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disability insurance, exclusions

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  • disability insurance, exclusions

    I am a resident in mid-30s and I applied for disability insurance. I am generally pretty healthy but the year prior to application I was diagnosed with multidirectional instability of the shoulders, received PT for pain, it resolved. This was in the setting of weight gain (after starting a very hectic GI fellowship) and lack of exercise resulting in decreased muscle tone. Additionally around the same time I had bilateral knee pain (chondromalacia patella), again received PT and resolved. In the last 5 years I had also received orthotic inserts for left foot pain which resolved. None of these issues lasted for more than a few months.

    On this background I applied, and divulged the above information. I don't take any medications and have since lost the weight I had put on and resumed regular activity and have a personal trainer. Received a clean bill of health from my PCP and my PT (physical therapist) recently.

    The insurer excluded both shoulders, knees and foot and removed benefit update rider. They are willing to reconsider the knees and foot if I remain symptom and treatment-free for at least 2 years from the effective date of the policy, subject to evidence of insurability and underwriting. The shoulder exclusion will remain for the life of the policy.

    For the remainder of my career I expect to be standing in the OR or endoscopy unit (I am training as an advanced endoscopist) and using my arms, hands and shoulders. The above stipulations make the policy useless since I mostly worry about musculoskeletal injury. What are my options? Can a letter from my orthopedics, PT and PCP mitigate these exclusions? I went through a financial planner who, I suppose, gets paid once I buy insurance from the company and he tells me that this is a good policy and I should purchase it. I would appreciate any advice. Looking forward to your reply! Thank you!!

  • #2
    I bought a policy about 6 months ago which was about 6 months after breaking my ankle and tearing several ligaments. I did some PT after it healed and signed saying I'm back to my normal activity and they did not exclude my ankle. Bob Bhayani was great to work with to get all that excluded. Berkshire (Guardian) is the issuer. Anesthesiology same specialty coverage (own occupation).


    • #3
      Studies show that endoscopists can suffer from wear and tear osteoarthritis/tendinitis in the long-term. I have neither of these right now and neither do CMP or MDI predispose to it. But my occupation might. Or I might get a fracture of my shoulders or knees or feet in an accident and per the stipulations of the policy I wouldn't be covered even though it would have nothing to do with MDI or CMP.
      I don't know if a letter would help - I was wondering if anyone hasd a similar experience and if that approach had any potential.
      Thank you tigeri for the input! I will contact Bob! You can pm me your contact if you'd like me to use your name as reference.


      • #4
        Don't buy an insurance product from your financial planner.


        • #5

          Don’t buy an insurance product from your financial planner.
          Click to expand...

          Yeah, this coverage does not sound great--you have valid concerns about those limitations. Agree with conniebird. Your planner may want you to buy just so they get the commission but sounds like you need to do some more detective work...or find someone who can do that for you. There are several disability insurance experts who are advertisers and post on the forum who would be tremendous resources.

          I got my disability policy through one of those advertisers, Larry Keller, who was great. When I was pestering him with a million questions he did state that he had successfully convinced underwriters at times to remove at least certain aspects of exclusions based on letters written by PCPs, etc. I would look up Larry or one of the other advertisers (WCI has vetted these folks) and explain your situation. They can shop around and help you secure the strongest policy (you get what you pay for with disability insurance) with guidance targeting your specific scenario. You can also wait for their input here--I'm sure at least one of them will respond soon to this thread.