The 10 Biggest Legal Mistakes Physicians Make When Filing a Disability Claim (Mistake #7)
If you have never filed a long-term disability claim, you may not have given much thought to how to quantify job duties, but if you end up needing to file a claim, this is one of the first questions you’ll be asked on the disability claim forms. It is very important to be careful when filling out these portions of the claim forms, to prevent your insurer from taking advantage of imprecise responses and/or taking your responses out of context in order to deny or narrow the scope of your benefits.
Ed Comitz’s article “The 10 Biggest Legal Mistakes Physicians Make When Filing a Claim for Disability,” published by SEAK, Inc. (2005), details ten of the most significant mistakes to avoid. The excerpt below discusses some considerations to keep in mind when completing this section of your initial claim form:
MISTAKE NO. 7: Quantifying Time
Physicians should be wary of insurance companies asking them to compartmentalize in percentages what activities they were engaged in pre- and post-disability. To the extent that there is any crossover, companies will often deny benefits or provide benefits for merely a residual disability. It is important that physicians broadly describe their important duties—rather than their incidental duties—so that the insurer has a clear understanding of the thrust of their occupation. For example, in response to a question about principal duties and the percentage of time spent on each duty, an anesthesiologist may be better off stating “100% surgical anesthesia” rather than compartmentalizing each and every incidental task (e.g., patient intake, supervising nurses during surgery, postoperative visits) into discrete percentages. The reason is the insurer may erroneously consider an incidental task a “principal duty,” and therefore downgrade the amount of benefits. For example, where a physician has duties as a businessman (e.g., supervising staff, overseeing payroll), the insurer may argue that the disabled physician can still manage his or her practice and is therefore only partially disabled.
Action Step: Physicians should not quantify their time until after they fully understand the definitions of “principal duties,” “disability,” and “occupation” under their policy.
To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.
