Understanding & Navigating Long-term Disability Claims for Physicians — Part 2

Understanding & Navigating Long-term Disability Claims for Physicians – Part 2 by Evan Schwartz

 

{3:00 minutes to read} In our previous article, we began to review the three components of a long-term disability (LTD) claim case. Below, we continue the discussion by looking at occupational duties of physicians, as well as total disability & residual disability.

The Occupational Duties of Physicians

There is a wide range of unique, occupational duties for doctors that vary based on specialty. Most commonly, duties are within the clinical care realm—examining, diagnosing, treating, and taking care of patients. Surgical duties are fairly typical as well, which often include interventional procedures in radiology, cardiology, etc.

In addition to hands-on duties, there are also non-patient care and research-based forms of medicine, each with a custom set of responsibilities. In fact, it is common for a surgeon to also have a non-surgical practice. In this regard, it is important to understand the differences between the clinical and non-clinical duties, particularly within the surgical category. Surgeons have duties that aren’t necessarily overt, like pre- and post-operative care, evaluations for surgery, etc. This distinction is especially important when dealing with “own occupation” disability benefits.

Verifying Occupational Duties

All occupational requirements of a particular position must be understood in depth, even if responsibilities are not performed all the time. For example, a supervisory emergency room doctor primarily engages in administrative tasks; however, he or she must be able to triage or perform an emergency procedure if necessary. If this doctor happens to become disabled from these duties only, he or she would only be unable to perform some of the duties required of an emergency room physician, and yet would be totally disabled from the position.

The most common way to verify occupational duties is to evaluate CPT codes, as a vast majority of professionals bill to third party payers. Very few doctors and surgeons are in a pure cash business. There are certainly other ways to verify duties, including the doctors themselves, support and office staff, appointment calendars, and the like.       

Total Disability & Residual Disability

Understanding the difference between total disability and residual disability is also very important, assuming that the physician has these provisions in his or her policy. The vast majority of doctors have a residual definition included in their policies. The residual disability definition contained in the policy is critically important because many doctors who suffer an injury or sickness do not file a claim or stop working immediately.

Often, by the time the physician seeks to file a claim, he or she has already tried to work through his or her difficulties by scaling back the physically demanding aspects of the job. Thus, when the doctor files the claim, there has already been a change in occupational duties.

Within the context of the residual definition, your attorney must be able to understand and track the changes in work duties that have already taken place as a result of the disability. This is a critical part of the evaluation.

If you have questions about an LTD claim, please contact us to discuss your specific circumstances.

Evan-Schwartz

Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com