Have I Changed My Regular Occupation?
If you are a licensed dentist or physician and file a disability claim, will your insurance company recognize your occupation as a “dentist” or “physician”? Not necessarily.
How is “Occupation” Determined?
Most disability policies look at what you are doing right before your disabling condition occurred (as opposed to your license or what you have done for the majority of your career) when it comes to defining your regular occupation. This can be problematic if you stop working, or change jobs or job duties prior to filing your claim.
One such example of this is the case of Hsu v. Northwestern Mutual Life.[1] Dr. Hsu, a physician specializing in interventional pain management, left his job to move to the west coast. Before he resumed practicing in his new location, he began to experience symptoms of constant right elbow pain that was exacerbated by wrist extension or elbow flexion. He decided to have surgery and then returned to work on a trial basis at a new practice.
Unfortunately, the surgery did not prove successful. Dr. Hsu found himself unable to work and he filed a claim with Northwestern Mutual Life (NML). After reviewing his file, NML determined that Dr. Hsu did not have a “regular occupation” because he was not working when he became disabled. As a result, NML denied his total disability claim.
Do You Know How Your Policy Works?
It is not uncommon for us to see similar situations to Dr. Hsu’s, where a physician or dentist has taken an extended break (whether because of a disabling condition or for an unrelated reason) only to later realize they cannot return to work and needs to file a claim. In fact, many policies have provisions that state if an insured is not working at the time of disability, their occupation will be considered that of a retired person. Of course, it is much harder to prove up that you cannot do the normal tasks of a retired person versus not being able to perform the duties of a practicing physician or dentist.
Other mistakes include significantly modifying job duties (e.g. doing exams only instead of all facets of dentistry) or taking on a new or side job in an attempt to make up for lost income. All these activities can significantly impact how your insurance company determines your occupation.
Oftentimes, dentists and physicians make this mistake because they assume that their policy only allows them to collect if they are severely injured or paralyzed and unable to work at all. However, many professionals have “own occupation” policies that protect them if they are unable to do their job, even on a part-time basis.
The Takeaway
In Dr. Hsu’s case, the Court indicated that whether or not Dr. Hsu had been a physician or had no regular occupation at the time of filing was debatable, and the case remains pending as of this writing. However, Dr. Hsu might have avoided the expense and stress of litigation if he had read his policy carefully, complied with its requirements, and properly timed the filing of his claim.
If you have a disabling condition and are thinking about filing a claim, please feel free to contact one of our attorneys directly.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If your policy’s terms are not what you expected, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1] Hsu v. Northwestern Mutual Life, C20-88 TSZ, 2021 WL 735374 (W.D. Wash. Feb. 5, 2021)
