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How Disability is Defined for Physicians With Long-Term Disability Policies

Professional physiotherapist supporting patient with orthopedic problem

Disability insurance is meant to protect a policyholder who, due to illness or injury, is no longer able to work. Long-term disability (LTD) means the claimant will be unable to work for a significant period of time–typically two years, five years, or even until retirement, depending on the policy. How the policy defines “disability” can be unclear, however. Is a surgeon with broken hands disabled if they are still able to diagnose and recommend treatments for patients? Or does their policy require them to work as a physician in any capacity, given the chance? Read on for an explanation of disability insurance for physicians from our experienced Los Angeles disability benefits denial lawyers.

Disability is Not An Objective Term

The most important factor for any physician shopping for disability insurance policies should be the definition of “disability.” There is no mandatory, objective definition of “disabled” in California insurance law. The meaning of disability is defined by the language in the policy. The contours of that definition will determine how much benefits a physician can collect and whether a given claimant can collect disability benefits at all.

The definition of disability turns on the physician’s capacity to work. Some policies will consider a person disabled if they are unable to practice their specific specialty–for example, an ophthalmologist who becomes susceptible to seizures and is no longer able to perform delicate eye surgery would be considered disabled. These policies are known as “own occupation, specialty-specific.” Such policies may offer full or limited benefits to physicians who are unable to practice their specific specialty even if they technically could, with time, switch to a new specialty that they are physically able to perform. These policies may offer partial benefits to physicians who can work part-time.

Other policies are less generous. A given policy might define a physician as disabled only when they are unable to work anywhere in the field of medicine–such as if they become quadriplegic or lose their mental capacity to practice medicine. A physician who is able to work in a different field will not receive benefits. These are more loosely-defined “own occupation” policies, not specialty-specific.

The worst definition of disabled in a policy for a skilled, licensed professional is “any occupation.” These policies only deem a policyholder disabled only if they are unable to work in any field. If you purchased a policy from one of the “Big 6” physician disability insurance providers, it is unlikely that your policy limits disability to any occupation. However, it is always important to carefully review policy language before purchasing, regardless of the provider.

Get Educated Help With Your California LTD or STD Disability Insurance Claim

If your disability insurance claim has been unreasonably denied, or if you are dealing with other bad faith insurance issues in California, fight for the coverage you are owed with the help of the seasoned and successful Los Angeles insurance claim denial lawyers at Gianelli & Morris. Call for a free consultation at 213-489-1600.

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