Working as a physician requires dexterity, intuition, and often long and unpredictable shifts. As a doctor, you work hard all day to heal others. But what happens when you develop a medical condition or suffer an injury that prevents you from working, or you become disabled and unable to complete tasks required for your job? You may face serious financial difficulties from a loss of income or loss of your practice. That’s why you purchased long-term disability insurance in the first place. But what if you can’t get the benefits you paid for?
The long-term disability insurance attorneys for physicians at Capitan Law understand the frustration and uncertainty that come with a change in your physical abilities and health. We’re on your side, and we’re committed to helping you secure your LTD benefits.
We focus on long-term disability claims and appeals and have a deep knowledge of the regulations that apply to LTD claims. We can help file your claim or draft an appeal and even communicate with the insurance company so you can rest and focus on your health. Contact us today at (267) 419-7888 for a free case review or fill out our online contact form.
What Kind of Long-Term Disability Benefits for Physicians Can I Receive?
Long-term disability insurance (LTD) provides benefits similar to short-term disability insurance. It covers people who are unable to work for a longer period of time (usually more than 90 days). Each policy is different, so review your policy documents to determine the duration of the waiting period. Although each insurance carrier sets its own specific benefits, most LTD policies offer these benefits:
- Wage Replacement: Most policies will provide income replacement for the time you cannot work. It’s not a complete replacement, though. Most policies offer between 50-80% of your wage. Your wage might be calculated based on your prior year’s earnings or what you were making when you bought the policy. These are terms you would have reviewed and agreed to at the time the policy was purchased. Review your policy for details.
- Waiver of Premium: Some insurance companies will waive your premium payments while you receive benefits, so you have one less expense to worry about.
- Cost-of-Living Adjustments (COLA): Some insurers will let you purchase a rider so you can get a cost-of-living increase as the financial picture changes for your area. This can help reduce the strain of inflation on a household with an already reduced income.
Common Disabling Health Conditions Among Physicians
Some of the most common health conditions that could cause a long-term disability for a physician include:
- Exposure to serious diseases
- Stress-related medical conditions, like high blood pressure or hypertension
- Repetitive motion injuries
- Bone fractures from slip-and-fall accidents
- Chemical exposure
- Cardiovascular disease
- Mental health conditions, like depression or severe anxiety
This isn’t an exhaustive list of medical conditions that lead to long-term disability. Any type of illness or injury that prevents you from working for several consecutive months could qualify for long-term disability.
Long-Term Disability Coverage Compared to Workers’ Compensation Coverage
Both workers’ compensation and long-term disability insurance provide financial benefits for people who are unable to work because of a work-related injury or health condition. There are several differences between the two kinds of coverage, including:
- How long you’re covered – Long-term disability benefits can last years, even until the recipient reaches retirement age, depending on the policy. Workers’ comp, on the other hand, may have a set term before benefits end. The term of benefits usually depends on the severity and nature of the injury or illness and the laws in your state.
- How you became disabled – Workers’ comp benefits are for employees who become injured or ill on the job and cannot work. Long-term disability benefits can provide benefits for a doctor who cannot work, no matter the cause of their illness or injury.
- Who pays for your coverage – Workers’ compensation is an employer-paid benefit, and employees do not have to pay premiums for coverage. LTD, on the other hand, is a voluntary type of insurance coverage. It may be offered through your employer, or you can purchase the policy on your own. LTD premiums are paid by the insured.
- How much money you receive – LTD wage replacement covers a percentage of your wages, often 50-80%. Workers’ compensation provides a partial wage replacement. State laws dictate how much you receive, and there’s often a cap based on the state’s average weekly wage. So, a doctor may receive even less than 50% of their pre-injury wage in workers’ comp wage replacement benefits if they were making a substantially high salary.
Legal Complications for a Physician’s Long-Term Disability Claim
Insurance companies are notorious for minimizing or even denying valid claims. They can concoct any number of reasons to pay less than your claim may truly be worth. This can be frustrating for a doctor who pays their premiums in good faith. Luckily, the long-term disability claims attorneys at Capitan Law have extensive experience helping clients with some of these common issues:
- Claiming that your disability is a pre-existing condition – It’s common for an insurance company to claim that some disabling medical conditions developed before you purchased the policy and, therefore, aren’t covered.
- Denying the claim in its entirety – Reasons such as not enough medical evidence that the insured is disabled to the point of being unable to work, problems with the application, or contending that the insured can work in a different capacity.
- Ceasing benefits after a certain amount of time – They can be ceased, even if the insured remains disabled to the point of being unable to work, based on “own occupation” or “any occupation” clauses in the policy. Some policies cover the insured if they can’t work in their own occupation, but then, after a period of time (often two years), switch to a policy that only covers the insured if they cannot work in any occupation.
Long-Term Disability Lawyers for Physicians Can Help You
If you’re having trouble getting benefits under your LTD policy, the LTD attorneys at Capitan Law can help. We have offices in Pennsylvania and serve clients in New Jersey as well. Call us today at (267) 419-7888 for a free case review.
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