Long Term Disability Insurance Application Process for Doctors, Surgeons & Dentists

Hi, I'm attorney Gregory Dell and today I'm joined by attorney Steven Jessup. Hi Greg. And today we are going to discuss the application process for long-term disability insurance specifically for medical professionals. That means medical doctors, chiropractors, basically doctors who either work in a hospital or have their own medical profession. And the reason we want to really focus on medical professionals is because of the fact that Identifying the occupational duties and identifying the CPT, the production code reports is usually one of the most important things, I shouldn't say the most important, but a very important element of determining what the occupational duties are in a claim. So what I want to start with though is walking through, walking a potential Claim a potential client who's watching this video and considering filing for a claim or is already in the application process about things they should be aware of to educate them about the process and also things that they should expect if they're just in the beginning of this process and also why it's important to have. Guidance, why it's important to have an attorney, someone who's really focused in doing this type of work to guide you through the process when dealing with an insurance company. So let's start with the beginning process and assume we're talking about a doctor who is considering getting ready to file a claim or just in the beginning of filing a claim because of the fact that they're having a medical issue. What's some of the first steps that that physician should take in order to have the best chance of getting their claim approved? First, and this would sound pretty basic and normal, but a lot of doctors don't necessarily do, is making sure you have copies of your policies on hand, especially if you work in a hospital setting where there may be a group-provided policy, making sure that anything you do have is the most up-to-date and recent. And then from there, it's organization. Like you said, it's going to be production reports. If you own your own practice, it's going to be financial documentation. There's going to be a large amount of information that's going to be requested. So if you are considering, you want to make sure, A, that you have the documentation. And then I think another big thing is also understanding that if you're in a hospital setting and you don't own your own practice, Obviously, the process might be a little different, you know, you may not be such a push on financial information. If you do own your own practice, what are your options, does your policy provide for Partial or residual disabilities or all or nothing proposition of total and it can be hard, you know, and am I shutting down my practice? So there's there's lots of things that you have to have your policy So you understand what the options are what the avenues to you know, getting the desired outcome are right? I mean, I think the first step of what you said most important is you've got to gather your policies and often we see Physicians that have multiple policies they have one from their employer or hospital or possibly the AMA May. Even if it's a dentist, which we've represented tons of dentists, they have the Great West or the American Dental Association policy, and then they'll have individual policies. And often it's very important to correlate the language between the two policies because you can have one definition of disability in one, another definition in another, pre-existing condition provisions in all the policies. So there's so many issues that have to be considered before you even think about filing the claim. So, getting the policy is obviously essential, and if you have a policy that you bought on your own, I know you can call the carrier and ask them for a copy of that. If you got it from a group, you call the group, ask them for that. If it's from your employer, you actually want to ask your employer for a copy of the policy and not the disability insurance company, because the employer has to give it to you. So, assuming we get the policy, and by the way, we always offer a free review of your policy, so if you get it and you have a question about your claim, give us a call, we'll look We'll look at it and let you know if we can help you with your claim. Let's talk about the medical support, because that is the most important thing. I know we're going to talk a little bit more about occupation, but you've got to get proper medical support. Even though we're talking about doctors, dentists, chiropractors, and they usually know what's wrong with them, what should they expect in terms of what type of medical support they're going to need for their claim? I think one thing that we've all come across is whether there's a certain level of self-treatment. Or they have friends who are of the, you know, specialty of whatever their promise, so their friend kind of does it and there's not necessarily medical documentation. You may know you have a medical condition, you may go to a doctor and he confirms it, but at the end of the day that diagnosis alone isn't going to cut it for the insurance company. You need the same amount of medical support and documentation, those medical records as to how it's preventing you from doing your job, you're having to cut back on account of it. The level of it has to be... It has to be sufficient to at least rise to a level that you can justify. Another thing you need to make sure, too, sometimes you see, especially in family practices, I've come across where a husband and wife, they have the practice and the wife's treating the husband. Sometimes in the policy it says your doctor can't be related to you. So some of this, you know, I've kind of been seeing, I talked to my one friend, he tells me I should do X, Y, and Z. That's not going to really, you know. You know, that's... And a lot of doctors say... We see it often, you know, I've been writing my, well, they don't really write themselves a script, but I got an MRI done recently, there's no record of it, I just asked somebody to do it for me, someone else, and I went and did it, or I know I've been having this neck pain for six months, but I haven't seen anybody, or I've been feeling depressed for six months, and I took some samples of a particular drug, but it's not happening. None of that's really going to cut it until you actually start making that commitment to treat. Now, we understand that there's a Tremendous liability exposure to a particular doctor, especially when we represent tons of surgeons. Because if let's say the surgeon's having an orthopedic problem, now they start reporting it, getting treatment from a doctor. Then, God forbid, they're continuing to work and having this problem, their medical records get exposed, and then they say, the malpractice person says, well, why were you working when you had this disability? So it's a very difficult situation. It's also very difficult for physicians, as we understand, because when you make that commitment to disability and you say to your patients and to your medical community that that I'm not going to work anymore. You're basically done. We understand. Everyone knows you're out of that medical community. Now, it's one thing if you're a surgeon and you're not going to operate anymore and you're going to do a general practice, but if you're getting out of your profession, it is a tremendous decision and a very difficult situation that a doctor has to deal with because they're no longer going to be able to work. So we understand all those things, and that's why you've got to be super prepared when you're doing this kind of thing. When getting medical support from the doctor, it's important that everything is documented, all the testing is done, and you're going to really need that in order to have the best chance of having a disability claim. Now, I know whenever we work with our clients, whether it's doctors, physicians, or any profession, we're going to work with you and we're going to work with your doctor to make sure you get the proper support. So let's move on and talk for a minute about the vocation, because that's where we usually see, when I say the vocation, determining what the occupation is. Of the claimant, in this case we're talking about doctors and dentists and chiropractors. So what should a claimant expect in terms of how the disability carrier is going to want to determine what their occupational duties were at the time that they're claiming disability? You can expect that first and foremost if you keep CPT codes or ADA codes, any type of document to show what you're billing, what procedures are being performed. Those are going to be wanted. They're going to want to see those on a monthly basis. Sometimes they ask for patient lists and stuff and the treatment done on it. You saying, oh, you know, I perform 75% of my time surgery, that's fine. But if your codes and your production is not supporting that, that's not necessarily what an insurance company is going to find to be your disability. Thank you. Recently we had a case with a gentleman who used to be, he was a full-time interventional cardiologist in a group. He split from the group, began doing his own thing. His reports and his codes started to show at that point that more and more of his production was general cardiological procedures. So when presented to the insurance company, the insurance company was like, well, he's not an interventional cardiologist. He's a cardiologist according to these codes. He did some interventional procedures, but the majority of the codes were elsewhere. So it changed. You know, and he doesn't necessarily want to say it, but what his occupation is, because the codes are going to really back up anything that you're trying to say. Well, I think you bring up an important point that I see that a lot of... A lot of doctors are either misadvised or don't understand when they buy their policy. And what they're usually told is, this policy is going to cover you in your profession. Meaning, when you buy the policy, let's assume we talked about the interventional cardiologist, that when that particular doctor bought the policy, he was doing 90% interventional cardiology. Well, guess what? 20 years later, he's doing 30% interventional cardiology and 70% regular cardiology practice. His impression, and an impression I see very often, is, well, what do you mean? I bought the policy to protect me from being an interventional cardiologist. The fact that I'm still doing it, the fact that I can't do it means I should be totally disabled. But that's not how these policies work. It's what your occupation is within the 6 months to 12 months before you become disabled. And that's one of the most difficult things to prove and that a lot of claimants don't understand. We see that all the time also with OB-GYNs who give up the OB practice, give up the surgery, and are just doing the GYN office practice. Or sometimes what you'll see is much later after the fact, say they were a surgeon, And because of a medical condition, they stopped doing it two, three years go by. They're doing general medicine, and then they want to try to say they're disabled from being a surgeon. Then you come into issues with notice of, you know, proof of loss and notice a claim to the insurance company. So it really is what you're doing at the time of disability. Now you talked about these CPT reports, and we know they're going to ask for monthly reports for a year or two-year period, annual reports for two years. Patient lists, calendars, appointments, all of those things. They're also going to ask for some financial documentation. Can you talk about what types of financial documentation will be requested? If you do own your own practice, obviously any type of corporate tax return, they're going to want to see that. Profit and loss statements. They'll want to see them on monthly, they'll want to see them on an annual basis. Why do they want to see those, the financial statements? The reason, two-fold in my opinion. First is if there's a potential claim for residual disability, so it's not total that you're saying, listen, I can only work some time, I have to cut back my hours. Your policy's going to have a provision that you have to have a requisite loss of income usually around 20%. Well, for them to figure out what you were making before The quote-unquote date of disability and what you are now, they're going to look into the profit and loss statements and see how that's broken down. On a second, on a flip side, sometimes they're always looking, like we've discussed, for some other reason to deny the claim, and especially on individual policies, there's always questions and concerns of secondary gain. Maybe the practice has been failing even before you had a disabling event, so they're saying that you're looking at this as a way to maybe, you know, a retirement policy, something along those lines. So they're always kind of investigating for other ulterior motives, and I mean, we've come across where in them digging into financial information, that sometimes there's even, you know, character questions that if you end up in trial can come up where they're being asked, well, why aren't their books, you know, showing right and things along this line. A, it's to determine whether or not you have a loss of income when it comes to any residual disability, but you also got to realize that they're looking for any valid way to paint a picture that you're not entitled to these benefits. You brought up a good point, which we don't really need to touch on in this, talk about in detail in this video, but the residual versus total disability, and we've done a whole other video talking about a residual versus a total disability claim, especially Especially for medical professionals, but that is a very common issue where We're representing a doctor, files a claim, and they say, well, we see that you're still working. And that's really the only time that the situation would come up with residual. And we don't think you're total. We think you're residual, which means we think you're partially disabled because you can do one or more of your duties. I've also seen, which you have too, where the doctor is no longer working anymore, and they're still arguing you're residual. But then they say, you're not entitled to residual slash partial disability because you're no longer working. And we still think that you could do one or more of those duties where you were making money. That's a common issue that we come across all the time. So again, if you have a long-term or short-term disability claim, and you're a medical doctor, a chiropractor, a dentist, we have represented literally hundreds of medical professionals. We're always available to give you tons of references for any of the medical specialties which you may have. We also encourage you to take a look at the tons of testimonials that we have on our website, resolved cases as well. Let's take a look at the insurance company section where you can learn a lot more about your particular disability insurance company and stories from other claimants, as well as cases and other experiences that we've had with these particular companies. So once you get your policy or whatever stage your claim is at, give us a call, we're going to review your policy, provide you with a free consultation, and we're going to let you know right away whether or not we can help you.