Long-Term Disability Claims for Doctors

We always urge those who are filing a long-term disability claim to consult with us first. The insurance company hopes that you do not understand their process.

That depends on your situation. 

If you haven’t filed for long-term disability yet, we strongly recommend you schedule a paid consultation with us first. Our team works with medical professionals all the time. We understand that unique challenges doctors face when trying to get claims approved, and the tactics insurance companies use to deny valid claims. We’ll review your policy and talk with you in depth about your condition and your job responsibilities. By the time the appointment is over, you’ll have a strong plan of action for your next steps. 

If your claim has recently been denied, email, fax, or mail a copy of your denial letter to our team now. We offer a zero-obligation review of your denial letter and give you a detailed strategy for moving forward. But you must act promptly—the insurance company only gives you a limited time to appeal, or their decision is permanent. 

After your free denial letter review, if more information is needed, our paid consultation is also a resourceful next step. We’ll answer any additional questions you may have and take a detailed look into your insurance policy. If you hire us at any point to do additional work on your claim, we will credit the appeal fee to the fee for future work. Often, this strategy call is all our clients need to resolve their cases. 

If you’re on claim but have questions, you can schedule a short, free review call with a non-attorney disability specialist or a paid consultation with Ben Glass, depending on your needs. We once got a doctor $500,000 in past-due benefits after just one paid consultation—you can read that story above. 

Plenty of reasons: 

• We file more disability appeals and lawsuits than any other firm in the Mid-Atlantic. (Source: Pacer, the official government site for Federal Court lawsuits.) 
• We have extensive experience handling difficult claims for doctors, lawyers, business owners, and other highly compensated, highly educated professionals with complex work responsibilities. We know our way around “own occupation,” “own specialty,” and other policies, riders, and language common to both employer-provided and individually purchased disability insurance plans for physicians. 
• We stay with you for the life of the claim, not just through the appeal process. We’ll continue to manage your benefits and deal with the insurance company so you don’t have to. We currently manage more than $33 million in future disability benefits for our clients. 
• We only get paid if we win. There’s no risk to you. 
• Ben Glass has taught attorneys all over the country about ERISA processes and education. He is a subject matter expert in the industry. 
• Our reviews speak for themselves. 

There are several. 

One of the biggest ones is that LTD companies frequently mischaracterize the work physicians do. They may simply assert that your condition doesn’t impair your occupational duties, even when it clearly does. Or, if your disability prevents you from some key duties of your job (for example, performing surgery) but you’re still able to do some clinical or administrative work, the disability company might try to deny or reduce your benefits—even if you have “own specialty” coverage. 

Another common complication is that physicians suffer from high rates of burnout, anxiety, chronic pain, and other mental, cognitive, and degenerative conditions. While these conditions may make it impossible to provide safe care to your patients, they can be difficult to prove, and may be subject to policy exclusions. 

Finally, there’s the good old-fashioned incentive all insurance companies have to protect their bottom line. Paying out claims for highly paid professionals like doctors is expensive. If they can find a “good enough” excuse to avoid doing it, they will. 

In addition to providing medical records, physician letters, and other evidence that supports your diagnosis and symptoms, you will also need to provide documents that: 

• Demonstrate your income 
• Outline the procedures, treatments, and other care you provided (in other words, the “substantial duties” of your occupation) 
• Provide a rationale for why your condition prevents you from performing those duties 

This is standard stuff for any long-term disability claim regardless of occupation. That said, if you’re a doctor, the insurance company will probably want to dig deeper and see what you’re actually billing for. You may be asked to provide: 

• Individual and business tax returns 
• Two years of pay stubs, profit and loss statements, pension and profit-sharing contributions, etc. 
• Two years of monthly production reports 
• Purchase and sale agreements 

It can be a truly massive undertaking to compile all the necessary paperwork the insurance company will need. And the cost of forgetting key evidence can be devastating. If you still have anything left out of your case file when you file your administrative appeal, you may not be able to add it later—even in a lawsuit. 

It’s no surprise that even highly educated doctors make mistakes when attempting to handle their claims on their own! In fact, the insurance company is counting on it. Talk with a long-term disability attorney as soon as possible to take the weight and stress of your shoulders and ensure your claim is in good hands. 

That depends on the specifics of your policy, but the answer for most doctors is yes. 

For example, let’s say you can no longer practice in your primary field of specialty, but can still work reduced hours or in a reduced capacity at a lower salary. If you have a residual or partial disability rider, you probably can still collect partial disability benefits as long as your income has been reduced by at least 20%. 

But again, insurance companies like to mischaracterize your actual job functions at the time you file. This is particularly relevant for doctors who suffer from degenerative conditions and have had to gradually change their occupational duties over time. Your insurance company might try to argue that your “reduced” role is your “real” role at the time you file, so you are not entitled to any residual benefits based on the higher salary level. 

This is another reason why it’s good to speak with an experienced disability attorney as soon as possible—ideally before you file.