Filing for Disability Insurance Benefits In the Wake of Coronavirus: What Every Physician Should Know
Physicians across the country are experiencing heightened levels of anxiety and stress in the face of the coronavirus pandemic. They are bracing for a spike in cases that the U.S. healthcare system will not be prepared to face, and some are already running out of supplies. Others are working in hospitals that are short-staffed, tending to both sick and anxious patients. And many physicians are balancing their desire to help patients with the risk of becoming a potential sources of contagion to their loved ones and community.
One doctor described this unique type of stress as “pre-traumatic stress disorder” as doctors brace for an outbreak that seems inevitable.[1] Another doctor observed “[m]ost physicians have never seen this level of angst and anxiety in their careers.” [2]
These unprecedented stressors can have a significant impact on physicians already dealing with mental health issues like depression, anxiety, panic disorder, or similar conditions. Physicians currently are experiencing increased distress and worry over physician shortages[3], shortages of supplies[4], and fears of becoming ill and/or quarantined themselves.
Organizational psychologist Adam Grant, in a piece in The New York Times, also recently explained that over half of doctors experience “burnout,” and risks of stress/burnout become even “more acute” during a pandemic because medical professionals are “braving high disease exposure, long hours and inadequate resources.”[5]
Even for those physicians not on the front lines, this pandemic has drastically impacted their bottom lines and work schedules as they have to postpone procedures, and potentially cut back on hours or close their practices entirely to preserve personal protective equipment (PPE). However, as we’ve noted in prior posts, unemployment programs typically do not provide high enough benefits for doctors to meet their obligations and expenses.[6]
In light of all of this uncertainty, many physicians have been reaching out to us to see if it is possible to file disability claims under their own-occupation disability policies. We’ve answered the most common questions we’ve been receiving from doctors, below, and will be updating this post throughout the coronavirus crisis as we receive more questions from physicians.
Each physician’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the medical community and answer physician’s questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.
Can I File A Claim for “Burnout”?
It depends on what you mean by “burnout,” and whether you have an actual, underlying mental health condition that has been treated by a mental health professional. Most disability policies require you to provide evidence of either a “sickness” or an “injury” that prevents you from being able to perform the material and substantial duties of your occupation.
If you file a claim based on increased stress levels and fatigue and label it “burnout,” we’ve seen insurers seek to minimize these things as “just part of the job,” determine that this does not qualify as a disabling condition and deny the claim. Some policies also specifically exclude coverage for mental health conditions, or limit benefits for mental health claims to a shorter time frame (usually around 24 months). So the first step is to determine whether your policy provides coverage for mental health claims.
If your policy covers mental health claims and you have a diagnosed condition, it is possible to file a disability claim; however, mental health claims are also some of the most challenging disability claims. They receive a high level of scrutiny, and can be difficult to prove up since most mental health conditions are diagnosed based upon subjective symptoms that are reported to your treating providers.
As a result, insurer’s medical consultants and in-house doctors often challenge and second-guess the diagnoses and treatment plans submitted by your providers. Oftentimes, an insurer will suggest more aggressive treatment because they want you to go back to work so they can save money. But if work is a trigger for you, that may not be in the best interest of your mental health.
Additionally, while some policies expressly require you to pursue treatment that would lead to a “return to work” and/or “maximum medical improvement,” other policies simply require you to be under the “regular” care of a provider, or require you to receive “appropriate” care. Where your policy falls on this spectrum typically informs how aggressive an insurer will be about challenging your treatment, and if there is a disagreement over whether a certain treatment is required by your policy, it may require the intervention of a disability insurance attorney and/or court involvement to resolve.
Our office has dealt with these issues before and has helped numerous professionals successfully navigate their mental health claims. While it can be a difficult process, it is possible to collect, if you have a legitimate mental health condition, an understanding of how your policy works and supporting documentation of your condition.
For a more detailed discussion of the challenges physician’s face when filing mental health claims, see our article in MD Magazine, “Can You Collect Disability Benefits For Burnout?”
Each physician’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the medical community and answer physician’s questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.
I Am a High-Risk Individual. Can I File a Disability Claim if My Office Environment Places My Health at Risk?
This is an interesting legal question that has not been fully developed in the context of a national pandemic. Most legal questions are resolved by consulting precedent and since, in many ways, the current COVID-19/coronavirus in unprecedented (particularly in the last 30 or so years when private disability insurance policies for professionals have been the most prominent) this is a open question that would likely require a disability lawyer and court involvement to resolve.
The strength of this sort of claim would largely depend on the physician’s specialty, the underlying policy, and the law of the jurisdiction in question. While most disability policies do not directly address what happens if there is a national epidemic, like the coronavirus, some policies do address situations that could be pointed to by analogy.
For example, some physician policies have riders that state that the company will recognize disability if the physician contracts a sickness or disease that could place the physician’s patients at risk (for instance, if a physician tests positive for HIV and there is a risk that the virus could be transmitted to patients in the course of the physician’s normal duties). If a physician has coronavirus, one could argue that practicing similarly places patients at risk and arguably falls under this sort of rider.
There is a fundamental difference, however, because the coronavirus is not something that is normally expected to be contagious for an extended period of time. If it is something that passes in a few weeks, then it is unlikely that any benefits would be due, because most policies require the disability to last for a specific elimination period before benefits are payable, and those waiting periods usually last at least three months (or longer).
Looking at it from another perspective, some courts have held that a physician should be considered disabled if the physician’s work environment places the physician’s health at risk. For example, if a physician were diagnosed with a heart condition and the stress and demands of practicing could cause a heart attack, a court might recognize such a condition to be totally disabling. By analogy, if a physician’s health were at risk due to coronavirus, one could argue that the physician is disabled from practicing for as long as that risk is present.
Again, these are untested waters, and there is no guarantee that a court would approve such a disability. Most likely, if the risk were just the general risk of contracting coronavirus, we expect that the insurer would deny the claim and a court would most likely uphold the denial. However, if there is an underlying health condition that places the physician at heightened risk of mortality if exposed to coronavirus (for example, the physician had a compromised immune system due to another condition, like leukemia) courts may be more sympathetic and more willing to recognize disability.
Each physician’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the medical community and answer physician’s questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.
I Can’t Focus and Am Afraid I’m Going to Hurt Somebody. Can I File a Claim?
If you are a physician and your ability to focus and think critically is compromised, you may qualify for disability benefits. However, mental health claims are often subject to policy exclusions and limitations, and are some of the most difficult claims to make.
For frame of reference, our physician clients who have filed claims for anxiety typically have a history of panic attacks that were non-responsive to treatment. Their specialties required a high degree of attention to detail and critical thinking, and often there is an underlying event or specific trigger that is work-related. Additionally, they take medication for their condition and that medication impacts their ability to think clearly and concentrate to a degree that it is not possible for them to safely practice their specialty when they are taking the medication.
So, in sum, whether you can file a claim depends on factors such as the severity of your condition, whether you have a history of receiving treatment for the condition, whether the anxiety is triggered by something that is work/occupation related, whether you are taking medication for the condition, and the nature of your specialty and job duties.
See also Can I File A Claim for “Burnout”?
Each physician’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the medical community and answer physician’s questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.
I Have Had to Isolate from My Family Because I’m Afraid to Get them Sick. Can I File a Claim for Depression?
If you are a physician suffering from severe depression, to the point where you would be putting patients at risk by practicing, you may be able to file a disability claim, as long as your policy provides coverage for mental health conditions.
As with a disability claim based upon anxiety/panic disorder, whether you can file a claim depends on factors such as the severity of your condition, whether you have a history of receiving treatment for the condition, whether the depression is triggered by something that is work/occupation related, whether you are taking medication for the condition, and the nature of your specialty and job duties.
See also Can I File A Claim for “Burnout”?
Each physician’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the medical community and answer physician’s questions about the impact of the coronavirus, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.
References:
[1] Alison Block, Doctors and nurses are already feeling the psychic shock of treating the coronavirus, The Washington Post, March 18, 2020, https://www.washingtonpost.com/outlook/2020/03/18/doctors-nurses-are-already-feeling-psychic-shock-treating-coronavirus/.
[2] Karen Weise, Doctors Fear Bringing Cornavirus Home: ‘I am Sort of a Pariah in My Family’, The New York Times, March 16, 2020 (updated March 17, 2020), https://www.nytimes.com/2020/03/16/us/coronavirus-doctors-nurses.html.
[3] Stephanie Innes, Number of hospital beds, doctors in Arizona are low compared with rest of U.S., Arizona Republic, March 15, 2020 (updated March 16, 2020), https://www.azcentral.com/story/news/local/arizona-health/2020/03/15/number-hospital-beds-doctors-arizona-low-compared-rest-u-s/5038216002/.
[4] As an example, The Utah Department of Health, according to a news article in The Salt Lake Tribune, announced on March 24th a halt to nonurgent medical, dental, and veterinary procedures in order to preserve protective gear for health professionals. The order currently runs through April 25th. See Sean P. Means, Lee Davidson, Bethany Rodgers, Utah increases COVID-19 testing, halts non-urgent care – but some doctors urge stay-at-home orders, The Salt Lake Tribune, March 24, 2020, https://www.sltrib.com/news/2020/03/24/utah-increases-covid/.
[5] Adam Grant, Burnout Isn’t Just in Your Head. It’s in Your Circumstances, The New York Times, March 19, 2020, https://www.nytimes.com/2020/03/19/smarter-living/coronavirus-emotional-support.html.
[6] For example, the maximum weekly unemployment benefit insurance in Utah is $580, with a total maximum benefit of $15,080.00.
See Unemployment Insurance Benefit Schedule, January 2020, Workforce Services Unemployment Insurance, https://jobs.utah.gov/ui/UIShared/PDFs/BenefitCalculation.pdf.
