Ameritas Disability Claim Tips for Physicians
Our law firm has extensive experience handling disability claims for physicians. Our attorneys understand how Ameritas operates and what it takes to file a successful Ameritas disability claim, and are happy to set up a free consultation to discuss your particular Ameritas disability claim.
Below are some answers to the most common questions our attorneys receive from physicians about the disability claim process, generally, and their Ameritas disability benefits, specifically.
Table of Contents
1. I have a Union Central policy, why is Ameritas handling my claim?
2. I am a physician filing a disability claim with Ameritas. Will Ameritas recognize my specialty?
4. I stopped working as a physician prior to filing a claim. How will Ameritas define my occupation?
6. How will Ameritas try to challenge my mental health claim?
7. How does the COBRA premium benefit work in my Ameritas physician disability policy?
9. Can Ameritas require that I undergo surgery in order to receive benefits?
11. How does the Good Health Benefit work in my Ameritas physician disability policy?
13. I’m a physician with a BOE policy. Can I collect for multiple periods of disability?
14. Do I need to hire an Ameritas disability attorney to file my physician disability claim?
15. When should I contact an attorney about my Ameritas physician disability claim?
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1. I have a Union Central policy, why is Ameritas handling my claim?
In 2006, Ameritas merged with Union Central Mutual Holding Company, acquiring the disability insurance policies previously sold by Union Central and their claims personnel.
It is not uncommon for insurers to sell portions of their business, including group and/or individual disability insurance policies, to other insurers, or to turn these businesses over to third party administrators, so the company you bought your insurance policy from might not end up being the one you interact with when it comes time to file a claim.
2. I am a physician filing a disability claim with Ameritas. Will Ameritas recognize my specialty?
Some individual, own-occupation Ameritas policies are specialty-specific—meaning that you are considered totally disabled if you are no longer able to work in your specialty.
In specialty-specific policies, occupation is typically explained as “[i]f you are a physician or dentist and have limited your duties to the performance of the usual and customary functions of a specific, professionally recognized medical or dental specialty, we will consider that specialty your occupation.” However, many policies, including Ameritas’s, include a dual definition of occupation when it comes to defining occupation that Ameritas may invoke to argue that you are working in other occupations outside your specialty, in order to limit or deny your ability to collect.
In Millis v. Ameritas Life Ins. Corp., 20 C 4146 (N.D. Ill. May 20, 2022), Dr. Millis, a liver transplant surgeon, filed a claim for disability after a wrist injury. Despite three surgeries, Dr. Millis was ultimately limited to performing surgeries that lasted under five hours (which meant he could no longer perform liver transplant surgeries, as they lasted in excess of five hours).
As part of his ongoing job, Dr. Millis also performed other surgeries, including complex hepatobiliary surgeries and was the director of hepatobiliary surgery at UChicago Medicine. Ameritas used this to argue that he actually had three occupations—that of a liver transplant surgeon, hepatobiliary surgeon and professor, and Ameritas then claimed he was only precluded from liver transplant surgery, meaning he was residually disabled under the policy but not totally disabled. The parties each had a variety of experts, including vocational experts, that disagreed about whether Dr. Millis had had one job or three at the time of his disability.
The Court found that Ameritas had not offered evidence that Dr. Millis’s performance of hepatobiliary surgeries and professional duties fell outside of the “usual and customary functions” of a liver transplant surgeon. Since Dr. Millis was able to offer evidence that these other activities (teaching, other surgeries) fell within the scope of the profession, the Court ultimately found that his occupation was that of a liver transplant surgeon and determined that he qualified for total disability benefits under his Ameritas policy. However, this case illustrates how insurers, including Ameritas, contest claims even when a policy has specialty-specific language.
Insurance companies have a strong incentive to try to make total disability claims residual ones, as they typically save money and insureds may not qualify for things like lifetime benefits, which are often only available to those on total disability claims. Insurers, including Ameritas, will try to pour over a physician’s CPT codes in an effort to find job duties that overlap with other areas of medicine and/or could possibly fall outside the scope of a specialty. Accordingly, it is important for you to have a plan for how you are going to prove-up your occupation if you are filing a physician disability claim with Ameritas.
3. Will Ameritas listen to my treating providers if they verify that I can’t practice as a physician?
Having a supportive treating provider can be key to a disability insurance claim. However, having physician support does not guarantee your Ameritas disability claim will go through smoothly.
In Goldberg v. Union Cent. Life Ins. Co., No. CIV.A. 01-5758 (E.D. Pa. Feb. 22, 2002), Goldberg, a production planning manager, filed a claim with Union Central/Ameritas based on bipolar disorder and drug and alcohol dependency. Both Goldberg’s treating providers (his psychiatrist, Dr. Zavodnick, and his physician, Dr. Forest) opined that he was unable to work.
However, Union Central/Ameritas called these finding into question. Ameritas claimed that Dr. Zavodnick did not have a good understanding of the nature of Goldberg’s work, even though both Dr. Zavodnick and Dr. Forest opined at points that Goldberg was unable to work at all.
In response, Goldberg underwent a vocational evaluation by a rehabilitation specialist, which backed up what his doctors were saying – that he was unable to work as a production manager. Further, Goldberg’s Social Security disability claim was approved. Despite all this, Union Central/Ameritas chose instead to rely on the opinion of one of its reviewing doctors (a Dr. Cohen) who concluded that Goldberg was not disabled.
The Court found that in one of Dr. Cohen’s reports, she failed to delineate the basis for her conclusion. They also found that she considered factors that were “completely immaterial” to whether Goldberg was “totally disabled” and that both her and United Central/Ameritas’s repeated requests for additional information were unfounded, stating “[i]t is hard to imagine what further information his treating psychiatrist, his treating physician for addiction, his psychologist and his rehabilitation consultant could have submitted. In our view, no matter what was provided it was never going to be enough information to satisfy Dr. Cohen and Union Central.”
This case illustrates how, even with the strong support of treating providers, insurance companies can seek to discredit a claim. An experienced disability insurance attorney can help if you feel that your insurance company is ignoring or misinterpreting medical records and/or the opinions of your treating provider.
4. I stopped working as a physician prior to filing a claim. How will Ameritas define my occupation?
In some instances, you may have stopped practicing medicine before filing a disability claim, without realizing how that can impact your occupational definition.
Most disability policies, including Ameritas, define your occupation based upon what you were doing immediately prior to becoming disabled and, if you were not working at the time, it can be difficult to collect disability benefits. For example, it might state that:
Your occupation means the occupation or occupations that you were engaged in, based on the duties you were performing for wage or profit, at the time disability began. If you are not employed at the time of disability, your occupation means any occupation you are able to perform based on your education, training and experience.
However, some Ameritas policies have a more favorable definition that most other insurers’ policies do not have. If you have the more favorable definition, your policy might state something along these lines:
Your occupation means the occupation or occupations that you were engaged in, based on the duties you were performing for wage or profit, at the time disability began. If you are not employed at the time of disability, your occupation means your last occupation or occupations, prior to disability.
If you are a physician or dentist and have limited your duties to the performance of the usual and customary functions of a specific, professionally recognized medical or dental specialty, we will consider that specialty your occupation.
As you can see, how “occupation” is defined can make a big difference for your claim. Accordingly, it is important to carefully consider your Ameritas policy’s definition of occupation before filing a disability claim.
5. I’m a physician with a mental/nervous condition. Will I be able to collect benefits under my Ameritas policy?
Some Ameritas policies for physicians have limitations on mental/nervous disorders, meaning benefits under these types of claims will only be paid out for a limited amount of time (usually 24 months/2 years).
You’ll want to look closely at your policy to determine whether limitations will apply to you, as Ameritas policies typically have an expansive definition of what they consider to be mental/nervous disorders. For example, your Ameritas policy might provide that:
MENTAL/NERVOUS DISORDERS. Means any psychotic emotional or behavioral disorder including disorders related to stress or substance abuse or dependency as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, most current as of the start of the period of disability. This does not include dementia resulting from stroke, trauma, infections or degenerative diseases, such as Alzheimer’s disease. If the DSM is discontinued or replaced, these disorders will be those classified in the diagnostic manual then in use by the American Psychiatric Association as of the start of a period of disability.
As you can see, not all disorders that effect mental capacity/cognition (e.g. Alzheimer’s or stroke complications) are subject to the limitation, but it is, overall, very broad and includes disorders “related to” stress (such as burnout). Accordingly, if you are filing a disability claim with Ameritas it is important for both you and your providers to be very specific about the nature of your disabling condition.
6. How will Ameritas try to challenge my mental health claim?
Mental health claims filed by physicians can be especially hard to prove up and insurance companies, including Ameritas, often seek to challenge them.
One example is the case of Goldberg v. Union Central Life Ins. Co., discussed above. Goldberg suffered from bipolar disorder, as well as drug and alcohol addiction. However, Union Central/Ameritas argued he could still work because he had worked for seventeen years with that employer, despite his prior history of mental health problems.
Further, Union Central/Ameritas questioned his motivation to work and pointed to a statement he made while at an in-patient psychiatric facility about working, using it to conclude that Goldberg’s decision not to work was “a career decision as opposed to a disability one.” The Court found these arguments unconvincing, and that Union Central/Ameritas had ignored the opinions of treating providers as well, and the Court found in favor of Goldberg’s claim.
As another example, in Hug v. Union Cent. Life Ins. Co., No. CIV.A. 98-5047 (DRD), Hug filed a disability insurance claim after developing PTSD as a result of treatment in her workplace. Union Central/Ameritas initially paid benefits, then terminated the claim because it did not believe she was treating aggressively enough.
Upon review, the court noted that Hug’s treating provider continued to certify that she could not return to work, but had also stated that Hug had failed to improve because she could not afford more frequent treatment. The Court found that because Hug’s policy had a care requirement that required her to be under the regular care and treatment of a physician, she had failed to receive care at an appropriate frequency, and could not collect benefits.
As you can see, mental health claims are often challenged by Ameritas. If you have a mental health disability claim, you should at least consult with an experienced disability attorney before filing.
7. How does the COBRA premium benefit work in my Ameritas physician disability policy?
If you have an Ameritas policies, you may be able to recoup some or all COBRA (Consolidated Omnibus Budget Reconciliation Act) costs. For example, your disability policy might provide as follows:
COBRA PREMIUM BENEFIT. We will reimburse the premium paid by you for medical coverage provided under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1984 or any subsequent amendments, beginning with the first premium due after you satisfy the elimination period of this policy, not to exceed the COBRA maximum monthly benefit shows on the schedule, if:
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- you are receiving monthly disability benefits under this policy; and
- you became unemployed due to your disability and, as a result, you are paying premium to continue medical coverage under that employer’s health or medical plan as provided for under COBRA.
This can be a useful provision to take advantage of, as it is important to continue seeing your doctors to satisfy your disability policy’s care requirement and the COBRA premium benefit can help offset health insurance costs.
8. What is a Nondisabling Condition Treatment Benefit? How does that impact my physician disability policy coverage?
Some Ameritas policies allow you to recover medical expenses even if your condition is not deemed to be disabling. For example, your policy might include a provision similar to the following:
TREATMENT OF NONDISABLING INJURIES. If you suffer an injury while this policy is in force that requires medical treatment prescribed by a physician, or the repair to natural teeth prescribed by a dentist, we will pay the expense of such treatment:
(1) only for expenses incurred with this policy is in force within 365 days from the injury date; and
(2) only if a claim is submitted within 365 days from the injury date; and
(3) provided no other benefits are payable under this policy or any of its riders.
We will pay you for such expenses up to the maximum amount shown on the schedule for this benefit subject to the following:
(1) if you have one or more of our disability income policies providing this benefit, we will not pay more than a total of 100% of the expense incurred under all policies; and
(2) if a nondisabling injury develops into a disability for which monthly disability benefits are paid, any benefits which have been paid under this provision will be offset against the monthly disability benefits.
The maximum amount that can be recovered will be set forth in the policy schedule, and is not going to be as much as you could recover under a disability claim. But it is something to look for and be mindful of if your disability claim is denied and/or have a condition that is not determined to be disabling under your Ameritas policy.
9. Can Ameritas require that I undergo surgery in order to receive benefits?
Virtually all disability policies have a medical “care” requirement that must be satisfied in order to be eligible for benefits. Some of these care requirements can be relatively easy to satisfy; for example, older disability policies often simply required you to be under the “regular care” of a physician.
In contrast, Ameritas policies can have much more onerous care provisions, and some even expressly mention surgery in the policy contract itself. For example, your Ameritas policy might contain the following provision:
DUTY TO COOPERATE. You have the duty to cooperate with us concerning all matters relating to this policy and any claims thereunder. This cooperation includes, but is not limited to. . . securing appropriate medical treatment for the condition(s) upon which your claim for benefit under this policy is based. This includes such corrective/remedial surgery or generally accepted medical procedures which to an ordinarily prudent person would appear medically reasonable for such condition(s).
In some instances, an insured may want to undergo conservative treatments and/or their treating provider may even recommend against surgery. However, Ameritas might have their own doctor conclude that surgery would be beneficial for the disabling condition, and try to enforce this requirement in order to provide benefits.
Accordingly, if you have an Ameritas policy and a disabling condition where surgery is a potential treatment option, it is important to speak with an experienced disability attorney about your disability claim prior to filing.
10. I’m a physician that needs to file a disability insurance claim. How long will I be able to collect benefits?
How long you will be able to collect benefits will depend on the specific Ameritas policy you have and its max benefit period. While many physicians assume that their policy will be valid through a typical span of time (age 65 or 67), this may not always be the case if you have an Ameritas policy. In some instances, your policy may be much shorter.
For example, your Ameritas policy could have a tiered approach to the max benefit period. It might state that for disabilities prior to age 55, benefits for a total of 120 months (10 years); for disabilities after age 55 but before age 63, benefits last to age 65; and for disabilities after age 63, benefits are limited to 24 months.
11. How does the Good Health Benefit work in my Ameritas physician disability policy?
Some Ameritas policies may contain a feature, called a “Good Health Benefit,” that can shorten the elimination period under your policy in certain circumstances.
An elimination period is the amount of time you are required to remain disabled before your benefits will begin to be paid out. Different policies can have different elimination periods (30-180 days is common, with 90 being what we typically see with most disability policies).
If your Ameritas policy has a “Good Health Benefit,” it may include language along the following lines:
GOOD HEALTH BENEFIT. We will reduce the elimination period shown on the schedule by two days for every consecutive policy year you complete after the issue date without receiving any monthly disability benefits under this policy.
Once you begin receiving monthly disability benefits under this policy, the good health benefit is reset to zero. It will begin to accumulate again by tow days for every consecutive policy year you complete without receiving any monthly disability benefits under this policy, beginning with the policy anniversary immediately following the date you are no longer receiving benefits.
In no case with this benefit reduce the elimination period to less than 30 days.
This provision is an interesting one, as it is likely intended to disincentive policyholders from filing claims. That being said, it is a unique feature that can be beneficial if you do end up needing to file a claim. If you have this provision, it is important to take a close look at Ameritas’s initial determinations relating to the elimination period, to make sure that they calculated it correctly.
12. Ameritas is requesting detailed financial information about my medical practice and personal history. Can they do that?
Most of the time, insurer’s requests for information relate to relevant facts at issue in the underlying claim, although it can sometimes be difficult to understand the purpose behind such requests if you do not have experience with filing disability insurance claims. At the same time, sometimes insurer requests are overbroad and the request.
In Storey v. Ameritas Life Ins. Corp., Civil Action No. 1:19-CV-01610-CMA-SKC (D. Colo. May 20, 2021), Storey, who worked in sales at the time he became disabled, challenged Ameritas’s discovery requests that arose during his lawsuit against the company.
Examples of what Ameritas was asking for included living history for the past 10 years, employment history for the past 10 years; information on all other insurance policies held for the last 10 years; social security application history; income history; all travel documentation; income taxes; past medical records; information on any legal history; any and all email address, websites, and/or weblogs crated, used or maintained during the past 10 years; and patents pursued.
Ameritas argued that it needed this information to assess whether Storey was disabled and to assess his credibility. For example, Ameritas asked for Storey’s residential history because Storey had indicated that he had lost his family home and resorted to sleeping in his car on occasion because he was not receiving disability benefits.
With many of these requests, the Court found that the look-back period of ten years was too lengthy, and shortened (but did not eliminate) the amount of information that needed to be provided by Storey. The Court also limited the amount of financial information he was required to disclose. However, in some instances, the Court determined that Ameritas was simply on a “fishing expedition,” such as with Ameritas’s request for litigation history or email/website/weblog information.
This case shows just how much information insurance companies will try to collect when adjudicating a claim, or in defending themselves in a lawsuit. While they are allowed to request substantial information, not everything is fair game. An experienced disability insurance attorney can assess a request for information and determine whether what Ameritas is overreaching.
13. I’m a physician with a BOE policy. Can I collect for multiple periods of disability?
Physicians with their own practices may choose to purchase Business Overhead Expense (BOE) policies to cover their practices’ business expenses if they become disabled. Under most BOE policies, there is both a maximum monthly benefit and maximum overhead expense benefit. While this may seem straightforward, issues can arise if there are multiple disabling conditions and/or successive periods of disability.
For example, in Sussmann v. Ameritas Life Ins. Corp., No. CV 17-2939, 2018 WL 705875 (E.D. La. Feb. 5, 2018), Dr. Sussman, an endodontist, filed a lawsuit against Ameritas claiming they owed him additional benefits. Dr. Sussman began to suffer from back pain due to stenosis of the lumbar spine in 2011 and was declared totally disabled in 2013. He underwent lumbar surgery in 2014 but continued to have ongoing chronic pain and was diagnosed with stenosis of the cervical spine.
Later on, he fell down the stairs in 2014 and suffered injuries to his low back that exacerbated his lumbar condition. Later in 2015 he was also involved in a car accident that caused further injuries to his spine. In 2016 he was diagnosed with nerve compression and then underwent lumbar laminectomy surgery. Finally, he was declared totally disabled because of mental and nervous issues as of January 2013 by his psychiatrist.
Ameritas approved his disability claim and paid out the maximum benefit amounts of both BOE policies. However, Sussman argued that because he suffered from multiple separate disabilities, this reset the BOE maximum benefit period and he was entitled to a full BOE benefits for each period of disability.
Upon review, the Court noted that when presenting his claim for disability benefits under his other policies, Sussmann claimed he was continuously disabled from back pain since 2013. The Court then found in favor of Ameritas, and held that Sussman could not simultaneously claim separate periods of disability under his BOE policy.
14. Do I need to hire an Ameritas disability attorney to file my physician disability claim?
While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis—in our experience physician claims are not that straightforward.
Many of our clients have more nuanced conditions, such as slowly progressive musculoskeletal conditions due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a physician. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test.
Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years, all to the insurance company’s advantage. Even if you prevail, it can be an exhausting process, and companies typically appeal, which can take at least another year or more, all the while you are not getting paid benefits.
In our view, it is more prudent to approach your claim carefully from the outset and have your attorney address any concerns that Ameritas may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off, you are not working and your only option is a lawsuit.
In our experience, the most common areas where complexities can arise in physician’s disability claims include:
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- The timing of the claim (particularly in situations where a disabling condition is slowly progressive);
- Claims made by physicians with multiple sources of income, some of which may continue post-disability;
- Claims made by physicians who have taken an active role in office/hospital administration or are involved in non-clinical work;
- Claims involving alleged preexisting conditions;
- Claims where the underlying condition is difficult to diagnose or diagnosed by exclusion;
- Claims involving multiple co-morbid conditions;
- Claims involving conditions that are irregularly and unpredictably disabling;
- Claims involving pain/musculoskeletal conditions;
- Claims involving mental health conditions; and
- Claims involving recommendations for or against certain treatments or surgery.
15. When should I contact an attorney about my Ameritas physician disability claim?
Physicians who are considering filing a claim for disability insurance benefits should meet with a disability attorney well-before submitting a claim.
Each disability policy has different, complex language that insurance companies may manipulate to circumscribe and restrict coverage. Before filing, physicians should make a coordinated effort, with an attorney’s assistance, to determine whether their particular claim is covered, and if so, how that claim is best presented to ensure payment.
The information provided above is offered purely for informational purposes. It is not intended to create or promote an attorney-client relationship, and does not constitute and should not be relied upon as legal advice.
Every claim is unique and the discussion above is only a limited summary of information that may be relevant to your claim. If you are concerned that Ameritas is not handling your claim fairly, an experienced disability insurance attorney can help you assess the situation and determine what options are available to you.
Notable Ameritas Disability Insurance Cases
Millis v. Ameritas Life Ins. Corp., 20 C 4146 (N.D. Ill. May 20, 2022).
Storey v. Ameritas Life Ins. Corp., Civil Action No. 1:19-CV-01610-CMA-SKC (D. Colo. May 20, 2021).
Hopkins v. Ameritas Life Ins. Corp., No. 1:15-CV-00051-GNS (W.D. Ky. Mar. 27, 2020).
Sussmann v. Ameritas Life Ins. Corp., No. CV 17-2939 (E.D. La. Feb. 5, 2018).
Hug v. Union Cent. Life Ins. Co., No. CIV.A. 98-5047 (DRD) (D.N.J. Apr. 10, 2006).
Goldberg v. Union Cent. Life Ins. Co., No. CIV.A. 01-5758 (E.D. Pa. Feb. 22, 2002).
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