Doctor and Dentist Disability Claims

Colorado Disability Lawyer

doctor disabilityMedical professionals in our country provide a great service by caring for millions of Americans who are rendered disabled by chronic illnesses and traumatic injuries. But, doctors and dentists can also quickly find themselves unable to work due to disabling medical conditions. What happens then?

Many such professionals have purchased individual disability insurance (IDI) policies, oftentimes years or decades earlier, to provide income protection if a disability interrupts their practice and ability to earn a living at their chosen profession. Of all forms of disability insurance, IDI coverage usually promises significant protection in most claim situations, giving peace of mind and financial shelter when serious illness or injury leaves you unable to work. (For a more in-depth review of an individual disability insurance claim, click here.)


A Physician’s “Own Occupation” IDI Policy

There are different types of disability insurance protection available. Most medical professionals who have purchased an IDI policy did so because the protection promised is usually superior to the protections of a typical group long-term disability (LTD) policy offered by employers. Some medical professionals may even have disability protection under both an IDI policy (bought by them) and an LTD policy (purchased by the medical practice). A close review of such policies will quickly reveal what can be major differences in the quality and amount of insurance coverage.

The replacement income provided by IDI policies, if purchased in sufficient amounts, can replace a significant portion (sometimes as much as 100%) of the medical professional’s monthly salary when they can no longer do their own occupation due to an illness or injury. Many IDI policies are referred to as “own occupation” policies. “Own occupation” disability insurance policies offer superior income protection because they essentially insure the medical professional’s chosen occupation (e.g., surgeon, physician, dentist, etc.). And, under most IDI policies, the insurance company should provide benefits (sometimes lifetime benefits) if the medical professional becomes unable to perform the main responsibilities of that chosen occupation. (By contrast, many LTD policies protect against the loss of a person’s own occupation only for a few years and then provide coverage only if the person is disabled from “any occupation.”) Some IDI policies offer even greater protection, providing insurance benefits when a medical professional cannot perform the duties of a specialty or even a subspecialty.


Other Common Policy Issues

IDI policies typically contain more generous terms and conditions as compared to the average LTD disability policy. We have already mentioned the advantage of an “own occ” policy. Many IDI policies will only be payable until the person reaches the age of 65 or 67. Other policies may contain a lifetime benefit rider which, as the phrase implies, means the monthly disability benefit can be payable for the person’s lifetime. However, usually certain conditions must be met before lifetime benefit protection is triggered. The most common requirement is that the medical professional must become disabled before turning 60 years old. At times, the trigger also requires that the person be disabled due to an “injury” (versus an “illness”) by a certain age. A closer examination should easily reveal the type of coverage in existence under an IDI policy.

We know that IDI policies are not cheap, and at McDermott Law we fight hard to make insurance companies keep the promises they made in those policies for which medical professionals dutifully paid their premiums. The amount of income protection insured under such policies is often far greater than what the average person is insured for under an LTD policy. Many medical professionals will have purchased several policies over their career to keep up with the ever-increasing income achieved with a successful medical or dental practice. We have seen doctor disability claims with as many as five separate policies—and not all of them being worded the same or providing the same exact coverage. Because of this, when a medical professional makes a claim under an IDI policy, the insurance companies often give special attention to such claims and most of them maintain separate departments with claims handlers who are trained to closely scrutinize such claims.

IDI policies often contain other policy language significantly different (and usually better) than the typical LTD group policy: partial disability benefit language not requiring total disability, cost of living adjustment clauses or riders, less severe or non-existent limitation provisions involving mental health, no benefit reduction for other sources of income such as social security disability, and still others. All of these policy provisions, benefits, and limitations should be understood before filing a disability insurance claim by a medical professional. And, we’re here to help.

One of the biggest challenges for a medical professional is the decision to cease all work activities, which often means closing a medical or dental practice or transferring partnership duties, control and ownership. Faced with such a prospect, many medical professionals will understandably delay the decision to give up their chosen occupation. These delays can result in challenges to a successful claim or result in an underpayment of the claim as the amount payable can be directly tied to the pre-disability earnings which may have steadily declined for months or years before the claim was filed.


Filing an Individual Disability Insurance Claim

At McDermott Law, we’re here to help you through all stages of an IDI claim. You can always call our practice for a consultation to learn more about your disability insurance policy, even if you have not yet filed a claim. We know you’ve paid a lot of money over a lot of years for your IDI policy. It is an important asset to you and your family. It is there to provide what can be significant income for many years after you have been forced to abandon your chosen occupation or specialty. We offer consultation services so that you can better understand your IDI policy. We can assist you through the claim process. One way to avoid a claim denial is to be prepared by speaking with an experienced attorney before you file.


If Your Individual Disability Insurance Claim is DENIED

If you have filed your IDI claim and it’s been denied, you should seek legal help from experienced disability insurance lawyers. McDermott Law has handled many disability claims for doctors, dentists, and other medical professionals over the past two decades, and we are uniquely set up to handle disability insurance claims in general. Disability insurance is what we do the majority of time.

An individual disability insurance policy is governed and regulated by state law. The typical group policy is most often governed by our country’s ERISA laws, which are federal. (To better understand an ERISA-governed claim, please click here to view other sections of this website.) Generally, state laws offer far more protection than the ERISA laws, some states better than others. At McDermott Law, we have years of experience handling both state and federal law governed claims for disability insurance, and routinely handle IDI claims throughout Colorado and surrounding states. We understand the difference between these laws and fight to make the insurance company do the right thing.


Contact McDermott Law LLC

Insurance companies will deny payment of your IDI claim for many reasons. Pursuing a denied IDI claim can be overwhelming for many people who have lost the ability to successfully pursue their chosen profession. If you have fallen victim to a disability insurance company, contact the Denver and Colorado IDI and insurance bad faith attorneys at McDermott Law.


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