Disability Claims Denied for Doctor or Health Care Professional?
Anyone can become disabled. Doctors are not immune to disabling conditions. A sudden illness or accident can end a doctor’s career. Depending on the doctor’s age, medical practice, and other factors, a doctor’s disability could result in millions of dollars of lost income over a lifetime.
For that reason, most doctors purchase long-term disability insurance. If a health care professional does not have a personal LTD insurance policy, they may have insurance coverage through their medical practice or as part of their benefits package with their employer.
While filing a long-term disability claim should be straightforward, it is not. Even though the doctor paid the insurance premiums faithfully over the years, the insurance company denies the disability claim when the doctor needs the insurance coverage. Group long-term disability insurance carriers can make it even more difficult to receive disability benefits after a disabling event.
Even though doctors are well-educated professionals, they do not necessarily have the knowledge and experience required to handle a long-term disability appeal. Our Kansas City long-term disability lawyers assist medical professionals as they seek disability benefits after becoming disabled. We fight to get doctors the disability benefits they deserve when they are unable to continue their medical careers because of a disability.
Call 816-203-0143 now to speak with one of our disability lawyers in Kansas City about your claim.
Medical Professionals Who May Be Denied Disability Benefits
Our lawyers represent physicians and other health care providers from all medical fields, including but not limited to:
- Medical Doctors (M.D.)
- Osteopathic Doctors (D.O.)
- Physician Assistants
- Nurse Practitioners
- And many other health care providers
If you received a denial of disability benefits letter, we are here to help.
Definition of "Disabled" for Doctors & Health Care Providers
Many physicians purchase private disability policies. These LTD insurance policies provide a safety net for the doctor’s income in case the doctor cannot work. However, the policies can be filled with terms and conditions that narrow the definition of “disabled” considerably.
For instance, a claims adjuster may decide that a doctor cannot perform some duties required for his specialty, but he can continue to practice in another area of medicine. Therefore, the claims adjuster determines that the doctor is not disabled because he can work in another area of medicine to earn a living, even though that area of medicine has nothing to do with the doctor’s training and expertise.
In another case, a claims adjuster may find that the doctor can perform “light” duties, such as consultations and follow up visits, even though the doctor may not be able to perform surgery. The claims adjuster denies the doctor’s long-term disability claim because the doctor can still perform some duties.
It is in the best interest of the insurance company to define “totally disabled” as narrowly as possible. Some long-term disability policies include the language to narrow the definition of disabled within the policy. Other policies might include vague terms that can be open to different interpretations.
For example, a group policy at a hospital may cover all hospital employees. The terms of the group policy may dictate that an “employee” is not disabled if that employee can perform any duties for a job within the hospital that is appropriate for the person’s age, education, skills, and abilities. Therefore, the claims adjuster determines that a doctor can provide administrative duties even though arthritis prevents the doctor from treating patients, so the doctor is not totally disabled.
Many LTD insurance providers hide behind language in the insurance plan to unjustly and unreasonably deny a doctor’s long-term disability claim. Our Kansas City long-term disability lawyers can review your LTD insurance policy. They determine whether the terms in the policy are legal. They also analyze whether the claims adjuster purposefully narrowed or misinterpreted the terms to deny a valid long-term disability claim.
Denied Disability? Read Your Long-Term Disability Policy
In addition to the specific terms included in the policy, the type of disability policy could have an impact on the outcome of your claim.
For example, if you file your doctor’s long-term disability claim under a group policy provided by your employer, federal ERISA laws apply to your claim. ERISA claims add another layer of complexity to a case.
Private long-term insurance policies are subject to state insurance laws. In many cases, denials of doctor’s disability claims under private insurance policies are subject to bad faith, breach of contract, and other causes of action.
Physicians and other health care providers may have long-term disability insurance coverage through group policies provided through an association, such as the American Medical Association. There could also be unique issues with filing claims or appealing denials under these LTD insurance policies.
Let our long-term disability lawyers in Kansas City look at your insurance contract to determine the type of policy you have and the laws that govern claims and appeals.
Why a Doctor May Be Denied Long-Term Disability Claim
Insurance companies want to make money. They make money, in part, by collecting the expensive premium payments charged for doctor’s long-term disability policies. The companies do not make money by paying doctors’ disability claims. Therefore, insurance companies go to great lengths to deny LTD claims by health care professionals.
Some of the common reasons you might hear when your long-term disability claim is denied include:
- The medical evidence does not support your claim of disability.
- You do not meet the definition of disability as outlined in the LTD insurance policy.
- You can perform some duties, so you are not totally disabled.
- Your condition does not prohibit you from working in another occupation.
- Our independent medical experts refute the findings of your physicians.
- The Functional Capacity Evaluation does not support the findings of total disability.
- Your condition does not meet the definition of disabled according to the “own occupation” or “specialty-specific” definition you gave when you purchased the LTD insurance policy.
Stand up to insurance companies who deny claims in bad faith. Underpayment of benefits, unjust denials of claims, and termination of LTD benefits should not be tolerated.
Insurance companies unfairly target doctors’ disability claims because of the high value of benefits paid for these claims. Our Kansas City long-term disability attorneys fight to stop insurance companies from taking advantage of a health provider’s employment setting and work conditions to deny valid LTD claims.
Do You Need a Disability Attorney for Your Claim or Appeal?
Whether you are filing a claim under an individual disability insurance (IDI) policy, employer-provided disability policy, or another LTD insurance policy, you need an experienced attorney at your side to protect your rights and best interests.
Interpreting the type of LTD insurance policy and the terms within the policy are crucial steps. Deadlines and specific rules vary depending on the type of policy. A thorough analysis is required to develop a strategy for obtaining long-term disability benefits for doctors.
At The Law Office of Kevin J. McManus, we have a dedicated team of legal professionals who have extensive experience handling long-term disability claims and appeals. If you have questions about your LTD claim, call 816-203-0143 to speak with a Kansas City disability claims lawyer for doctors.