedic condition affecting your wrist. If you can perform multiple procedures one day, but are in too much pain to do any on the next day, you do not have reasonable continuity in your occupation.
Why can it be so difficult to recover under a disability insurance policy?
Many insurance companies are shameless about exploiting loopholes or being downright dishonest in denying coverage.
Insurers also often manipulate the medical findings about the degree of disability. As a medical professional, if you yourself have become ill, such manipulation is something you need to watch out for. An attorney skilled in handling long-term disability issues can help you assert your rights.