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Why "own occupation"?

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  • #16
    Thanks Larry, that's interesting.  I do wonder whether certain specialties are at a higher risk of submitting a claim, I am sure there are stats on that.  Also curious what you mean by claim experience being "not great" for psychiatrists - harder to cash in on a policy if needed?  That's really my worry as a psychiatrist.  Anyway, we'll discuss my options individually, thanks for all the help so far with life insurance.  PS Larry is great, highly recommend to everyone!


    • #17
      Yes, "not great" means that the claims experience (the number of psychiatrists filing claims for benefits) is higher than expected.  Generally, the largest number of claims come from Orthopedic Surgeons, Neurosurgeons, Anesthesiologists, Cardiothoracic Surgeons and Emergency Medicine Physicians. Thank you for the kind words!


      • #18
        I am lawyer who for more than 20 years has handled long term disability claims for physicians, dentists, lawyers and other professionals. My firm currently represents more than 250 clients in the long term disability claims process, most of them currently being paid, and none of them currently involved in lawsuits.  My firm represents at least 6 radiologists as clients right now, one who had a hip replacement and disc compression, two with visual problems, one with cancer, one with shoulder problems and one with lower back problems.  All of these doctors have own-occupation disability insurance policies.  I cannot emphasize enough the importance of having an own occupation benefit, and a residual/partial disability benefit, as part of your long term disability policy.  These clauses often make all the difference in the world in getting a client paid -- in you getting your benefits.  I as a lawyer have the maximum, own occupation disability insurance I qualify for and I'm glad to have it.  If you are a physician and you are considering purchasing one of these policies, I urge you to discuss it with an experienced insurance broker.  So my advice.  Spend a little less money on a few meals and a few bottles of wine, and get the own occupation clause in your long term disability policy.  It's a critical asset in your financial arsenal.

        Evan Schwartz


        [email protected]



        • #19
          Evan -

          Thanks for your input. Great to have a lawyer's perspective here.

          Are the 6 radiologists that you mention interventional radiologists?  Among those who are not, on what basis would their claims be denied had they neglected to get 'own occupation'?  What other occupation for which they are reasonably qualified could they be doing?


          • #20
            Hi and thanks for your follow up.  3 interventional and 3 non.  For the non-interventional, the fact that each of them has the "own occupation clause" in their policies was very important in getting their claims paid.  I cannot state whether their claims would have been denied without it, because the answer to that would require an analysis of the hypothetical policy language they actually would have had, their disabling conditions, etc. etc.

            All I can say is they are all glad they have policies containing the "own occupation" clause.

            Evan Schwartz, Esq.

            Schwartz Law PC


            [email protected]


            • #21
              No matter how well-intentioned an insurer might be, though, sometimes the IME falls short. Attorney Rafel tells about a radiologist who suffered from permacular gliosis and malignant myopia and could no longer distinguish shades of gray. The insurer denied benefits after its independent medical examiner had him read an eye chart and declared him not disabled. In response, Rafel set up a meeting with her client and another radiologist who brought in 10 X-rays. Her client misdiagnosed seven. Rafel taped the session and sent the tape to the insurer. Her client got his benefits.

              This was part of an interesting article (link below) that is on Evan Schwartz's website in the blog section