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Why "own occupation"?

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  • LBKCLU
    replied
    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

    http://schwartzlawpc.com/press/read/keep-that-insurer-from-blocking-your-disability-claim/

    Leave a comment:


  • Insurancelawman
    replied
    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

    www.schwartzlawpc.com.

    [email protected]

    Leave a comment:


  • rb6p
    replied
    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?

    Leave a comment:


  • Insurancelawman
    replied
    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

    SchwartzLawPC

    [email protected]

     

    Leave a comment:


  • LBKCLU
    replied
    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!

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  • Slav4ikMD
    replied
    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!

    Leave a comment:


  • LBKCLU
    replied
    It will vary but, generally, policies for non-invasive practitioners will be less expensive compared to those physicians that perform procedures.

    That being said, claims experience for psychiatrists in not great. As a result, certain carriers like MetLife and Principal will put your specialty in the same occupation class as some surgeons (so you pay a higher premium).

    Ameritas, on the other hand puts a psychiatrist in their top occupation class and also may include a "preferred occupation" and association discount making their premium rates very favorable. However, their policy has a 24 month limitation for claims related to mental/nervous and/or substance abuse disorders which some psychiatrists may find unacceptable.

    Leave a comment:


  • Slav4ikMD
    replied
    Question:  would a policy with the same benefit generally cost less for someone who is in a specialty where it is "harder" to become disabled enough to not be able to perform it?  e.g. it will take a lot more for me to be unable to perform my work as a psychiatrist than say for a surgeon who is basically out if he or she looses a finger.

    I am currently considering looking at some own occupation options and my biggest fear is that it will likely be rather difficult for me to demonstrate disability for something that is a non-catastrophic event, because of nature of my work...

    Leave a comment:


  • AlexxT
    replied
    I think it's reasonable  to assume that if you're in a specialty with a lower likelihood of disabiltiy you will pay a lower premium for the "own occupation" rider.  In other words, you probably are being charged a fair amount based on the risk of disability for the practice of your specialty. That's why there are 4 or 5 different categories of jobs.

    Leave a comment:


  • rb6p
    replied
    MSooner -  I'm glad you posted this because I'm also doubtful that "own occupation" is as important for a radiologist as it may be for other specialties.

    Perhaps a no-brainer for a surgeon, but I haven't seen a single convincing argument that it makes sense for a radiologist.

    Is the floaters scenario or the impaired shades of grey perception a realistic scenario?  Doesn't seem so to me.  Any ophthalmologists here interested in chiming in?  Realistic enough to warrant a 20% increase in premium?

    It'd also be great to hear the perspective of a lawyer well-versed in disability insurance claims.

    Leave a comment:


  • Zaphod
    replied
    Agree, its kind of a no brainer.

    Leave a comment:


  • AlexxT
    replied
    A friend of mine, not an MD, who works in an office, was shopping for disability insurance.  The "own occupation" rider cost about 20% more in premiums, if I remember correctly.  I advised against it, since I could not imagine a disability that would make it impossible for him to do his current job, yet still allow him to do another job.  However, as a surgeon, I don't want to be told that I can work in urgent care or some other field.   I think that demonstrating that I'm disabled as a surgeon will be a lot easier than showing that I'm disabled for any work, or for "substantially similar" work, so I would advise "own specialty" for physicians.  Keep in mind that the amount you pay for "own specialty" is tied to the nature of your specialty, so you won't be paying too much extra for that rider if your specialty isn't procedural.

    A friend is collecting on his policy right now. He was diagnosed with a neurological condition which intermittently makes doing his procedures impossible, although the condition is otherwise not currently a problem.  He submitted evidence of the diagnosis, and got his first check within a month.  Had he not had the "own specialty" rider, he wouldn't have been able to collect, and would have had to retrain into another specialty.

    Leave a comment:


  • LBKCLU
    replied





    Click to expand…

    For me its more about protecting myself from having to do further training to be competent in whatever other job I would be capable of doing.


     
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    Keep in mind that this is typically NOT the case with individual policies. However, group LTD policies may include language such as "After 24 months of payments, you are disabled when UNUM determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience".

    Even an individual "Loss of Earnings" or "Modified Own-Occupation" policy will not make you work and will include language such as "You are totally disabled when you are unable to perform the principal duties of your regular occupation and not gainfully employed in any occupation. Here, if you cannot perform the duties associated with your occupation or medical specialty, you can decide if you want to be gainfully employed (and work doing something else) or not. It is your choice.


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  • climbhigh
    replied




    Just to play devil’s advocate — why are people so emphatic that you should get long-term disability insurance that covers you if even if you could do some kind of work different than your current practice?  For a temporary situation (say a year or two of cancer treatment or rehab) I can see wanting to just wait until you can go back to your regular job.  But for something permanent it can really accelerate a downhill slide to cast yourself as unable to work because of disability if you could in fact be doing some kind of work.  Clearly it makes sense to protect against loss of income since most replacement jobs would probably pay less than being a doctor.  But as doctors we are presumably more aware than most of how important it is to keep getting out in the world and on with your life if you’re in any way able to do so.  So why do we want to insure ourselves against having to do that?
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    For me its more about protecting myself from having to do further training to be competent in whatever other job I would be capable of doing.

    Imagine if you are disabled from your surgical subspecialty, but were deemed "fit" for duty as a radiologist or some other "low-impact" field (thus denied benefits from your insurance company since they view you as not really disabled). While you may physically be capable of performing the new job it would likely require you to go back and do further residency training in your new field, something I am just not willing to do.

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  • PhysicianOnFIRE
    replied




    While that may be true, think about it. Floaters in his eyes or the ability to differentiate among shades of grey could be career ending for him but still allow him to do any number of other jobs using his education training and experience.

    As I mentioned before, the cost for “Own-Occupation” coverage is not necessarily more expensive (and in some cases can be less expensive) compared to those with other, less liberal definitions.

    Unless there was a significant cost savings associated with a more restrictive policy, why would you knowingly want to settle for anything less?
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    Good point.  I heard somewhere that there are something like 50 shades of gray.

    Leave a comment:

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