Disability Insurance Claim Advice
Experts Decipher Disability Coverage
Physician's Money Digest, September 2000
By Art Fries
Many physicians purchase disability insurance to provide cash flow in the unfortunate case of an injury or illness requiring a considerable absence from medical practice. This cash flow guarantees financial stability for these physicians and their families. However, attempting to decipher what coverage disability insurance provides can befuddle even the brightest minds. One way to figure it all out is to request the assistance of an expert in the field -a disability claim consultant.
In addition to simply providing expert advice on all aspects of disability insurance, consultants help prepare an overall strategy in connection with a disability claim and provide the following services:
Review of entire disability insurance policy and accompanying application and medical exam.
Answers to questions on claim forms and related questionnaires.
Analysis of physician diagnosis and prognosis report.
Advice on communications with attending physicians.
Determination of whether a total or partial disability claim is applicable.
Resolution of whether a claim relates to occupation, earnings, both, or some other definition.
Suggestions on how to handle meetings with claim investigators, CPAs, and independent medical examiners.
Determination of what can and cannot be done with respect to predisability and postdisability duties.
Explanations of exclusions, offset provisions, earnings clauses, and other contractual wordings
Advice on whether the help of more consultants, such as physicians, CPAs, or other disability professionals, is needed.
If insurance companies are denying or terminating physician claims, or subjecting physicians to harassment on existing claims, the first instinct may be to seek the services of qualified attorneys. However, disability claim consultants form a viable alternative; disability experts can review claims and strengthen physician positions.
Insurance companies have at their disposal a number of defenses to avoid responsibility for paying claims. The crux of their arguments may be incontestability, preexisting conditions, ERISA, loss of license, dual occupation, choosing not to go back to work, financial gain, or inconsistent activities, among other possibilities. With insurance companies armed with so much ammunition for fighting claims, physicians must find a way to level the playing field
Using a forensic approach disability claim consultants may be able to communicate to insurance companies in a way to facilitate claims being paid or reinstated. Even if this approach fails, despite the medical merits and other favorable aspects of a claim, consultants can help to clarify the issues and enable attorneys to proceed with legal actions against insurance companies. Often, disability consultants can recommend attorneys proficient in this specialized area of law.
The potential payout under a disability policy is substantial. For example, a 45-year old physician faced with total disability and $10,000 of monthly benefits could anticipate receiving $2.4 million, assuming the benefits were paid until the physician reached age 65. With a lifetime payout, the benefit could reach $4 million. If a cost-of-living adjustment were included, the payout could be even higher. When dealing with these dollar figures, going it alone could be financially distastrous.